Care Home: The Grange Care Centre

What the care home does well The home has a good system in place for assessing the needs of potential residents and uses a person centred approach to planning care. The privacy and dignity of residents is generally upheld by the way staff work with them. The home has developed an excellent approach to managing residents medication with a robust audit system in place. A varied range of suitable activities are offered to residents, with some contact maintained with the local community. Residents` relatives are encouraged to maintain on-going contact with staff in the home in the interests of the residents. The home was well-maintained and very clean providing residents with a comfortable environment. A high priority is given to ensuring that residents are cared for by suitably trained staff and the home is staffed to meet residents` needs. The home has developed a range of quality assurance checks and the home has won a number of national quality awards. What has improved since the last inspection? An activity session specifically aimed at people with dementia has been introduced to the home. There has been an improvement in recruitment procedures these are not only robust to protect residents but are subject to a number of quality checks. Cleaning materials are now stored safely. There is a more robust approach to checking the safety of portable electrical appliances. There has been an improvement in the approach to moving and handling with improved training, risk assessments and checks on practice. What the care home could do better: Staff should consider how they address residents in terms of the use of preferred names. The registered provider must carry out visits and compile reports under regulation 26 of the care homes regulations. Any obstruction of fire exits should be checked against the home`s fire risk assessment. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Grange Care Centre The Grange Care Centre Eastington Stonehouse Glos GL10 3RT     The quality rating for this care home is:   three star excellent 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: Adam Parker     Date: 0 4 0 6 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 28 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 28 Information about the care home Name of care home: Address: The Grange Care Centre The Grange Care Centre Eastington Stonehouse Glos GL10 3RT 01453791513 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : thegrange@eastington.freeserve.co.uk Saddlers Hotels Limited care home 75 Number of places (if applicable): Under 65 Over 65 75 dementia Additional conditions: Date of last inspection Brief description of the care home 0 The home is registered to accommodate 75 older people whose nursing/care needs arise from frailty due to a dementia illness. The Grange is a grade two listed Georgian country house with Victorian and modern extensions situated on the fringe of the Cotswolds and the outskirts of the village of Eastington, near Stonehouse. It is set in five acres of parkland with enclosed gardens to the rear of the home and a large enclosed courtyard to the side. The accommodation consists of both single and double en-suite bedrooms. They are well furnished and maintained to a good standard. There are en-suite facilities in all but one room; there are assisted bathrooms/shower room and a number of toilets in the home for residents to access. Specialised equipment is provided to meet with individual needs. Current fees are 467.30 pounds for local authority funding to 750.00 pounds for privately funded residents per week. Hairdressing, chiropody, toiletries, entertainment, pension and benefits allowance administration and acting as a trustee are charged Care Homes for Older People Page 4 of 28 Brief description of the care home extra. The home makes information about the service, including CQC reports available to residents and their representatives through a service user guide and statement of purpose available in the home. Care Homes for Older People Page 5 of 28 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection visit was carried out by one inspector over two days in June 2009 with a second inspector using an observational tool on one day of the inspection visit. The registered manager of the home was present for the two days of the inspection visit which consisted of a tour of the premises and examination of residents care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of residents were selected for inspection against a number of outcome areas as a case tracking exercise. Observation was made of the care and supervision of the residents in some communal areas. Three residents were spoken to during the inspection visit. We requested an Annual Quality Assurance Assessment (AQAA) from the home, which was provided. Care Homes for Older People Page 6 of 28 Because people with dementia are not always able to tell us (The Commission) about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involved us observing four people who live in the home for two hours and recording their experiences at regular intervals. This included their state of wellbeing and how they interacted with staff members, other people living in the home and their environment. