Care Home: The Grange Nursing & Residential Home

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What the care home does well Written information is available to new and current service users in the Statement of Purpose and Service Users Guide. It sets out the objectives and philosophy of the service and gives a clear account of the specialist services provided at The Grange. Service users receive a good assessment process including detailed written information. Service users plans included risk assessments which are regularly reviewed as their individual needs change. Care plans and risk assessments in place for all aspects of care. These were clearly written and easy to understand. Staff were seen addressing the service users respectfully and by their preferred name. Surveys from service users told us, "Its a very good home." "They are always very helpful nothing too much trouble. Always very polite and caring." Meals are varied and nutritious and meet peoples special dietary needs. Residents told us "The food is nice, you get plenty to eat, sometimes they ask you to eat a bit more." Staff were seen to be managing service users with diabetes and monitoring blood sugar levels well. This will benefit service users health care and well being. The home was found to be clean, tidy and comfortable. Residents rooms were personalised with their belongings. Surveys from service users told us, " Very friendly staff and a nice atmosphere." " The home looks after my mother very well. They do their best. Staff are very good, and reliable." There is a varied staff training programme. Some staff receive National Vocational Qualification (NVQ) training which provide staff with a basic understanding of care practises. What has improved since the last inspection? Service users plan of care are produced from a comprehensive assessment are kept under review, and are reflective of individual needs. Care plans inform staff of what actions to take, to meet each identified need. Assessment procedures are more robust. This will ensure people are not admitted to the home without their needs being assessed, and assured their needs will be met Medication management practises have improved greatly. This ensures service users health and welfare is not put at risk. An identified service user`s safe access to their bedroom was reviewed. Any unnecessary risks to the health or safety of service users was identified and so far as possible eliminated. Some improvements around keeping staff recruitment records and recruitment procedures have been made, but the standard dropped recently. What the care home could do better: Equipment provided at the care home for use by service users or persons who work at the care home are maintained in good working order. Service users must have confidence that equipment necessary for the promotion of tissue viability and prevention or treatment of pressure sores is working properly for them. Improved arrangements for the recording, handling, and safe administration of medicines will ensure service users medicines are safely administered. Service user told us they would welcome more leisure and social activities, and greater opportunities for stimulation. The Registered Person should consult with service users about their social interests and make arrangements to enable them to engage in local, social and community activities. Training to be identified for staff and managers to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This will ensure service users are kept safe. Staff recruitment procedures to be robustly reviewed to ensure service users are protected. The Registered Person shall ensure that any complaint is fully investigated with a record of all complaints held and details of investigations and any action taken. Service users and their relatives must be assured their complaints will be taken seriously. Ensure all staff receive regular formal supervision. This will ensure staff are suitably trained and supported. The same requirement was raised at our last visit. All parts of the care home which are used by service users should be kept warm and comfortable particularly in colder weather. The home should be kept free from offensive odours. This will ensure service users personal care needs are addressed, and their living areas are maintained without unpleasant odours. Key inspection report Care homes for older people Name: Address: The Grange Nursing & Residential Home Smeeton Road Saddington Leicester Leicestershire LE8 0QT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Abel     Date: 0 8 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: The Grange Nursing & Residential Home Smeeton Road Saddington Leicester Leicestershire LE8 0QT 01162402264 01162404888 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Banesh Laxmilall Bhatoolall Name of registered manager (if applicable) Mrs Karen Lesley Little Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 52 The registered person may provide the following category of service only Care home with Nursing, Code N, to service users of the following gender, Either whose primary care needs on admission to the home are within the following categories, Old age, not falling within any other category, Code OP, maximum number of places 52, Dementia Code DE maximum number of places14, Physical disability Code PD maximum number of places 52 Date of last inspection 0 4 0 3 2 0 0 9 14 0 52 Over 65 0 52 0 Care Homes for Older People Page 4 of 32 Brief description of the care home The Grange Nursing and Residential Home is registered to accommodate up to 52 older people, within the categories of older persons and physical disability. The home is located in the village of Saddington, Leicestershire and is approximately 12 miles from Leicester City centre. It is accessible by public or private transport and there is car parking at the home. The home is a large, traditional style house with bedrooms on two floors. The upper floor is