Care Home: The Homestead

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What the care home does well The home has a website which gives information about the services provided for prospective residents and their families. People are encouraged to view the home and spent time there before making a decision about residency. Robust pre admission assessments are in place to make sure that people`s needs are assessed and the home is clear that they can be met before they move in. All residents have a detailed, person centred care plan that is tailored to their individual needs and gives clear instructions and guidance to staff on how such needs will be met. Residents are seen very much as individuals and Mrs Butler and the staff are aware of equal opportunities good practice and this is very much part of the culture of the home. A professional who visits the home commented that` the care I have observed is genuinely given, heartfelt and of a very high standard`. Another professional commented that The Homestead was` a very good home`. Residents have access to relevant health and medical professionals whenever necessary and the home has effective professional working relationships which make sure that residents receive prompt and effective health care. Aids and adaptations including pressure relieving equipment are provided whenever necessary. People are treated with respect and their right to privacy and dignity an integral part of the culture and care practice at the home. The routines of the home are as flexible as possible and take into account residents choices and preferences to make sure that they have as much control as possible over their day to day routine. Residents are encouraged and supported to maintain contact with their friends and family and visitors are made welcome to the home and encouraged to visit on special occasions such as birthdays or social events. The meals served at the home are nutritious, well-balanced, home cooked and residents are very satisfied with the quality and variety of food served. Residents are offered the opportunity to make suggestions for inclusion in the menu. Policies and procedures are in place to make sure that people who live and work in the home can raise any concerns or complaints and be assured that they will be taken seriously and addressed. The Homestead provides a clean, tidy and homely environment that current residents are satisfied with and meets their expectations. Residents are encouraged to personalise their rooms to reflect their own lifestyle choices and preferences. The staffing levels at the home allow person centred care to be delivered in an unhurried way that meets the individual needs of each resident. There is a low turnover of staff which means that care provided is consistent and staff are familiar with individuals needs.The training programme at the home is extensive and ongoing and staff are encouraged to take up opportunities that will benefit their career development and skills and provide positive outcomes for residents. What has improved since the last inspection? The registered manager has improved the recruitment process in line with the requirements raised at the last inspection. A new floor has been laid in the dining room and infection control is now better maintained through the introduction of foot operated bins and the removal of communal toiletries. The owner has installed radiator covers to those radiators which required them, ones that remain uncovered have appropriate risk assessments in place. What the care home could do better: The provider needs to ensure that it improves the guidance to staff with regards to the administration of medication on a per required needs basis so that people are not put at risk from mal administration of medication. The provider needs to introduce systems to ensure that people are not put at risk from Health and Safety issues such as excessive hot water temperatures and unrestricted windows on upper floors. Whilst the risk assessments in relation to fire safety are good for residents this approach needs to be expanded to include the use of the top floor flat by the family of the owner and any visitors. Key inspection report Care homes for older people Name: Address: The Homestead 101 West Bay Road Bridport Dorset DT6 4AY     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: Susan Hale     Date: 1 9 1 0 2 0 0 9 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 27 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 27 Information about the care home Name of care home: Address: The Homestead 101 West Bay Road Bridport Dorset DT6 4AY 01308423338 01308423338 adrianbutler@hstead.eclipse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Susan Patricia Butler,Mr Adrian Charles Winslow Butler care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Homestead residential care home is registered to provide care and accommodation to a maximum of 13 older people over the age of 65 years. The home is owned and managed by Susan and Adrian Butler. The Homestead is situated halfway between the Market town of Bridport and the seaside resort of West Bay, approximately 1 mile from both places. The accommodation for residents is arranged over two floors.There is no passenger lift and therefore the home mainly accommodates people who retain sufficient mobility to manage stairs and/or manage to use the stair-lift. There are 11 single and one double bedroom. The Homestead is a pre-existing home (prior to implementation of National Minimum Standards) with 7 bedrooms providing space above 10 square metres and 5 with less than 10 square metres. There are bathing and toilet facilities on both floors and 4 single and the 1 double room have en suite toilet facilities. Communal rooms comprise a ground floor lounge and dining room. The home has a sunny and attractive sensory garden to the front, with pleasant areas to sit, Care Homes for Older People Page 4 of 27 Over 65 13 0 2 8 0 5 2 0 0 9 Brief description of the care home which is well used by residents in the warmer weather. The rear garden is steeply sloped, set to lawn with a vegetable patch, which is not used by residents due to inaccessibility. A parking area is available for visitors at the front of the house.The current fees range from 323 pounds to 500 pound. Additional charges are made for hairdressing and chiropody. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Care Homes for Older People Page 5 of 27 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: The inspection was undertaken by two inspectors over the course of one day in September 2009. This was followed up by a compliance visit on the 4 of November 2009. The focus of both inspection was to look at relevant key standards which focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good, adequate and poor. The judgment descriptors in the seven sections are given in the individual outcome groups and these are collated to give an overall rating for the quality of the service provided. We looked at four care files in detail, the staff files of two members of staff, undertook a tour of the building and looked at all the documentation relevant to the running of the care home. We spoke with the registered provider, staff and people who live at the home. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: The home has a website which gives information about the services provided for prospective residents and their families. People are encouraged to view the home and spent time there before making a decision about residency. Robust pre admission assessments are in place to make sure that peoples needs are assessed and the home is clear that they can be met before they move in. All residents have a detailed, person centred care plan that is tailored to their individual needs and gives clear instructions and guidance to staff on how such needs will be met. Residents are seen very much as individuals and Mrs Butler and the staff are aware of equal opportunities good practice and this is very much part of the culture of the home. A professional who visits the home commented that the care I have observed is genuinely given, heartfelt and of a very high standard. Another professional commented that The Homestead was a very good home. Residents have access to relevant health and medical professionals whenever necessary and the home has effective professional working relationships which make sure that residents receive prompt and effective health care. Aids and adaptations including pressure relieving equipment are provided whenever necessary. People are treated with respect and their right to privacy and dignity an integral part of the culture and care practice at the home. The routines of the home are as flexible as possible and take into account residents choices and preferences to make sure that they have as much control as possible over their day to day routine. Residents are encouraged and supported to maintain contact with their friends and family and visitors are made welcome to the home and encouraged to visit on special occasions such as birthdays or social events. The meals served at the home are nutritious, well-balanced, home cooked and residents are very satisfied with the quality and variety of food served. Residents are offered the opportunity to make suggestions for inclusion in the menu. Policies and procedures are in place to make sure that people who live and work in the home can raise any concerns or complaints and be assured that they will be taken seriously and addressed. The Homestead provides a clean, tidy and homely environment that current residents are satisfied with and meets their expectations. Residents are encouraged to personalise their rooms to reflect their own lifestyle choices and preferences. The staffing levels at the home allow person centred care to be delivered in an unhurried way that meets the individual needs of each resident. There is a low turnover of staff which means that care provided is consistent and staff are familiar with individuals needs. Care Homes for Older People Page 8 of 27 The training programme at the home is extensive and ongoing and staff are encouraged to take up opportunities that will benefit their career development and skills and provide positive outcomes for residents. 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 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 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to provide information for prospective residents and their families to enable them to make an informed decision about residency. People do not move into the home until their needs been assessed and it has been confirmed by the home that they can be met. Prospective residents are encouraged to visit the home so they can make an informed decision about residency. Evidence: The home has a web site which enables prospective residents and their families to obtain information and see photographs of the home before making an inquiry. we were informed that the home does not provide intermediate care for people. Care Homes for Older People Page 11 of 27 Evidence: We looked at the care plans of the last person to take up residence of the home since the last inspection. The documents evidenced a robust pre admission assessment undertaken before the individual moved into the home. The initial assessment was used to draw up an initial plan of care. The persons documentation also evidenced that a statement had been formerly made with regrids to the home being able to met their needs. The new resident had signed a number of the documents indicating that they had been consulted about the arrangements that were being made and confirming their agreement to them. There was evidence that the home encourages prospective residents and their families to visit The Homestead and spend time there before they make a decision about moving in. Care Homes for Older People Page 12 of 27 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 care provided is person centered, flexible and able to meet the individual needs of people who live at The Homestead. Residents have access to all the relevant health and medical professionals whenever necessary and the home has close and effective relationships with external agencies. All the necessary aids and adaptations to improve residents health or quality of life are provided whenever necessary according to need. Appropriate risk assessments are in place to support peoples health needs and also to support individuals choices and preferences. Medication practice is safe and promotes residents health and well being but one aspect needs to be improved. Residents rights to privacy and dignity are an integral part of the care practice at The Homestead. Care Homes for Older People Page 13 of 27 Evidence: We looked at four residents care plans. Care plans covered the recommended range of topics and any additional individual needs whenever necessary. They were person centered, detailed,tailored to the individual and contained clear guidance and instructions to staff on how individuals need should be met. Individuals personal and health care needs were recorded and it was clearly detailed how these will be delivered. Records showed that staff were aware of and respected peoples individuality and care plans were tailored accordingly. Care plans had been regularly reviewed and updated as necessary so that they were reflective of peoples current circumstances.Residents are involved in care planning and are asked whenever possible to sign their agreement to the way that care is delivered by staff. Appropriate risk assessments were in place in relation to nutrition, moving and handling and pressure sores and these have been regularly reviewed and updated when necessary. Additional risk