Care Home: Sutton Manor Nursing Home

What the care home does well The staff are good at providing nursing and personal care to each resident in a way that maintains their privacy and dignity. The home is well decorated and furnished and the residents said they liked the communal and private areas of the home as well as the extensive and well kept gardens. The vast majority of the residents said that liked the meals at the home. The food is served in a very pleasant dining room where family and friends are welcome to join residents for a meal. What has improved since the last inspection? The manager now writes to prospective residents to confirm that the home can meet all of their needs before people move in. The service has changed the way they formally assess people before offering a place at the home. Prospective service users now have an updated statement of purpose that gives them information they need to help them make a decision about the home and it`s facilities and services. The manager and staff have begun to change the care plans which guide the staff to offer individual care that meets peoples needs. This is still in progress but the care plans that have been rewritten include information on peoples health needs, their preferred routines and their likes and dislikes. The staff have gathered improved information about how people like to spend their time and any hobbies or interests. Not all of the residents feel there are enough opportunities to go outside the home unless with their families and friends, although the activities organiser does have plans to increase the trips out. The provider has changed the policy on protecting vulnerable adults. This document guides the staff in how they should report any suspicions and who they should contact. A further minor amendment which was discussed with the provider will help the staff to access this quickly and efficiently. What the care home could do better: The staff have begun to change the care plans but this is still in progress. The provider stated that the process of improving all of the plans would be complete by the end of 2009. This could mean that staff are still working with limited information and therefore not all of the residents needs may be met. The medicines trolley in an upstairs corridor was found to have been left unlocked and unsecured. This was also found at the last inspection and at that time it was secured and no requirement was made. Because the providers had not ensured the security of the medicines and because of the obvious risks to the residents an immediate requirement was made. This has been followed up by a letter to the providers to require them to safely store the medicines at all times. The registered provider has failed to follow their own complaints procedure. They responded to a written complaint ,verbally which may not meet the residents needs as they may require this information to refer to at a later date. There was no record of any investigation or of the actions taken. The home is generally well and safely maintained but it was found that a door leading directly to the cellar had been kept open with a light on. The home provides care and nursing to people who may develop dementia and those who require mobility equipment and the steps could be a danger to the residents. This was discussed withthe provider and arrangements were made to lock the door. A requirement has been made to ensure that all parts of the home to which the residents have access are as free as possible from hazards and risks. The providers have employed a new manager who the providers have assured the commission will apply to register as the manager as soon as possible. The home has not had a registered manager for over 12 months. The providers representative stated that they had not carried out the required monthly visits to the home and produced a report. They said they were too busy making other improvements. The provider produced a new form that, if used, would meet this requirement. They said they were at the home frequently but no reports were available for the last three months. These visits and reports are the way a provider who is not in day to day control of the home can manage and assess the quality of the service and ensure that the appointed manager is carrying out their duties and meeting the aims as stated in the homes statement of purpose. The staff have improved the way they seek the views of the residents and a recent survey had been carried out, but the provider has yet to use these results to make improvements to the service with the exception of plans to improve the choices people are offered at supper time. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sutton Manor Nursing Home Stockbridge Road Sutton Scotney Winchester Hampshire SO21 3JX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kima Sutherland-Dee     Date: 0 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Sutton Manor Nursing Home Stockbridge Road Sutton Scotney Winchester Hampshire SO21 3JX 01962760188 01962761185 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Evelyn Mary Cornelius-Reid Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 38 Number of places (if applicable): Under 65 Over 65 38 0 old age, not falling within any other category physical disability Additional conditions: 0 38 The maximum number of service users to be accommodated is 38 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Sutton Manor is one of three homes owned by Mrs Cornelius -Reid, two are in Hampshire and the other in Wiltshire. Sutton Manor is a care home that also provides nursing care. The home is registered to provide personal care for up to thirty-eight service users over the age of sixty five, in the categories of old age and physical disability, not falling within any other category, and nursing care may be provided for Care Homes for Older People Page 4 of 31 2 1 1 1 2 0 0 8 Brief description of the care home up to twenty of the residents. Sutton Manor is in Sutton Scotney and set within sixty acres of delightful parkland. The home has large and airy sitting rooms and dining room on the ground floor. All bedrooms have en suite facilities with the exception of one room, which has a private bathroom in an adjacent room. The current weekly fees are #662 - #787 per week. Extra services such as hairdressing and chiropody are usually billed monthly. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: We prepared for this inspection using the AQAA which the service sent us as well as any other information we have received about the service since the previous key inspection. Eighteen residents kindly completed and returned surveys which have been used throughout the report. A site visit to the home took place on the 8th May 2009 when we reviewed a sample of the documents and spoke to three residents, the staff and the registered provider. The fees for this service are between 3045.00 pounds per calender month and 3615.00 pounds per calender month. The contract also includes a required deposit payment when a room is secured this is currently 15,000 pounds for a single room and 25,000 pounds for a double room. Care Homes for Older People Page 6 of 31 Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The staff have begun to change the care plans but this is still in progress. The provider stated that the process of improving all of the plans would be complete by the end of 2009. This could mean that staff are still working with limited information and therefore not all of the residents needs may be met. The medicines trolley in an upstairs corridor was found to have been left unlocked and unsecured. This was also found at the last inspection and at that time it was secured and no requirement was made. Because the providers had not ensured the security of the medicines and because of the obvious risks to the residents an immediate requirement was made. This has been followed up by a letter to the providers to require them to safely store the medicines at all times. The registered provider has failed to follow their own complaints procedure. They responded to a written complaint ,verbally which may not meet the residents needs as they may require this information to refer to at a later date. There was no record of any investigation or of the actions taken. The home is generally well and safely maintained but it was found that a door leading directly to the cellar had been kept open with a light on. The home provides care and nursing to people who may develop dementia and those who require mobility equipment and the steps could be a danger to the residents. This was discussed with Care Homes for Older People Page 8 of 31 the provider and arrangements were made to lock the door. A requirement has been made to ensure that all parts of the home to which the residents have access are as free as possible from hazards and risks. The providers have employed a new manager who the providers have assured the commission will apply to register as the manager as soon as possible. The home has not had a registered manager for over 12 months. The providers representative stated that they had not carried out the required monthly visits to the home and produced a report. They said they were too busy making other improvements. The provider produced a new form that, if used, would meet this requirement. They said they were at the home frequently but no reports were available for the last three months. These visits and reports are the way a provider who is not in day to day control of the home can manage and assess the quality of the service and ensure that the appointed manager is carrying out their duties and meeting the aims as stated in the homes statement of purpose. The staff have improved the way they seek the views of the residents and a recent survey had been carried out, but the provider has yet to use these results to make improvements to the service with the exception of plans to improve the choices people are offered at supper time. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has changed the information that is available to residents and no one is admitted to the home without a full assessment of their needs. Evidence: At the previous key inspection an immediate requirement was made that all new service users had a full assessment of their needs prior to them moving to the home. This was to enable the home to assess whether they were able to meet all of the service users needs. The AQAA stated that previously the home had not always formally recorded assessments but that now the documents had been formalised. One new person had been admitted and their file contained a detailed assessment of their needs along with a letter to that person stating that these needs could be met. Therefore the registered person has met this requirement and a system is in place to ensure that all future prospective residents have an assessment. Care Homes for Older People Page 11 of 31 Evidence: A requirement was also made to update the statement of purpose as it was out of date. The AQAA stated that this had been achieved since the last inspection. The statement of purpose which gives residents and people who are interested in the home detailed information about all aspects of the service and facilities had been updated. There was only one minor change that needed to be made to reflect a recent change in the homes management and the providers representative made an assurance that this would be completed. The AQAA states that people are welcome to visit the home and how much people had enjoyed their visits. This was confirmed by a resident who said that they had been to the home for a meal and a tour before they decided to move in. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents should benefit from the changes that have been made to 4 care plans, but staff may not be able to meet all of the residents needs based on the information in the remaining care plans. The home is not storing medication safely for the protection of the residents. The residents benefit from a staff team who treat them with respect and who are improving the way they support people at the end of their lives. Evidence: The AQAA states that the home have reviewed the care planning system and they have introduced new documents that are common across the other homes in the group. They also state that updating the existing care plans will continue over the next twelve months. A sample of 6 care plans demonstrated that 4 had been improved. The nurse on duty stated that these were the only four to have been changed since the new system was introduced. The new care plans had more detailed information on health care such as skin assessments and oral care. They also include improved