accessible by stairs, stair lift or the passenger lifts. The home has 38 single rooms and 7 double rooms. Bathrooms and toilet facilities are located close to the bedrooms and the communal areas. There are two large comfortable lounges and the dining area is situated off the main lounge. All areas of the home are accessible to people using mobility support, aids and equipment. Information about the service is provided to prospective and current residents in a service user guide. The weekly fees range from £304- 497.30 There are additional charges for hairdresser, chiropodist and escort fees. The most current Care Quality Commission inspection report is held in the reception area and/or available upon request. Care Homes for Older People Page 5 of 32 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 Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was a Key Inspection that focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for Older Persons. Two Regulatory Inspectors Helen Abel and Ruth Wood undertook this visit. The Inspectors spent time planning the areas to focus on based upon information gained from reviewing the homes service history, the last inspection report, surveys from people living at the home, complaints and concerns received, and the Annual Quality Assurance Assessment (AQAA). The people living at The Grange Nursing and Residential Home prefer to be called service users. The primary method of inspection used was case tracking that involved selecting six people and reviewing the care that they received through inspection of the written information available on their their care plans. Discussions took place with Care Homes for Older People Page 6 of 32 service users, visitors, staff and Managers. The visit was unannounced and started at 9.30 on a Monday morning and took place over a period of approximately five hours. In addition policies and procedures and records in relation to residents, staff recruitment, complaints, and upkeep of the home were viewed. Upon arriving at the home residents were observed getting ready for the day following breakfast. Some people were in the two communal lounges watching television and reading newspapers and magazines, other people were in their own bedrooms, reading or having some quite time. Throughout the day visitors came and went to see their relatives. This service is rated as 1 Star. This means the residents who use this service experience Adequate quality outcomes. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Service users plan of care are produced from a comprehensive assessment are kept under review, and are reflective of individual needs. Care plans inform staff of what actions to take, to meet each identified need. Assessment procedures are more robust. This will ensure people are not admitted to the home without their needs being assessed, and assured their needs will be met Medication management practises have improved greatly. This ensures service users health and welfare is not put at risk. An identified service users safe access to their bedroom was reviewed. Any unnecessary risks to the health or safety of service users was identified and so far as possible eliminated. Some improvements around keeping staff recruitment records and recruitment Care Homes for Older People Page 8 of 32 procedures have been made, but the standard dropped recently. 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 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 32 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 32 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. Service users receive a good assessment process including detailed written information. Evidence: Written information is available to new and current service users in the Statement of Purpose and Service Users Guide. It sets out the objectives and philosophy of the service and gives a clear account of the specialist services provided at The Grange. Admissions to the home only takes place if the service is confident they can meet the assessed needs of the prospective service user. The Registered Provider Manager Mr Banish Bhatoolall normally undertakes the assessment with the prospective service user and family members. Other information is considered from other care professionals. Completed assessments were seen. All this key formation is drawn together to produce a personalised service users plan. Service users are provided with a statement of terms and conditions, or a contract Care Homes for Older People Page 11 of 32 Evidence: The Care Quality Commission (CQC) most recent inspection report is currently being replaced in the hallway as the last copy was removed. Staff told us people who visit the home look at the inspection report. This will enable people to see the findings and comments and experiences of service users living at the home. Care Homes for Older People Page 12 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and personal care needs were well met. Evidence: Service users plans were found to be comprehensive including individuals strengths and personal preferences. Some information was given about the persons life experience, and staff responded to this with positive individualised support. Service users plans included risk assessments which are regularly reviewed as their individual needs change. Care plans and risk assessments in place for all aspects of care. These were clearly written and easy to understand. Preferred communication style of the individual is recorded and enables the service user to participate in life at the home. This good practise. One service user told us of their discomfort with a pressure relieving mattress during the night. This was deflated in one area. There was no guidance to care staff as to what the air mattress should be set to. The Registered Provider Manager took action Care Homes for Older People Page 13 of 32 Evidence: during our visit. The service user received a new pressure relieving mattress