assessments were in place in relation to the environment and individuals needs and circumstances. One member of staff commented that the home also involved service users families in their care as we get to know them very well as we are a small welcoming home. Another member of staff commented that they felt that the home did well in supporting service users family and friends. Residents are provided with appropriate pressure relieving equipment including mattresses and cushions and any other aids and adaptations according to need. It was clear from looking at a care records and talking to residents that they had access to district nurses, GPs, and any other health and medical professional whenever necessary. We looked at the way medication was managed in the home, the home has an efficient medication policy, procedure and practice guidance. All staff have access to this information and are clear about their role and responsibilities. All staff have completed accredited training to make sure that they have the skills and knowledge necessary. Records seen were well kept and audited regularly by the manager. It was noted that some people require medication on a Per required Needs (PRN)basis. There did not appear to be any guidance to staff for the administration of medication on this basis. This may put people at risk of mal administraion of medication. Care Homes for Older People Page 14 of 27 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 routines of the home are flexible to suit the needs and preferences of people who live in the home. Activities are provided and tailored to suit the choices of the people who live in the home. Visitors to the home are made welcome and are invited to take an active role within the home if they want to. The home offers a variety of nutritious home-cooked food that meets residents dietary needs and takes into account their likes and preferences. Evidence: People spoken to on the day of the inspection told us that they got up and went to bed at times to suit themselves and that staff were aware of their preferences. This was confirmed by observation during the visit as people were having breakfast at different times to suit their own choice. Care plans detailed the way in which individuals wished to spend their time and how staff would support them with this. Residents are encouraged to maintain contact with their families and friends. People spoken to told Care Homes for Older People Page 15 of 27 Evidence: us that their visitors are made welcome and are free to come and go at any reasonable time. The home does not employ an activities organiser and this is undertaken by all members of staff. A weekly programme of events was in place which included cards, films, exercises and television. A volunteer visits the home once a month to do art and craft work with residents. People who we spoke to at the inspection confirmed that they enjoyed living at the home and there were some things to do if you wished. The manager informed us that they make organise outings to the local beach front and nearby garden centre. The home has been awarded a five star rating from the Environmental Health department. The food is home cooked and the cook and staff are familiar with individual residents dietary needs, likes, dislikes and preferences. We saw that there was a plentiful supply of a wide range of good quality food. Mealtimes are seen as a social event and looked forward to by residents. The manager informed us that a clear policy is in place to protect mealtimes as a positive occasion for residents and that care tasks including medication administration is not undertaken at such times.They further informed us that on a residents birthday they are able to choose their favouriate meal at lunchtime and can invite their friends and family to join them. Staff were observed offering unhurried discreet assistance to residents at mealtimes. Care Homes for Older People Page 16 of 27 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. The home continues to have an open culture that allows residents to express their views and concerns. Residents felt safe and confident that if they raised any concerns they will be listened to and taken seriously. Policies and procedures for safeguarding the people who live in the home are available and give clear specific guidance to those using them. There are clear systems in place for staff to report concerns including to external agencies if necessary. Evidence: The complaints procedure has been updated as recommended at the last inspection. The people who we spoke with were clear as to who the manager was and how to make a compliant. They felt that they were listened to and felt they could raise issues.A whistle blowing policy to make staff aware of how to raise concerns if necessary was in place. Policies and procedures to protect the people living at the home are in place and the home had a copy of the locally agreed procedures. The managing physical aggression policy has been updated as recommended following the last inspection visit Care Homes for Older People Page 17 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is kept clean, tidy and free from odours and provides a homely place to live. Residents are encouraged and supported to maintain their own lifestyle and standards within the space constraints of their private room. Infection control measures have improved since the last inspection. Risk assessments need to ensure that people are not put at risk from unnecessary harm Evidence: The home was clean, tidy and free from unpleasant odours. Residents are encouraged and supported to personalise their rooms and can bring in their personal belongings within the space constraints of their rooms. We were informed that improvements had been made in the home since the last key inspection. All radiator guards throughout the home have been fitted with the exception of two rooms were a risk assessment is in place. We were also informed that a new wooden floor had been laid in the dining room and one room that had caused some concern had been refurbished. Care Homes for Older People Page 18 of 27 Evidence: Access to the home for people who need to use a wheelchair is via a side entrance. It was established that some of the owners immediate family live on the top floor. Through discussion with the owners it was established that whilst the family members rarely have visitors, if they do the visitor would enter the building via a side fire escape. Therefore there was no record of who was on the premises at any given time which may have put people at risk ie fire officers in the event of a fire. An immediate requirement was left with regards to this issue which was further discussed at the compliance visit on the 4/11/09. Following these discussion it was agreed that all visitors to the home and flat must use the front door so that all visitors are