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 28 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 9 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission procedure ensures that all residents are admitted on the basis of a full assessment of their needs, so that they can receive the care that they require. Evidence: The assessment documentation for a number of residents recently admitted to the home was looked at. An assessment of their needs recorded on an assessment summary prior to admission to the home. One assessment looked at was particularly thorough. In addition copies of assessments and care plans produced by funding authorities had been obtained before admission as well as a hospital discharge summary for one resident. Since the previous inspection the home has updated its admission procedures with a visit being made to any potential resident before admission and consultation with relatives regarding the service that the home would offer any resident. Care Homes for Older People Page 10 of 28 Evidence: The home does not provide intermediate care and so Standard 6 does not apply. Care Homes for Older People Page 11 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning and risk assessments backed by frequent quality checks ensure that residents medication and health and personal care needs are met and their privacy and dignity is generally upheld. Evidence: A number of residents were selected for case tracking and their care plan files were examined. It was well documented how assessed care needs would be met with clear actions recorded for staff to follow. One care plan relating to a residents behaviour was particularly thorough in the areas it covered. Care plans had also been reviewed on a monthly basis and had been subjected to a regular audit process. One resident had a good record made of past tropical diseases that they had suffered with an explanation of how these may still affect them. Risk assessments had been completed for pressure areas which detailed any equipment in use. Nutritional risk assessments using the Malnutrition Universal Screening Tool (MUST) tool had also been completed. There was recorded evidence of residents having input from health Care Homes for Older People Page 12 of 28 Evidence: care professionals such as General Practitioners (GPs), dentists, an occupational therapist and chiropodists. In addition the home had given good consideration to the choice of visiting eye examination service and had chosen one that it felt best met the needs of residents in the home. One resident had a recent visit from a speech and language therapist and following this the home had produced a detailed care plan for communication which demonstrated how the home had worked in conjunction with health care professionals in the interests of the resident. Base line physical observations such as pulse and temperature had also been completed for each resident. Use of our observational tool also showed how residents health care needs were being met, one resident had a swollen ankle and this was placed in an elevated position by a member of nursing staff. One resident had a urine infection and staff were requested to offer frequent amounts of small fluids. However the resident slept for most of the morning. Staff confirmed that a monitoring chart would be used and that fluids would be offered in the afternoon when the resident awoke. The arrangements for medication storage, administration and recording were checked. Medication was stored securely in all areas of the home and a number of measures had been taken to ensure that storage was being maintained at the correct temperature. This had been achieved in all units although some slightly raised temperatures were noted in Hardwicke. Medication containers had been dated on opening and medicines for external and internal use had been separated in storage. Examination of the medication administration records (MAR) showed that these had been kept in good order and where omissions had been made, appropriate codes had been used. No gaps in recording administration were seen. Clear and concise directions were available for staff making decisions about giving medication prescribed on an as required basis,good examples were seen for medication given to aid sleep and to reduce anxiety. Any changes to medication directions had been made with two staff signatures and where medication had been stopped clear information had been recorded about this. One resident had a topical cream prescribed and initially directions were unclear, the GP had been contacted for clear directions about the use of the cream. Where staff had hand written directions these showed that they had been checked and signed by a second member of staff. Work had also been carried out to ensure that information on any allergies and in particular medication allergies was made known to the supplying pharmacist for printing on the MAR. Assessments have been undertaken as part of the admission procedure to identify any issues with medication prior to the resident entering the home and this is good practice. As found at the previous inspection the most positive factor in the management of medication in the home was the monthly audit conducted by a member of the nursing staff which remains a commendable piece of work. In addition staff work towards an NVQ level 3 in administering medication to individuals. Care Homes for Older People Page 13 of 28 Evidence: Our use of the observational tool showed that staff were polite and respectful in interactions with residents, asking them what they wanted to eat and drink, giving choices, calm at all times and taking things at the pace of the resident either asking questions of or supporting with personal care such as wiping hands or mouth (asking permission first to do this) or moving and handling tasks (describing processes as they did them) or helping with drinks or eating. One resident had their blood pressure taken in a communal area although was moved to their individual room when it was realised