and this was set to meet the individuals needs. The Acting Manager assured us this information would now be included in individuals pressure area care management plans. Service users must have confidence that equipment necessary for the promotion of tissue viability and prevention or treatment of pressure sores, is working properly for them. Service users have access to hearing and sight tests and appropriate aids according to their needs. In addition service users receive visits from their GP, dental, chiropody, and community heath services. A health professional visiting the home told us that instructions around nursing care were followed through by staff and this had improved over the months. Service users health needs were being fully met. Staff were seen to be managing service with diabetes and monitoring blood sugar levels well. There was good care practise around monitoring, treatment, and intervention. The Inspector observed the Acting Manager during a medication round. She had a good understanding of medicines and why service users held particular medicines. The medication areas were inspected and found to be well maintained. The Medication fridge was clean and tidy and fridge temperatures were recorded daily. Staff were seen addressing the service users respectfully and by their preferred name. Service users were seen wearing their own clothes, women with jewellery and handbags and the men in long sleeved shirts and trousers. staff were observed interacting positively with service users. Completed surveys from service users told us, Its a very good home. They are always very helpful nothing too much trouble. Always very polite and caring. A visitor told us Staff let me know if there were any problems when I come to visit my relative. You hear a lot about bad nursing homes but this one is lovely. I think the staff are wonderful, a wonderful team and I think they enjoy their work, its a pleasure to see them. The following medication management procedures should be improved: Medicines should not be directly handled by staff. Spoons, plastic medicines cups, a pill dispenser maybe used. In addition staff should wear disposable gloves where appropriate. Medicine records should be signed after service users have taken their Care Homes for Older People Page 14 of 32 Evidence: medicines, and not before. This will ensure service users medicines are safely administered. Care Homes for Older People Page 15 of 32 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. Service users told us they want more social activities. Meals are varied and nutritious and meet peoples special dietary needs. Evidence: There are some daily activities provided such as ball games, karaoke and musical activities. Some people were seen reading newspapers in the communal lounge. Service users told us, Nothing else goes on, you have to make your own entertainment. We sit here all day until after dinner, then we sit here again. Im just stuck here day in day out doing nothing, Im not happy here. The Registered Provider Manager agreed to review this and ensure service users are properly consulted about their leisure preferences. This would ensure service users are receiving leisure activities which suit their needs, preferences and capacities. The home has links with the local church, and religious services are regularly provided. Surveys from a service users and relatives had some suggestions on what the home could do better. A request for day outings. Another person suggested- the home could Care Homes for Older People Page 16 of 32 Evidence: provide the facilities to send an email message (printed out) to read to a resident when a relative is away or unable to visit. The Registered Provider Manager may consider this. A service user has support with exercising their choice and control over their lives. At lunchtime the Acting Manager gave a cold fortijuice drink to a service users who specifically asks for them cold. Outside agencies have been involved with full support from staff and managers. Service users can contact Advocates through the Service User Guide and Statement of Purpose and information displayed around the home. Meals were seen to be well balanced, varied and nutritious. Religious and cultural diets were well met. The Acting Manager confirmed received training around therapeutic diets and has changed the way the home offers special meals. This has helped individual service users maintain appetite and nutrition. A hot lunch was being served and the atmosphere was observed as unrushed and relaxed for service users. People could sit at a dining table or stay in their chair or in one of the communal lounges. Staff were available to help people to eat and this was done in a calm and respectful way, allowing people sufficient time to chew and swallow. Dessert was orange sponge and custard, fresh fruit or rice pudding. The rice pudding had been made with sweetener so that it could be served to people with diabetes. A service user had eaten chips, chicken, fried egg, beans and tomatoes for lunch and told us it was, The best meal Ive had since I got here. Another service users told us, The food is nice, you get plenty to eat, sometimes they ask you to eat a bit more. Care Homes for Older People Page 17 of 32 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. Procedures for recording complaints and safeguarding are not robust and reduces the opportunity for resolving problems, and puts service users at risk of receiving poor care. Evidence: A complaints procedure is outlined in the Statement of Purpose Service User Guide. The complaints record confirmed the last complaint was received in February 2009. However the Care Quality Commission (CQC) received a copy of a complaint in January 2010 that was sent to the Registered Provider Manager for investigation around poor care practises. The Registered Provider Manager confirmed he did not properly respond fully to the allegations made. The Registered Provider