Care Home: The Keepings

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What the care home does well This home provides a comfortable and clean environment. It is spacious with well kept gardens. People told us they like their home. Staff presented as caring and responsive and people told us the staff members are helpful and nice. What the care home could do better: There is a need to improve record keeping and ensure records are updated. People at risk of falls must have a risk assessment to identify how this will be minimized. Some risk assessments require further details such as the equipment used to support people and the numbers of staff. There needs to be more robust management and analysis of accident and incidents to ensure these are notified and reduced. Safeguarding issues must be referred to the Local Authority safeguarding unit. We identified that there are some gaps in mandatory and specialist training that need to be planned for. A review of staffing ratios and dependency levels is needed to ensure there are adequate numbers of staff to meet assessed needs. There needs to be effective management time to oversee the running of the home and ensure care practices are monitored improved to ensure the well being of everyone living in the home. Random inspection report Care homes for older people Name: Address: The Keepings 12 Priory Road Dudley West Midlands DY1 4AD two star good service 23/01/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Monica Heaselgrave Date: 2 1 0 6 2 0 1 0 Information about the care home Name of care home: Address: The Keepings 12 Priory Road Dudley West Midlands DY1 4AD 01384253560 01384214726 gordonnuttall@tiscali.co.uk gordannuttall@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Gordon Nuttall Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 23 Number of places (if applicable): Under 65 Over 65 23 old age, not falling within any other category Conditions of registration: 0 One service user identified in the variation report dated 6 September 2004 may be accommodated at the home in the category DE(E). This will remain until such time that the service users placement is terminated. Date of last inspection Brief description of the care home The Keepings is a large converted and extended domestic property located within easy reach by foot of Dudley Town centre, and therefore close to all public amenities. There is car parking to the front of the property and on the main road. To the rear there is a large garden which is well established with a variety of plants and a large patio area with a number of tables and chairs available. The home has 19 single and 2 shared rooms. Residents accommodation is on two floors, the upper floor accessed by a stair Care Homes for Older People Page 2 of 20 2 3 0 1 2 0 0 9 Brief description of the care home lift. The bedrooms are individually decorated and reflect peoples tastes and personalities. Residents can bring in their own furniture if they wish dependent on space requirements and following discussion with the provider. The home has a number of bathrooms with assisted bathing facilities on each floor. There is a large lounge with a conservatory. The dining area is situated on the ground floor. Communal areas are decorated and furnished to a high standard. Care Homes for Older People Page 3 of 20 What we found: We the Care quality Commission undertook this random inspection visit on 21st June 2010. The last key inspection to this service took place on 23rd January 2009. No requirements were made as a result of that visit. The reason for this inspection was to assess the safety and well being of people living at the home. This is because we received some notifications of incidents where safeguarding referrals have been made. This random inspection was unannounced which meant the home was not given notice of our visit. An inspector and pharmacist inspector spent a day at the home from 10:00 to 16:45. There were 23 people living there. We looked at care files for four people living in the home. We completed a partial tour of the building and observed staff performing their duties. We also reviewed the medication system and staffing rotas and the staff training matrix. We looked at the systems for notifying us of concerns and incidents. We looked at staffing and management arrangements. We talked with people living at the home as well as the care staff and the owner. Management and staff assisted us to complete our inspection and we were made to feel welcome. Health and Personal Care We looked at the care files four people who live at the home. The care plans provided staff with sufficient information about how they should assist people to meet their individual needs in a way that they prefer. We found care plans reflected some good personal information that is important to the individual. For instance one told us that self image was of particular importance to the individual who liked to look smart. It was positive to see that the plan is responsive to the individual need and preference. A second care plan showed that the service has considered the independence and abilities of the individual by for instance stating what the person can do for themselves. We saw that the care plan informs staff that the individual can choose their own clothes and likes to wear jewellery. The care plans we sampled had information of the persons needs in relation to their health care needs and specific areas of risk. This included where people were at risk from pressure sores or falls. We also saw that care plans included moving and handling guidance needed to support the individual. We spoke to care staff about the specific needs of some of the people and they were able to give a verbal profile of the area of need and how this was being met. We looked at the accident and incident records as well as the daily records. We found that whilst there is health care information in the care plan we saw that there are some gaps where staff has not updated the care plan when needs had changed. For instance we saw that one person had a change in behaviour that led to wandering during the night. The daily records described this behaviour as aggressive and the person had wandered outside of the building. We were told that