that further examinations were required. Generally staff were observed treating residents respectfully although one male carer was observed calling female residents Darling rather than using their names. Information about using appropriate names is available to staff in each residents care plan file under the heading of Personhood. This also includes information on respecting privacy and acting with courtesy. Care Homes for Older People Page 14 of 28 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 home takes an active role in encouraging residents contact with family, friends and parts of the local community. This in conjunction with varied and appropriate activities for people with dementia provides a good degree of social contact. In addition residents are offered a varied diet and are well supported by staff at mealtimes. Evidence: The activities organiser was spoken to and she described the range of activities provided for residents both inside and outside of the home. Since the previous inspection the home had introduced a specific activity session for people with dementia called SONAS. A session was held during one of the days of the inspection visit. In addition it was reported that the sensory room had been in use which provides a suitable and stimulating environment for people with dementia. Trips out of the home were taking place and recent locations had been boat trips, the seaside, shopping trips and coffee mornings at local church. Musical entertainers had visited the home as well as dog visits organised under the pat a dog scheme. Residents had been involved in gardening making use of the greenhouse in the rear enclosed garden. A record was Care Homes for Older People Page 15 of 28 Evidence: being kept of residents participation or otherwise with the activities provided. One to one activities were also in use with one female resident having her nails polished during the inspection visit. As well as visits by local Clergy,Holy Communion and blessings were being provided on a one to one basis by a member of staff who had connections with the local Church of England and had received training. In addition a Roman Catholic Priest visited the home once a month. Through use of our observational tool in one communal area it was noted that music was playing, at one point the CD went wrong, staff picked up on this quite quickly and changed to another CD. People were not asked about their choice of music but one resident quite enjoyed the golden oldies remembering some of them in preference to classical music. One person asked if they wanted to read a magazine and said no. Another person was given a book but held it rather than reading it. During the inspection visit a number of visitors were seen and there were no visiting restrictions as outlined in the homes Statement of Purpose. There were no residents in the home controlling their own finances. Relatives and representatives were helping residents with this or acting on their behalf. The home had information available on how to contact advocacy services who may act in the interests of residents. Evidence was seen of residents bringing their own personal possessions into the home including items of furniture. Lunch was observed being served in a number of areas of the home during the inspection visit. Staff gave assistance to residents who needed this on an individual basis and there was a relaxed atmosphere. Where meals were pureed they were presented in such a way that all the portions of the meal were identifiable. A record of alternative meals provided was being kept. One resident was eating a vegetarian diet and records of meals provided had been kept. The home offered a three-week menu with seasonal changes. Use of our observational tool showed that at breakfast residents were offered a choice of cereals and toast with marmalade if they wanted. With drinks some people needed help and this was given at their pace and unrushed. At breakfast and lunch residents chose whether to sit in the dining room or in the lounge. Care Homes for Older People Page 16 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are acted upon in the interests of residents and the homes approach to training staff in safeguarding vulnerable adults should ensure that residents are protected from any possible abuse. Evidence: The homes AQAA document stated that no complaints had been received in the twelve months prior to its completion in March 2009.The complaints procedure was clearly displayed on a notice board in the home and was available to representatives of residents in the statement of purpose document. This acknowledged the role of other agencies and gave guidelines to any prospective complainant on who to approach. There was also a time line clearly setting out the process of how a complaint would be dealt with. It was reported that it was the homes intention to resolve any concerns or issues before they become a complaint and there was on-going contact with relatives and representatives of residents. Dealing with complaints formed part of the training provided to staff following their induction. The home has produced a policy on the Mental Capacity Act 2005 that outlines how it would act if this legislation were enacted for any resident in the home. Staff had also received training in this area. In addition work has also been carried out relating to the Deprivation of Liberty Safeguards ( DOLS) although no referrals had been made. Training in DOLS had been attended by team leaders. Care Homes for Older People Page 17 of 28 Evidence: Since the previous inspection a move has been made to provide training to all staff in protecting vulnerable