Care Home: The Heathers Nursing Home

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What the care home does well Generally the home was found warm, clean, tidy and free from offensive odour. Individuals living in the home were found relaxed in their homely environment and looked well cared for with positive and respectful interaction with staff. The Annual Quality Assurance Assessment stated that the organisation has a robust recruitment process to ensure that the right people are recruited. All workers receive a job description and a hand book. All staff receive induction training and regular updates. The home has a clear and accessible complaints procedure that illustrates time scales and how complaints are dealt with. Aids and equipment are provided in sufficient quantity to assist care staff in meeting the needs of the indivisuals living at the home. What has improved since the last inspection? The AQAA stated that the home had invested in clinical equipment for example matresses, hoists and hospital beds. Staff now enjoy benefits such as bonus sheme, enhanced rates for overtime, non contributary life insurance. All staff have a trainng plan. The new " common induction" has been introduced to all staff. What the care home could do better: The requirement that we made in relation to person centred care for one new resident had been met before this report was completed. The new manager assured us that she would provide all the residents with person centred care plans tailored to their needs. We would review this at the next inspection. We made recommendations in relation to medication adminstration and auditng accidents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Heathers Nursing Home Bowling Hill Chipping Sodbury South Glos BS37 6AX     The quality rating for this care home is:   two star good 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: Grace Agu     Date: 0 4 0 2 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Heathers Nursing Home Bowling Hill Chipping Sodbury South Glos BS37 6AX 01454312726 01454315614 theheathers@acaciacare.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Hitan A Patel Name of registered manager (if applicable) Mr Roger Tippings Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 30 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any othr category (Code OP) Date of last inspection Brief description of the care home The Heathers is a Grade II listed Georgian manor house situated in Chipping Sodbury close to the town centre of Yate. There is access to public transport for surrounding areas and the centre of Bristol and the home is close to the Avon Ring Road and motorway system. It is a care home with nursing and offers accommodation in single and shared rooms. The accommodation for residents is on two levels and there is a passenger lift between floors. There are several lounges and a small courtyard to the front of the building for use in good weather. The home operates a No Smoking Policy, Care Homes for Older People Page 4 of 31 care home 30 Over 65 30 0 Brief description of the care home staff and service users who smoke must do so outside of the building. Fees start from 520 per week. 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: two star good 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 was an unannounced site visit as part of a key inspection that was undertaken by three inspectors over nine hours to review the requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. The pharmacy inspector reviewed the homes medication and her report can be found in the body of the report under Standard 9. Mr Michael Miles our Regulation Manager looked at the environment and his comments can also be found under those group of standards. We met with the new manager Anne Shilston and the registered provider Mr Patel. who Care Homes for Older People Page 6 of 31 assisted with the inspection process. A tour of the building was undertaken and a number of records were viewed. Residents, staff members and one relative were spoken with on the day. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 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 9 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 process of admission is well planned with clear information about the services provided to enable the resident or their representatives to make a decision. Evidence: The Home stated in the Annual Quality Assurance Assessment that information about services and facilities provided at the Home, including complaint procedure is provided to prospective residents and or their relatives when they make enquiries to enable them to make informed choice. Residents are assessed before admission to ensure that the home is able to meet their needs. The home told us in the AQAA that if the home is unable to meet a prospective residents needs after assessment explanation is given to them and their relatives. The AQAA also stated that the home offers trial periods to prospective residents to Care Homes for Older People Page 10 of 31 Evidence: enable them to make up their minds to stay at the home. A written contract that sets out their rights and responsibilities is provided when a resident pays for all or part their care fees. Two care files of recently admitted residents, contained pre-admission assessments documents. Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers care and support to service users throughout their life and towards the end, it also protects service users by reviewing their health needs. Management of medicines is satisfactory. Evidence: Five care plans were reviewed. There was evidence of pre-assessment before admission to the home. The needs identified had care plans on how these needs were to be met. One new resident, who was admitted from the hospital with wound from recent surgery, had a detailed wound care plan and this was regularly reviewed. There was a daily progress record in each care file showing how the health and wellbeing of the residents are being monitored. Another individual with a complex medical condition had care plan in place. Whilst these care plans were satisfactory, they were generalised and needed to be person centred as stated in the AQAA. We also noted that the home has a policy on person centred care planning however this policy was not being implemented. Care Homes for Older People Page 12 of 31 Evidence: The new manager stated that she would review the present care planning system to ensure that it is more holistic and tailored to each residents need. We discussed the care file of a resident who was admitted ten days before our visit that had no care plans completed in relation to four of the individuals assessed needs. The new manager stated the registered nurse responsible for completing the care plans was off sick she would ensure that in future another registered nurse would be allocated to carry out the task to ensure that the resident receives appropriate care. We received evidence from the home showing that detailed person centred care plan and other required documents in relation to the individuals care had been put in place before this report was completed. The manager stated that the care plan developed for this individual will be used as a benchmark for reviewing other care files. Care staff were noted knocking on doors before going into service users rooms as stated in the AQAA. One resident stated, staff treat me with respect and they knock on the door and wait before coming in. Another resident stated staff make sure the door is closed when I am using the toilet. Staff were noted interacting with the residents in a respectful and dignified manner. Residents are empowered to make choices about their personal care through the key working system. We spoke with several residents and with the relative of one person. Everyone was complimentary about the staff at the home saying, nothing was too much trouble and telling us that they were happy at the home. The relative and her mother that we spoke with were particularly happy with the respite arrangements provided by the home because of how it accommodated the persons assistive technology to enable the respite care to be successful. The person that stayed in the home confirmed that staff had acknowledged that she could become isolated as she remained in bed and often called in to chat with her. She was also thankful for the way she was treated with dignity when receiving personal care. The care files viewed had evidence of visits from the health professionals to include Care Homes for Older People Page 13 of 31 Evidence: General Practitioners (GP) Chiropodists, Opticians and Dentists. The home has a policy and procedure in the event of death of a resident. Terminally ill residents are cared for in a dignified manner. Residents, representatives are able to stay with the individual if required. Evidence of residents wishes upon death was seen on the care files. Staff spoken with stated that they are aware of confidentiality of information in relation to the residents at the home. The pharmacist inspector looked at the handling of medication in the home. Residents are all registered with a local doctor and medicines are supplied by a local pharmacy using a monthly blister pack system. At the time of this inspection all the medicines used in the home are looked after by and given by the nursing staff. A policy to ensure that a resident who wanted to look after their own medicines is available but this should be more detailed and include a risk assessment to make sure that residents health is protected. A homely remedy policy has been agreed so that staff can give a small range of medicines to treat minor ailments. We saw staff giving some lunch time medicines using safe procedures. Nursing staff record the medicines that they have given on printed medicines administration sheets that the pharmacy provides each month. We checked the blister packs and these indicated that medicines had been given as recorded. However we could not check the medicines supplied in standard packs because there was no indication of when the pack had been started. Staff should ensure that a system is in place that allows medicines to be checked to see that they have been given as recorded. We looked at the medicines administration sheets for the current month. Some handwritten additions made by staff had not been signed and dated or checked by a second member of staff, this is to reduce the risk of mistakes being made which could lead to someone being given their medicines wrongly. Two medicines prescribed with a variable dose did not always have a record of the amount of medicine that had been given. This means that it is is not always clear how much medicine the person has had Care Homes for Older People Page 14 of 31 Evidence: in the day. Two people had a medicine given to them less frequently than written in the dosage instructions. In both cases staff told us that the doctor had told them to reduce the dose, however this change had not been recorded on the medicines administration sheet. Any changes to the dose of medicines should be recorded on the administration record sheet so that all staff are clear of the correct dose to give. Staff