Manager confirmed he will go back and revisit this complaint. Service users and their relatives must be assured their complaints will be taken seriously. Another complaint is still being progressed with the provider and again further action is being required of the Registered Provider Manager in respect of Safeguarding. The complaints record should include a record of all complaints made and include details of investigations and any action taken. The managers agreed the complaints record would be updated to reflect these changes. A service user told us he was unhappy with care at the home. The boss thinks that Care Homes for Older People Page 18 of 32 Evidence: everything is OK - I have spoken to him to complain. Steps were taken to reassure and meet the concerns of this service user throughout our visit. Recent complaints raised by the service user were not held in the complaints record. Some Safeguarding Adults training has been provided for some staff, but not provided regularly. Managers and staff must ensure they receive regular safeguarding training to ensure they know how to keep service users safe. Care Homes for Older People Page 19 of 32 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. Service users benefit from a comfortable living environment, with some improvements required around heating and minimising odours. Evidence: During the visit, the Inspectors looked around parts of the home. The ambient temperature in the music lounge felt cold.Two bedrooms seen in the morning all had their radiators off, and in one of these rooms the wall clock was set incorrectly. This could lead to confusion about the correct time for the person staying in this room. A third radiator was was set on a low setting but the bedroom felt cold. This was discussed with the Registered Provider Manager agreed to immediately review the thermostatic control setting in view of the colder weather. Stale odours were noted in one bedroom and on one upstairs landing area. The Registered Provider Manager agreed to minimise odours to ensure a more comfortable environment for service users. All other parts of the home were seen to be clean, tidy and comfortable. Staff were observed regularly hand washing, wearing disposable gloves and aprons and using hand sanitisers. This ensure cleanliness and hygiene standards for service users. The Registered Provider Manager makes sure that safety precautions and checks are Care Homes for Older People Page 20 of 32 Evidence: carried out in the care home. There are systems in place for making sure laundry is done efficiently. Staff told the Inspectors about safety precautions for controlling the spread of infection and there are procedures in the home to make sure that staff work safely. Care Homes for Older People Page 21 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from some adequate staffing levels. Improvements in the recruitment procedures and safeguarding adults training will provide better protection for service users. Evidence: Staff were well deployed and observed interacting positively with service users. Completed surveys from service users told us, Very friendly staff and a nice atmosphere. The home looks after my mother very well. They do their best. Staff are very good, and reliable. The Inspector checked a sample of staff records and found these were in order. However the Registered Provider Manager confirmed he had recruited a staff member and had became aware of some concerns. He had not reported these concerns, or taken appropriate advice and guidance from the Care Quality Commission (CQC), Placing or Safeguarding Authorities. This had the potential to adversely affect the quality of individual care and support that service users receive, and put them at risk. Staff recruitment policies and procedures should be reviewed to ensure service users are protected. Service users would benefit from managers receiving training in Safeguarding Adults. They would then have the knowledge and understanding in this area and be able to Care Homes for Older People Page 22 of 32 Evidence: protect service users. (See also requirements made under Complaints and Protection). There is a staff training programme and some staff confirmed participating in recent training. They had received a range of training moving and handling, end of life training,catheter care, Deprivation of Liberties, nutrition food hygiene. Some staff received National Vocational Qualification (NVQ) training which provides staff with a basic understanding of care practises. Staff training records were difficult to track. The Inspector suggested a clear training record would capture all staff training and development received, and planned for. This will ensure future training can be better managed and staff be adequately trained to meet service users needs. Care Homes for Older People Page 23 of 32 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. Managers are improving and developing systems that monitor practise and compliance, but need to work harder to promote Safeguarding policies and practise. This will ensure service users are better protected. Evidence: The Registered Provider Manager Mr Bhatoolall confirmed the Acting Manager is in the process of applying to be a second Registered Manager with the Care Quality Commission (CQC). The Acting Manager has been in post for some months and is in day to day control of the home, together with Mr Bhatoolall. The Acting Manager has brought her nursing knowledge, experience and skills to ensure better outcomes for service users at The Grange. Mr Bhatoolall confirmed he had not always kept the CQC informed of developments around an identified complaint including adult protection issues in January 2010. This had resulted in service users being at risk of harm. Care Homes for Older People Page 24 of 32 Evidence: There is evidence of seeking the views of service users around food preferences. Service users and their relatives are asked to comment on