adults to the same standard as the local authority alerters training. This followed one of the staff attending the enhanced safeguarding adults training. A number of staff had also attended a Conflict Resolution training aimed at staff dealing with incidents of potential violence and aggression. A safeguarding incident in the home in April 2009 was correctly dealt with. The home liaised with all relevant agencies and took appropriate action. Care Homes for Older People Page 18 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are accommodated in a well-maintained and clean property with on going upgrading that is designed and furnished to suit their needs. Evidence: A tour of the premises was conducted. All areas of the home inspected were found to be clean, well maintained and with appropriate and attractive decoration. There were a variety of communal spaces available for residents throughout the home generally consisting of lounges and dining areas in each unit. Outside there were well maintained gardens that included a large enclosed courtyard to the side of the home and enclosed areas to the rear providing a safe area for residents to access. Outside areas have been developed with garden furniture,plants and a new greenhouse. Individual rooms were very clean and well decorated with plenty of personal items evident in most of them. One room had its own enclosed courtyard. It was noted that there were no pictorial signs on rooms such as toilets and bathrooms suitable for residents with dementia. This was discussed and the home started the process of finding suitable locations for these where it was considered it would aid the independence of residents. The laundry was equipped with hand washing facilities and suitable wall and floor Care Homes for Older People Page 19 of 28 Evidence: coverings. The home places great emphasis on infection control and in particular the hand hygiene of staff. Hand cleaning gel is available at points throughout the home along with reminders as to the importance of hand hygiene in controlling infection. Generally the home was fresh smelling although there was one area with an odour in St Georges unit which was to the main entrance. This was discussed during the inspection visit and plans had been made for complete refurbishment of the particular area. Care Homes for Older People Page 20 of 28 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. Residents needs are met by the numbers and skills of staff with a strong emphasis on training. In addition recruitment practices have improved and are now robust enough to protect residents. Evidence: Staffing in the home was arranged so that each unit had a separate team of care staff during the day. A shift is also worked by a member of care staff in the evening to provide support where needed over the whole home. Nursing staff are allocated to cover the whole home with two registered nurses on duty during the day and one at night. Nursing and care staff are supported by cleaning staff, catering staff, administration and maintenance staff. The home had well over 50 of care staff trained to NVQ level two or level three with a number of staff having achieved an NVQ level four in care. Other staff had started working towards an NVQ level four in leadership and management in care services. The home also had some staff working on City and Guilds Vocational Related Qualifications (VRQ). Records for recently recruited members of staff were examined. All the required information and documentation had been obtained including an employment history Care Homes for Older People Page 21 of 28 Evidence: against which any gaps in employment could be explored. Checks against the Protection of Vulnerable Adults list were being made as well as with the Criminal Records Bureau. Since the previous inspection auditing processes have been introduced to ensure robust recruitment in the interests of protecting residents. The homes recruitment procedure is based on equal opportunities and this has been demonstrated by winning an award from Age Positive with regard to the benefits of a mixed age workforce and gaining a Mindful Employer charter for employers who are positive about mental health. All care staff receive induction training using the Common Induction Standards. This then leads on to NVQ training and a City and Guilds certificate in Health and Social care. Staff are also required to sign certain policies to indicate that they have read and understand them during the induction period. Evidence was seen of an audit taking place of the induction training provided in the home. Staff had also undertaken training in dementia care as provided by the local authority under their link worker scheme. One member of staff spoken to during the inspection visit confirmed the training that they had received and commented on the good access to training courses that they had experienced whilst working in the home. Care Homes for Older People Page 22 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A strong management team with an improved focus on some areas of safe working has ensured that the home is being operated in the interests of residents well being. Evidence: The registered manager has a number of years experience in management, has achieved the registered managers award and has a relevant qualification in mental health. She has recently undertaken training in diversity and the Mental Capacity Act 2005. The manager is not a nurse but is supported by a support manager who is a registered nurse. There is a senior carer with an NVQ qualification in charge of the residential unit. Quality assurance systems were in place in the