subject to the same level of controls and information in relation to visiting a care home. Infection control measures were in place and most staff have completed training. We noted that action has been taken to ensure infection control practices have been improved with the introduction of waste bins in communal bathrooms that are foot operated. Hand wash and paper towels were available in communal facilities again representing an improvement in provision. We noted that many of the windows in the upper levels of the home were unrestricted and no risk assessment was in place to ensure the safety of those who live at the premises. At the compliance visit it was established that the all windows had now been restricted. We further had concerns over a number of the hot water outlets at the home, one being on a communal bath and the other on a sink in a residents bathroom. Although there was a water temperature monitoring book in one of the bathrooms the hot water outlet did not appear to be covered by this monitoring system. An immediate requirement was left for this to be addressed. The aforementioned compliance visit established that these matters had been attended to. Several of the communal toilets and one bathroom did not have any form of heating. This had been addressed by the time we carried out the compliance visit Care Homes for Older People Page 19 of 27 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. Recruitment processes are now robust and establish peoples fitness to work at the home. All the staff who work at the home are qualified to at least NVQ level 2. Evidence: We looked at the personnel files of members of staff who had gave us cause for concern during the last inspection. The issues that had been highlighted in relation to establishing the persons fitness had been addressed and now fully evidenced what the home had done to improve . No new staff had been appointed since the last inspection. As recorded at the previous inspection all the staff are qualified to NVQ level 2 with some having achieved or currently undertaking NVQ level 3. All new staff complete the Skills for Care common induction standards and have access to a wide range of training tailored to meet in the needs of people who live in the home and individuals staff skills and knowledge. The staff we spoke with told us that they were encouraged and supported by the manager to attend training. The manager is currently undertaking training in palliative care and all staff qualified to NVQ level 3 will also do this in the near future. Care Homes for Older People Page 20 of 27 Evidence: Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to be run by a committed manager/provider who creates an open and positive atmosphere which supports good care practices for residents. The home regularly reviews its performance through quality assurance systems which include people who live and have contact with the service and the home is run in the residents best interests. Health and safety is taken seriously but improvements in management systems to ensure people are safe need to be made. Evidence: The home is managed by the registered provider supported by a consistent staff team. The manager has many years experience in the care sector and has achieved the registered managers award and regularly undertakes training to update her knowledge. Recent training includes palliative care, dementia, and diabetes. Care Homes for Older People Page 22 of 27 Evidence: Whilst there is a range of quality assurance audits in relation to the service provision health and safety of parts of the environment did not feature on the audits at the time of the inspection. For this reason the outcome rating in this section is adequate as we identified areas of serious concern as detailed in this report ( hot water temperatures, lack of window restrictors on the first floor windows or risk assessments covering these areas) Residents meetings are held and minutes taken. We were shown the minutes of a meeting held in January 2009. Residents were advised of the forthcoming visit from the donkey sanctuary and a musician, both in January. People were asked to put forward any suggestions for food they would like to to see included on the menu and these were recorded and passed on to the cook. It was clear from the minutes that residents are consulted about any changes planned such as the replacement of the dining room carpet and their views sought and taken into account. The home does not manage personal finances for any of the residents, this is undertaken by their families or a solicitor if necessary. An accident book continues to be in use and had been correctly completed and entries cross checked with care plans were all found to be correct. Record showed that appropriate action had been taken when accidents have occurred. A very good falls audit was in place to identify risk areas in times and to develop very clear strategies to reduce the risk to individuals. Whilst the fire safety analysis was good and demonstrated that each individual had a risk assessment the use of the top floor flat by members of the providers immediate family was not included. Furthermore the fire risk assessment for the top flat did not consider visitors to the home. As mentioned earlier agreement was reached at the compliance visit regarding the use of this area in the future. Care Homes for Older People Page 23 of 27 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 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 38 13 The provider must ensure that risk assessments are in place for all unrestricted windows To prevent the possibility of harm to people who live at the home. 08/12/2009 2 38 13 The provider must ensure 08/12/2009 that fire risk assessments are in place for all parts and usage of the building To prevent the possibility of harm to those who live , work and visit the home. 3 38 13 The provider must ensure that all hot water outlets available to the people who live at the home do not exceed 43 degrees Centigrade To prevent the risk of scolding 08/12/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The manager must ensure 16/12/2009 that there is clear guidance to staff with regards the safe administration of medication Care Homes for Older People Page 25 of 27 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 on a per required needs basis. To ensure people who live at the home are not put at risk form the mal administration of medication. 2 25 23 The provider must ensure that communal toilet and bathing facilities are adequately heated For the comfort and wellbeing of those who live at the home 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 15/12/2009 Care Homes for Older People Page 26 of 27 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. Copyright © (2009) Care Quality Commission (CQC). 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