service users likes and dislikes on a regular surveys. General surveys are being sent out for an internal audit. These steps will ensure the home is run in the best interest of service users. Small amounts of money are held on behalf of service users to assist them with paying for things. Money and records of these transactions were sampled for some people case tracked and found to be in good order. Service users finances are safeguarded. Some staff receive staff supervision, but it is not regular or formal. Staff supervisions should take place regularly and cover all aspects of practise, philosophy of care in the home, career development needs. This aspect was raised at our last visit. A sample check of staff training records identified that the majority of staff have received training in movement and handling, food hygiene, fire safety.The Registered Provider and Manager confirmed staff training plans are in their Quality Assurance Assessment. During an inspection by the Health and Safety Authorities in 2009 a number of requirements around safe working practises were made which the home has now met. A number of service users had the same illness over a short period in 2009. This was reported onto the appropriate Authorities. Managers dealt with this well and swiftly and service uses health and welfare was promoted. Care Homes for Older People Page 25 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 36 18 Service users must be 31/03/2009 supported by appropriately supervised staff. Staff to receive formal supervising at least six times a year. Staff must be appropriately supervised and supported. Care Homes for Older People Page 26 of 32 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 8 23 The Registered person shall 08/04/2010 have regard to the number and needs of the service users and ensure that (c) equipment provided at the care home for use by service users or persons who work at the care home are maintained in good working order. Service users must have confidence that equipment necessary for the promotion of tissue viability and prevention or treatment of pressure sores is working properly for them. 2 9 13 The Registered Person shall make arrangements for the recording, handling, safekeeping safe administration and disposal of medicines received into the care home. This will ensure service users 08/04/2010 Care Homes for Older People Page 27 of 32 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 medicines are safely administered. This will ensure service users medicines are safely administered. 3 12 16 The Registered Person shall have due regard to the size of the care home and the number and needs of services. Consult service users about their social interests and make arrangements to enable them to engage in local, social and community activities and to visit or maintain contact or communicate with, their families and friends. Service user told us they would welcome more leisure and social activities, and greater opportunities for stimulation. 4 16 17 A record of complaints made 31/03/2010 by the service users or representatives or relatives of service users or person working at the care home about the operation of the care home, and the action taken by the registered person in respect of any such complaint. The complaints record should 30/04/2010 Care Homes for Older People Page 28 of 32 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 include a record of all complaints made and include details of investigations and any action taken. Service users and their relatives must be assured their complaints will be taken seriously. 5 16 21 The Registered person shall 31/03/2010 ensure that any complaint is fully investigated. Service users and their relatives must be assured their complaints will be taken seriously. 6 18 13 The Registered person shall make arrangements, by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This will ensure service users are kept safe 7 18 13 The Regsitrered person shall 31/05/2010 make arrangements, by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 31/05/2010 Care Homes for Older People Page 29 of 32 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 This will ensure service users are kept safe. 8 25 25 The Registered Person shall 31/03/2010 ensure having regard to the number and needs of the service users ensure that (P) Ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users. This will ensure service users are always kept warm and comfortable particularly in colder weather. This will ensure service users are always kept warm and comfortable particularly in colder weather. 9 26 16 The Registered Person shall have due regard to the size of the care home and the number and needs of services (K) Keep the care home free from offensive odours and make suitable arrangements for maintain satisfactory standards of hygiene in the care home. This will ensure service users personal care needs are addressed, and their living areas are maintained without unpleasant odours. 31/03/2010 Care Homes for Older People Page 30 of 32 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 10 29 10 The Registered Manager 31/05/2010 shall undertake from time to time such training as is appropriate to ensure that he has the experience and skills necessary for managing the care home. To ensure service users are supported by a trained manager he must ensure his knowledge of Safeguarding Adults issues is current, in order to help keep service users safe. 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 29 30 Staff recruitment policies and procedures to be reviewed to ensure service users are protected. Service users benefit from some trained staff. Ensure a staff training and development plan is produced and includes staff and managers training received and being planned for. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 32 of 32 - 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. 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