home in the form of resident quality assurance questionnaires. These had carried out with a number of selected residents which despite having dementia were able to complete the questionnaires with support from a carer. The results had been compiled and recorded. In addition the home has a Care Homes for Older People Page 23 of 28 Evidence: clinical governance business plan in place set to run from 2008 to 2010 entitled See Me Not Just the Dementia. This is a plan to evaluate the care given by the service through the eyes of residents. Members of the senior management team had been allocated various areas of responsibility under the plan. Other forms of quality assurance are the senior management meeting, team leaders meetings and audits in such areas as care planning, falls and use of bed rails. There is a business plan for the home which sets out planned developments and objectives over a twelve month period. The plan for 2008 to 2009 covered such areas as care, quality assurance and staff development. It was found that the responsible individual had not been carrying out or recording visits in line with the Care Homes Regulations 2001 since September 2007. Although it was reported by the registered manager that the responsible individual had been visiting the home on a regular basis. The home had achieved a number of awards in the past such as the Investors in People Award and the Investors in People Management and Leadership Award. In addition the home has been awarded winner status in the Gloucestershire Workforce Development Award in 2006 and was the winner of the south west Age Positive Award in 2006. The home has secure facilities for storage of cash and valuables although these are rarely used except for items that are found in the home. The general arrangement is for residents representatives to take responsibility for these. The home is not involved in paying any money into bank accounts on behalf of residents. A record of a valuable item held on behalf of one resident was looked at. Infection control and in particular hand hygiene has been a priority in the home with staff provided with training not only in infection control but specifically in hand washing. The home also has an annual infection control action plan which for 2009 to 2010 was planned to include hand washing assessments of all staff. Training had also been provided for all staff in moving and handling. Since the previous inspection the emphasis on moving and handling in the home had increased. As well as forming part of induction, moving and handling training updates are provided with a focus on practical skills and the use of equipment. It was reported that checks on moving and handling practice are carried out. Our use of the observational tool showed that where hoists were in use, two staff were assisting the resident . All staff had received fire safety training.The home had completed a fire risk assessment and had received a visit from the fire safety officer in 2007 where no issues were raised. Individual risk assessments had been completed by all residents with regard to evacuation in a fire. During the inspection visit it was noted that a fire exit from one of the communal areas was blocked from the outside with garden furniture. The reasons for this were given however the home should check that this practice is in line with the homes fire risk assessment. Staff had also received training in food hygiene and selected staff had received first aid training. During a recent inspection by the local authority the home Care Homes for Older People Page 24 of 28 Evidence: was awarded five stars (the highest score) for food hygiene. The home has had specialist work undertaken to reduce any risks to service users and staff from Legionella and this has been ongoing as the home has expanded in size. The home has a water system that is designed to be Legionella limiting. Checks had been undertaken on boilers and heating systems as well as lifts and moving and handling equipment in the home. The checking of the functioning of window restrictors had been carried out in the home with records kept. These form part of the monthly maintenance checks along with bed rails and water temperatures. Portable electrical appliances had been tested for electrical safety with a new checklist in operation for any electrical items brought into the home for residents. Since the previous inspection more attention had been given to the correct and safe storage of cleaning substances. An approved list of cleaning substances was in operation in the home. A check of all storage areas was made and materials were stored safely. Care Homes for Older People Page 25 of 28 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 26 of 28 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 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 33 26 The registered person must 30/09/2009 complete unannounced visits to the home and produce reports in accordance with regulation 26 keeping copies in the home. This is so that the registered provider can demonstrate that they are checking that the home is being managed in the interests of the residents. 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 1 2 10 38 Consideration should be given to always using residents preferred names when interacting with them. The home should check that the practice of blocking a fire risk assessment with garden furniture is in line with their fire risk assessment. Care Homes for Older People Page 27 of 28 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. 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. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!