the G.P. had prescribed medication for this person. We saw that the person was receiving this medication. However the care plan which had recently been reviewed by the staff and social worker did not have any reference to this behaviour or the incidents that had occurred. There was no risk assessment to show the person was at risk in this area and how staff should manage this. We also checked the notifications file and found that the service had not informed us of this incident and a second incident where staff had been assaulted. Care Homes for Older People Page 4 of 20 We saw that care files reflected that people had access to appropriate health care professionals as their needs required. However some improvement is needed to make sure all staff is recording information in the separate records available. For instance there was no written record of the G.P visit in the care notes when the individual was prescribed medication for behaviour. However there was a recent entry of the G.P visiting for other reasons. Staff told us that when they phone the G.P with concerns this is recorded in the communication book. We checked in the communication book and found no entry of the call. From the information available the individual was receiving the required medication so we could not clearly state there are poor outcomes in this area for people. At the start of the visit just after 10 a.m. we observed a lady sitting at the dining table scratching and rubbing her hands. She looked agitated and distressed. We asked her what was the matter and she showed us her hands which had a very red and sore looking rash between the fingers and on the palms and back of the hands. The rash had travelled up both arms. We spoke with the deputy who said she noticed this at breakfast at 8a.m. and had tried to phone the G.P. to book an appointment. We looked in the communication book and the daily records to see how staff recorded and followed up health care concerns. There was no entry recorded in these records. The only entry was at 8a.m. when the night staff had made their recordings and these did not include any comments relating to a rash. We spoke to the deputy again who said she had been trying to get the G.P. but the line was busy. She told us she had not recorded her efforts to obtain the G.P. We saw later in the morning that this information was put in the daily records but not in the communication book. At this time the Acting Care Manager had not been made aware that the staff had concerns about the lady. We asked the deputy if there is a night care plan for this lady and were told this was in her care plan. However staff was unable to find the care plan. There was a pile of records on the table which staff looked through to no avail. The management staff told us that sometimes staff read records but fail to replace them. We noted that staff is very busy assisting people but there were several examples of information not being recorded. When information is not recorded this compromises communicating to all staff that needs had changed. There is a need for some improvement in recording to make sure all staff are recording and updating in the separate records available. We discussed this with the acting manager who acknowledged our concerns. We shall continue to monitor staff recordings as part of our regulatory activity to ensure positive outcomes for people being cared for. We noted that no notification had been sent to CQC regarding the incidents of behavior where this person left the building. We also noted that this incident had not been reported under the safeguarding procedures as it should have been to ensure the person is not at risk of harm. One care plan identified the person to be at risk of falls. We looked at the accident book and saw that this person had fallen on two occasions in the last few months. We checked the notifications file and found that the service had not informed us of these falls. Care Homes for Older People Page 5 of 20 During the course of our visit we observed this individual who was walking from the conservatory to the rear garden. He was using his zimmer frame for support and we noted that care staff came to support him further. However we observed that his footwear was poorly fitted with one foot barely in the slipper causing him to walk on the side of the slipper. This was a visually obvious risk but had not been noted by the staff. We shared this observation with the acting care manager so that immediate steps could be taken to ensure safer footwear. We checked the care plan and saw that footwear was not included in the risk assessment for falls. We advised that a risk assessment needs to be in place so that the risk of falling can be minimized. We shall continue to monitor staff recordings as part of our regulatory activity to ensure positive outcomes for people being cared for. We saw in the accident book that another person had a fall. On the back of the accident form staff had recorded that the paramedics had been called out. They examined the person and found no injuries but diagnosed low blood pressure. We spoke to the acting care manager to see how the home had followed up this incident. We found that no follow up had been made with the G.P to check the blood pressure. This is worrying as this could be the cause of the fall and could remain a continuing risk to the individual. We also found that no notification had been made to CQC about the fall. We told the acting manager to contact the G.P. for a blood pressure check and rule this out as a possible risk of falling. We looked at how those people who are unable to mobilise independently are supported. One of the sampled care plans we saw did not reflect what staff had told us. We were told that this person needed a hoist to transfer them from one area to another. We looked at the manual handling assessment dated 20.4.10 but this did not state the hoist used or the numbers of staff needed to carry out safe transfers. Whilst staff were able to tell us how they transferred the person this must be recorded in their manual handling risk assessment so that all staff have up to date accurate guidance on the safest manner to carry out this task. We advised that manual handling risk assessments need to be updated