detail about each residents likes, dislikes wishes and preferred routines. These individual Care Homes for Older People Page 13 of 31 Evidence: details will give the staff improved guidance on how to meet each residents needs. The care plans that had been changed included regular reviews and a sheet to show that the resident or their family had been consulted about the plan. The remaining plans did not contain these details. The care plans that are yet to be changed have less detail and they did not include poeples preferences and how the staff should meet all of their needs. This means that the staff may be unable to meet all of their needs until their care plans have been changed. Eighteen residents kindly completed a survey. Eleven responses were positive about the care at the home and comments included, The care is excellent The girls are very kind Others said that they promise to come back but they dont It would be better to have more staff around all the time During each day there are normally 1 trained nurse and four or five carers on duty. The trained nurses said that was usually enough to care for people and meet their needs. The care plans record any health or nursing care or visits from health professionals such as doctors or dentists. The residents can choose to have regular chiropody and the home are trying to arrange for a new visiting dentist. The handover between two nurses was observed and they discussed the care details of the residents in a way that passed on useful information whilst being respectful and caring. The residents said during the inspection that the staff were good and treated them with respect. the AQAA stated that privacy and dignity is maintained and the the residents agreed with this when we asked them. At the last inspection a requirement was made to ensure that all medication that was administered was signed for to maintain accurate records. This had been achieved and the records were complete. The AQAA states that a letter went to all the trained staff to remind them of their responsibilities to ensure the correct documentation.This letter also reminded staff of the need to lock the medicine trolley and attach it to the wall when not in use. It was found that the trolley in the upstairs corridor was unlocked and not secured to the wall. This could present a serious risk to the residents and compromise the security of the prescribed medication. The provider agreed that this was unacceptable and because this was the second time the trolley had been found to be unsecured an immediate requirement was left with the provider to ensure they complied straight away. The trolley was locked during the site visit to the home and the provider made arrangements to prevent this happening again. The AQAA states that the home intend to introduce by June 2009 a new care planning system for people who are at the end of their lives. This system is seen as the best practice for terminal care and it guides the staff to provide care for all a person and their families needs at this time. This aspect of the care plans had improved and the sample seen included peoples wishes at the end of their lives. The AQAA recognised that not all of the residents wish to discuss their plans or views but where possible Care Homes for Older People Page 14 of 31 Evidence: these have been recorded. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents have the choice of joining in with a range of activities at the home and their interests are taken into consideration. The residents would benefit from more opportunities to go out with the staff. The residents are able to choose how they spend their time and their family and friends are welcomed at the home. The residents are offered a choice of food that meets most of their needs. Evidence: A sample of the care plans showed that the home had improved the information they record about peoples preferred activities and their interests. The care plans include any limits on personal freedom for any reason such as the need to use a wheelchair or because of their mental capacity. After consulting the residents the staff have recorded peoples preferred routines and their preferences such as what clothes they like and whether they wish to follow their religion. These details are not yet available for all the residents especially if they are unable to verbally communicate their wishes to the staff or where their relatives have been asked but are yet to supply this information. The surveys that were completed said that seven people felt there were always Care Homes for Older People Page 16 of 31 Evidence: activities available but they could choose whether to participate. Five people felt the home usually provided activities and five that there were activities sometimes. The AQAA states that the receptionist sees each person and informs them daily what is going on. There is also a monthly newsletter that includes any activities. One resident said they read the newsletter and then decide what to do, they said the home sometimes had dancing. Other activities such as crafts, singing and exercises are available and advertised on the noticeboard. The AQAA says that recent events have included the local community such as a choir and visiting musicians. The comments from the surveys said that there is still little opportunity to go out unless this is provided by visiting families. But the AQAA states that the activities co-ordinator is planning more trips out for shopping or to places of interest. Another person said they realised it was difficult to provide activities to suit everyone. The activities coordinator stated in the AQAA that they continue to provide one to one activities for people who are unable or choose not to join group activities, and they are happy to hear suggestions from the residents. The home arranges a mobile library and a visiting manicurist. People are supported to continue their chosen religion and there are visiting clergy from the church of england and roman catholic church who conduct regular services. The AQAA says that family and friends are welcome and that all residents have their own telephone to allow them privacy to contact their families or friends. The residents said that their families and friends were welcome at the home and could join them for a meal in their rooms or in the dining room. The home has a large and well decorated