told us that two residents sometimes need to have medicines disguised because they sometimes refuse medicines which are important to their health. Staff told us that for each person this has been agreed with the relevant doctor and family members and that the correct assessments had been made of the capacity of the people concerned to make these decisions. There was no information in the peoples care plans about these assessments. We asked staff if they had checked with the pharmacy that the medicines were suitable to be given in the proposed way. They told us that the doctor had checked this, however this should be confirmed by the nursing staff who are responsible for giving the medicines safely. Records are kept of the receipt of medicines into the home. However some medicines received outside of the regular monthly cycle had not been recorded. Staff must ensure that records are kept of all medicines received so that there is a clear audit trail for all medicines used in the home, to show that they have been been correctly. Records are kept of the disposal of medicines, however the policy for medicine disposal needs to be updated to reflect current practice. Secure storage is provided for medicines. A medicine fridge is available. Records showed that staff monitor the temperature once a week to check that this is safe for medicine storage. This temperature should be recorded every day so that swift action can be taken if the temperature is too high or too low for safe storage of medicines. Suitable storage is available for medicines called Controlled Drugs which need to be kept more securely. A register is available to record these medicines and records show that they have been looked after safely. A supply of Oxygen cylinders is kept and a suitable warning sign was in place. Staff should ensure that a warning sign is in place for all areas where Oxygen cylinders are kept and ensure that all cylinders are secured so that they cannot fall over causing injury. Care Homes for Older People Page 15 of 31 Care Homes for Older People Page 16 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. Residents are enabled to maintain links with their families and are also provided meaningful activities. The food is nutritious with varied choices available. Evidence: The visitors book showed that the relatives and representatives regularly visit the residents. Residents spoken with confirmed that they had regular visitors. One resident spoken with said that the relatives visit regularly. The AQAA states that residents are able to have private telephones installed in their room to enable to contact and receive calls from their families and friend whenever they like. An Activity Co-ordinator has been in post since November 2008 and is solely responsible for organising and providing activities for all the residents based on individual capabilities.The individual offers a variety of weekly and monthly activities to ensure that residents are regularly stimulated. We noted that at the time of the inspection she was in the process of updating the staff picture board to help residents and visitors to recognise staff working with them. Care Homes for Older People Page 17 of 31 Evidence: A programme of activities is arranged and there were records of trips to the Pantomime, a Tea Party at the Chipping Sodbury Town Hall, for pub lunches and to the Garden Centre that enable those that live in the home to participate in the wider community. The Community Bus Service is used to assist with this. Activities in the home include Bingo and Sing-a-long and there were photographs of these and other events displayed around the home to remind residents of the activity and to give prospective residents an idea of what life is like in the home. One to one interaction is offered to all residents who prefer to stay in their rooms and also those who are unable to participate in the activities. There is a record of all activities undertaken in the individual care records. Residents interviewed stated that they have a choice of when to get up and when to retire and have not been pressurised by staff to change their routines. Personal items and furniture were noted in resident rooms and a list of personal belongings were noted in residents care files. There is a four-week menu plan. Staff told us that residents make a choice the day before but can chose an alternative if the were not happy with the meal of the day. The menu is currently under review to widen choices available to those that live in the home. We noted that on the day of the inspection the meal options were Faggots or Savoury Mince with Vegetables. We suggested that a review of the menu was needed, as these options were similar and recommended some publications related to meeting the dietary needs of older people and of those with Dementia. The food looked nutritious and staff were noted either supervising feeding or assisting residents who were having difficulties with feeding themselves. This service was provided in a dignified manner. The meal was not hurried. Residents spoken with stated that they enjoyed their meals. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for protecting residents and responding to their concerns are in place and are satisfactory. Evidence: The home has a complaints policy, which is also included in each residents care file. The complaints procedure contains information about the Commission for Social Care Inspection (CSCI) to enable the residents to contact us if they were not satisfied with the outcome of their complaint to the organisation.The complaints procedure also contained details of how complaints would be dealt with and time scale. We noted that this document was displayed at the entrance of the building for easy access. The home stated in their AQAA that all residents are informed of the complaints procedure and would be fully supported by staff in making their complaint. One resident stated that she would talk to the Manager if she had any concerns and that she felt safe at the home. The complaints book contained two recorded complaints since the last inspection. However a record of the investigation and action taken was not recorded. The manager stated that the action taken was recorded in a different folder and that the complainant was satisfied with the outcome. It was agreed that the home keep a full Care Homes for Older People Page 19 of 31 Evidence: record of complaints and this includes details of the investigation and any action taken in one folder/book for easy access during inspection. There is the South Gloucestershire No Secrets policy for dealing with suspected abuse. The AQAA stated that staff have received training on the protection of vulnerable adults. Evidence from staff records show that staff have received this training. Two newly employed staff members had Criminal Record Bureau checks, two satisfactory references and record of identity. The home has a policy on whistle blowing to enable staff to report bad practices without fear of reprisal. We observed whilst touring the building that some residents have bedrails applied to the bed frames for safety and that risk assessments were in place along with consent from the residents representatives. 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 home provides a suitable, safe and well-maintained environment where residents are happy to live. Evidence: The Heathers is a Grade II listed Georgian manor house situated in Chipping Sodbury close to the town centre of Yate. There is access to public transport for surrounding areas and the centre of Bristol and the home is close to the Avon Ring Road and motorway system. No changes had occurred in relation to the homes suitability for its stated purpose and the provision of care for the residents. The home operates a No Smoking Policy, staff and service users who smoke must do so outside of the building. Individuals living in the home were found sitting in the communal areas and appeared relaxed in their homely environment. The home was found, warm, well lit and free from unpleasant odours. Care Homes for Older People Page 21 of 31 Evidence: We noted that there were maintenance staff adjusting the fire doors and ensuring that they were properly fitting for the safety of residents, staff and visitors to the home. One of the maintenance staff is permanently based at the home and carries out ongoing maintenance and upgrading of the home. Some areas of the home were looking tired but this did not detract from its homely feel. One of the residents spoken with as part of the inspection confirmed, when things go wrong they get put right straight away. 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 homes recruitment process demonstrates safeguards are in place and ensures staff competency with adequate numbers and skill mix along with training to protect the residents. Evidence: The home has a robust recruitment procedure to ensure that suitable staff are recruited to meet residents needs. The records of 4 recently recruited staff members through a recruitment agency contained required information to include personal details, previous employment details, two satisfactory references, Criminal Record Bureau (CRB) disclosures and United Kingdom Clearance confirmation letters. The manager told us that she has developed a checklist for recruitment to ensure that all required documentations were in the file. Registered Nurses working at the home had satisfactory checks from the Nursing and Midwifery Council. In terms of inducting new staff, the Annual Quality Assurance Assessment (AQAA) stated that all staff receive a job description and organisational hand book. The manager also stated that the homes induction programme is undertaken through a Care Homes for Older People Page 23 of 31 Evidence: training organisation called Q Training. The deputy manager confirmed that he had three months induction training when he started and received leadership training from the former Home Manager. This company also undertakes the National Vocational Qualification (NVQ) for care staff. We reviewed staff training and evidence showed that four care staff are undertaking NVQ at Level 2 and one person has achieved NVQ 2. All new staff are currently undertaking fire safety and Manual Handling training and all other staff will be receiving training updates in February 2009. All staff spoken with stated that they attended various training courses to include training on food hygiene, manual handling and fire safety. Records also show that two carers have completed a course on Continence care and the new manager attended a course on person centred planning with Age Concern on 12 December 2008. One trained staff attended training on wound care with Pharmacy Plus. The manager also told us that she had obtained an End of Life Palliative Care package to deliver to staff. The manager and the provider told us that the home has recently achieved Investors In People Award which is designed to recognise organisational achievement in relation to staff training. This is commendable. The AQAA stated that the home is looking for further ways of accessing training for example distance learning and looking further into the possibility