dining room with a conservatory. Meals are provided for the residents as well as visitors from the independent living houses in the grounds. The menu is changed frequently and the residents are asked their choices daily. The AQAA states that the home aims to improve by offering a more varied supper menu and the head of housekeeping showed this menu and discussed their plans during the site visit. The survey results showed that out of eighteen responses nine people said the food was always good, six that it was usually good and one that it was sometimes good, one person did not complete this section. People commented that the food was very good It is always hot and good It is good but the portions are too big One person was very dissatisfied and they said that the food and drink was tepid and the vegetables although generous were overcooked. The puddings and cheeses are good so I fill up on those. The majority of the residents were happy or satisfied and a recent questionnaire at the home sought their opinions on the food, which led to improving the menus. Care Homes for Older People Page 17 of 31 Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents cannot be assured that when they complain their complaint will be responded to according to the homes own procedures or in a way that meets their needs. The residents are protected through staff training and improved procedures to guide the staff. Evidence: The home state that they have not received any new complaints since the last inspection. The staff have increased the the number of times they consult the residents and the AQAA states that they have an open house policy to allow comment at any time. The survey results show that out of eighteen respondents eleven residents knew who to speak to if they were unhappy, three said they sometimes knew who to see and one said they never knew, one person did not respond. When residents were asked if they knew how to make a complaint thirteen said they did and two people said they did not one person did not respond. they commented that they would speak to their family or the staff. One person said they didnt know who was responsible for the home. The complaints procedure is included in the information for new residents and is on display in the home. The providers representative stated that they had responded verbally to a resident who made a complaint in writing to them last year. There was no written record of the response available. The registered provider is not following their own procedures. The needs of the resident may not be Care Homes for Older People Page 19 of 31 Evidence: met by responding verbally bacause they may need a response in writting to refer to at a later date to remind them of any actions that were taken. The home have kept a number of written compliments from either residents or relatives that praise the care at the home. The homes abuse procedures were reviewed in May 2009 and they do include all the details that the staff need however the provider agreed they needed to be simplified to allow staff to consult a quick reference guide. This will tell the staff how to act and who to contact. The staff are aware of where the procedures are kept and they have had training in safeguarding adults. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in a well maintained and comfortable home, but the providers must ensure that the safety of the residents is protected at all times. Evidence: The home is a fine listed building surrounded by acres of well maintained grounds to which the residents have access. The home is large with well decorated and furnished communal and private areas. The providers employ staff to maintain and clean the home. The maintenance records demonstrate that repairs are dealt with promptly and staff are reporting faults to the maintenance department. Eighteen residents completed surveys and twelve said the home was always fresh and clean, four said it was usually clean and two did not complete this section. Positive Comments were Yes it is clean the girls are very good Negative comments included The windows are filthy outside and never cleaned Yes its clean but I dont like dirty windows Three people also commented that the home was cold at times especially at night when they needed to get up. The heating was discussed with the provider at the last site visit and they said that the thermostat was set but if the staff or the residents said they were cold the heating was turned on or up. This is not being made a requirement because the majority of residents made positive comments. The home was a comfortable temperature during the site visit but in the interests of meeting all of the residents needs the provider should consult them and ensure that the home is kept at a suitable Care Homes for Older People Page 21 of 31 Evidence: temperature. One resident said they liked their own room and they had their own belongings around them. The AQAA states that people are welcome to bring their own furniture and belongings to the home. It was noted that a door to the cellar was held open with a magnetic opener and the light was on. This could be a serious risk and it is recorded fully in the management and administration section of the report where a requirement has been made. The provider discussed the previous requirements regarding the facilities at the home and the layout of a bathroom that had been made as a result of a complaint made by one resident which had not been responded to. The provider has since had discussions with the resident and the issues have been resolved. The providers representative discussed the recent visits of the fire officer and that they had or were soon taking action to meet the officers requirements. This included fitting new lights and doors. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are protected by the improved recruitment procedures and a well trained staff team. Evidence: A sample of 4 staff files showed that the information included in these files had improved. Each member of staff has a Protection of vulnerable adults check(POVA) and a criminal records check(C.R.B), as well as references and identification. The AQAA states that the home have improved the induction training that new staff have and this is now formalised. The records for two new staff demonstrated that this was the case and their induction training was complete or in progress. The staff are well trained and they have attended a range of courses including Manual Handling, fire safety and the safeguarding of adults. The trained nurses have completed more specialised courses which will update their skills. The providers organisation employs a training manager who has worked with the home manager to improve the recording of training. Two trained nurses said that there were usually enough staff to meet the residents needs unless there were any emergencies. This was confirmed by the response to the survey when fifteen people said there were always or usually enough staff. One person added that you just have to ring the bell and the staff are there One negative Care Homes for Older People Page 23 of 31 Evidence: comment was They promise to return but they do not but the staff said this may be due to an emergency or that they do return but not as quickly as that person may want. There are usually one trained nurse and four or five carers on duty during each day and the residents spoken to said that the staff were very good at helping them and providing the care they needed. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The providers have made changes to the running of the home and to the systems which measure the quality of the service. They have not had a registered manager at the home for the last year. They have yet to make improvements that were identified as needed as a result of the quality audit, although they have made plans to do so. One area of the home was not free from posible hazards to the residents. Evidence: A new manager has started at the home since the last key inspection and the provider assured us that they would register with the commission as a matter of urgency. A letter in the staff files that had been written to inform the commission of the change of manager had not been received by the commission. The new managers personnel file showed that they have the qualifications and experience to manage the home. This person was on holiday at the time of the site visit. This standard has been assessed as almost met because although a manager is employed the registered person has failed Care Homes for Older People Page 25 of 31 Evidence: to register a manager in the last twelve months. The provider explained that they had not completed or recorded monthly visits to the home because they had been so busy making other improvements, so there were no records of visits over the last three months. A new form for these visits had been developed but was not in use. The providers representative said they visited the home frequently each week but this had not been recorded. This requirement to visit the home monthly and produce a report is a statutory responsibility of the registered provider and it is not dependent on the registered providers workload or priorities. The provider has met a requirement to develop a system for seeking the views of the residents. A satisfaction survey had been completed in March 2009 and the results had been analyzed and they were available to the residents but they had not yet been used to address identified areas for improvement. The providers representative explained that the fire officer had made a number of requirements and most of these had been met. The fire officer had set a deadline of June 2009 to achieve the required standard. New fire doors and emergency lighting were being fitted and the records were being improved. The manager maintains health and safety records and these demonstrated that the maintenance and servicing of equipment was up to date. It was noted that a door to the cellar was held open with a magnetic opener and the light was on. This could be a serious risk especially for people who require mobility equipment or those who have a dementia. The provider agreed that the door would be locked and arrangements were made during the site visit to secure the door. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 the registered person must make arrangements for the recording, handling,safekeeping,safe administration and disposal of medication. You were required to immediately ensure that the medicines trolley in the upstairs corridor was kept locked and secured at all times when not in use. This is to protect the residents and the staff from harm. 04/06/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 31/08/2009 ensure that there is a written plan as to how the service users needs in respect of health and welfare are to be met. This plan should be made in consultation with the service user or their representative whenever possible and must be kept under review. The care plan should be the basis of all care that is offered to a resident and it Care Homes for Older People Page 28 of 31 should guide the staff to meet all of their needs in a way that suits the preferences and routines of the resident. The care plan must be regularly reviewed and must reflect any changes to a residents needs. 2 16 22 The registered person must establish a procedure for considering complaints and this procedure must meet the needs of the service users. The provider has not followed their own complaints procedure which states that complaints must be responded to and a record kept. Also because the response to a written complaint was not given in writing this does not meet the service users needs as they may be unable to recall a conversation about their complaint and how this was being resolved. 3 33 26 The registered provider 30/06/2009 where they are not in day to day control of the home must visit the home or appoint a representative to do so at least once a month and a report from these visits must be kept at the home. These visits and reports are part of the providers responsibility to ensure the 16/06/2009 Care Homes for Older People Page 29 of 31 home is being managed properly and to seek the views of the service users and use these to make improvements as a result. 4 38 13 The registered person must ensure that all parts of the home to which the service users have access are so far as reasonable practicable free from avoidable risks. The cellar door being left open poses a real risk to people in the home and therefore the registered person must ensure that they take steps to minimise this risk. 15/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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