of concepts such as team building exercises to encourage staff to work together. Staff that we spoke with confirmed that they receive regular supervision and that this has enabled them to evaluate the work that they do and to seek help in areas that they need to improve. On the day of inspection there was one trained nurse 8am to 2pm. One trained nurse from 2pm to 8pm and one trained nurse from 8pm to 8am. The home manager works full time supernumerary hours. We believe that this meets the minimum requirement that had been set by the Health Authority staffing notice before the inception of Commission for Social Care inspection. There were also five care assistants from 8am to 2pm, four care assistants from 2pm to 8pm and two care assistants from 8pm to 8am on the rota. At the home also were two cleaners, one handyman, one laundry assistant and two cooks. Care Homes for Older People Page 24 of 31 Care Homes for Older People Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is supported by the registered provider and staff to provide clear leadership at the home with all staff demonstrating understanding and awareness of their roles and responsibilities. Evidence: Anne Shilston recently took over the management of The Heathers Nursing Home after the departure of the previous manager. Anne is a Registered Nurse and holds a Bachelors Degree and a diploma in European Humanities and also has the Registered Managers Award. Anne has a certificate in Teaching and assessing in Clinical Practice and NVQ Assessor and Verifier certificate from City and Guilds. She has submitted an application to the Commission for Social Care Inspection for registration and is awaiting Fit Persons Interview. Care Homes for Older People Page 26 of 31 Evidence: Anne is well experienced in the care of older people. Although Anne is new in the post staff spoken with on the day of inspection commented positively on her ability in relation to managing a care home for older people. The manager stated that her objective is to draw up care plans for the needs of the residents using the Person Centred Plan and we were led to believe that this would be completed in the next two months. We will review this at the next inspection. The home is currently monitoring its quality of service through the monthly provider visits, relative questionnaires, staff meetings, good relationships with the local General Practitioner practice, and care plan reviews and regular minuted management meetings to ensure that the home is run in the best interest of residents. We noted that there were several books of letters of thanks kept in the hallway of the home. These remind the home of how people have appreciated the care given and provide an interest for those visiting the home. The home was awarded a Four Star rating for food safety by South Gloucestershire Council to reflect standards of hygiene in the home. This gives reassurances to those that live at The Heathers of the homes commitment to their safety. Individual residents records and home records were kept secure in the Home, and information was readily available to staff. The records seen were well maintained and organised within the Home. Other records have been referenced elsewhere in this report. The fire log book was up to date and showed that the required tests had been carried out. Generic risk assessment was in place however it was agreed that it should include the bedrooms, corridors and dining areas in order to offer adequate protection to the residents.The inspection of fire fighting equipment and fire alarm systems as well as the staff update in training in fire safety had been carried out. Fire risk assessment was carried out on 12/01/09 by a Health and Safety consultant. The Manager stated that the person will be back in February with Avon Fire Brigade to review the systems We saw recent service contracts for the lift, which showed a service, had been carried out on 12/09/08.The service records for the hoist equipment were seen, they had been serviced on 19/08/09. Care Homes for Older People Page 27 of 31 Evidence: We reviewed the residents accident records, and there was evidence that registered nurses evaluted and updated each accident and ensured that risk assessments were in place to minimise falls after the incident. We recommended that the home audit the accidents regularly to enable the manager to establish if there is a pattern and to put an action plan in place in order to offer more protection to the residents. Care Homes for Older People Page 28 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 29 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 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 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 9 It is recommended that systems are in place to allow medicines supplied in standard packs to be audited. This is so that stafff can check that they have been given correctly. Handwritten addititions to medicines administration records should be signed, dated and checked by a second person to reduce the risk of mistakes which could lead to medicines being given incorrectly. Changes to the dose of medicine to be given, agreed with the doctor, should be clearly documented on the medicines administration record sheet so that all staff are aware of the correct dose to be given. Auditing the accident records regularly would enable the manager to establish if there is a pattern and to put action plan in place to offer more protection to the residents. 2 9 3 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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