to reflect the actual support needed and the equipment used. This will ensure that the management of risk is positive in addressing safety issues. We looked at the training matrix and saw that four staff had completed manual handling training. Two of these staff is from the management team and two from the care staff team. All staff must undertake training in this area to ensure they have the skills to support people safely. We shall be continuing to monitor risk assessments and the staff training as part of our regulatory activity. We saw from the sampled care files that one person had been identified as at risk of losing weight. We looked at the weight records and saw that regular weight checks had been carried out. It was positive that the weight of this person showed a steady weight gain. We noted that nutritional screening had been undertaken and assessments for tissue viability to ensure the person was not at risk of developing pressure sores. The practice in this area reflected that these needs had been assessed and followed up accordingly. However the staff training matrix did not reflect that training in either tissue viability or nutritional screening had taken place. We did note that there has been several changes to the staff team therefore staff competencies in this area should be monitored so that all staff has the skills to manage this aspect of health care and the health and wellbeing of people are not placed at risk. We observed that some people have dementia. Staff was able to describe how this affects the individual and how they support them. We Care Homes for Older People Page 6 of 20 looked at the training matrix to see how staff is supported in their role. We saw that six staff has had dementia awareness training. These six included the acting manager the deputy and three seniors. Not all of the care staff has had training in this area. As there have been changes to the staff team the service should now work towards updating staff team knowledge and skills in relation to meeting and understanding specific needs. One person has been identified with specific needs in relation to mental health. We did not see that staff had training to support them in understanding these specific needs. Pharmacist Report Summary The pharmacist inspector visited the home on 21st June 2010 to check compliance of the six requirements regarding the safe handling of medicines left at the last inspection on 14th April 2010. We looked at medication storage, some care records and medication administration records. We spoke to one member of staff and the Acting Manager. We found that there had been some improvements in the handling and control of medicines, however there continued to be some areas that had not been met to ensure people were safe from harm. Four of the six requirements left at the last inspection regarding the safe handling of medicines had been met. This means that two requirements had not been met and increased the risk of harm to people. The Acting manager told us that all trained staff had received training and an update on the safe handling of medicines from their supplying Pharmacy immediately following our last inspection on 14th April 2010.This was to ensure all trained staff were kept up to date with safe practice. We saw that the available storage for medication was safe and secure. We saw a locked cupboard and medicine trolley and a locked refrigerator used to store peoples medicines. This means that there was an improvement in the security of peoples medicines and the requirement was met. The controlled drug (CD) cabinet did not meet the legal requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. However we were informed by the Acting Manager that the home did not store any controlled drugs but a new CD cabinet was on order from the pharmacy. We saw medicines administered to people and recorded following safe practice. We saw that medicine records were recorded after each individual administration, which was an improvement since we last visited the home on 14th April 2010. We looked at the Medicine Administration record (MAR) charts, which were printed by the pharmacy and found that staff signatures were recorded for the administration of medicines or a reason was recorded if medication was not given. We looked at five peoples MAR charts and overall found that the records accurately documented what medicine had been given to a person or a record was made to explain why it had not been given. For example, one person was prescribed three different tablets. One of the tablets was prescribed to be given as one or two tablets to be given four times a day when required. We saw that staff were documenting the amount actually given and that there was a written protocol available to support staff to know when to give the tablets. We checked the amount remaining against the documented records and found that the Care Homes for Older People Page 7 of 20 records were accurate and up to date. We checked the administration of the other two prescribed tablets and found that our check matched the records and the amount of tablets given. This means that the records showed that the person had been given their prescribed medicines as prescribed. We saw that three people were prescribed medicines to help calm and control behaviour and to reduce anxiety. These medicines were prescribed to be given when required or when it was necessary. We found that there was no information available in their care plans to help support and inform staff when to give these medicines. For example, one person was prescribed a medicine to be given as 2.5ml to 5ml at night when required. We looked at the MAR chart and saw that it had been signed as given regularly every night, however staff had not recorded the amount actually given. We looked in the persons daily records and there was no documented record to explain why the medicine had been given. We spoke to a member of staff who was able to give a reason why the medicine had been given, however this had not been recorded. We were concerned that the personal care plan were not person centered or specific to their individual needs and a medicine was being given regularly with no reason documented to explain why it was necessary. We gave full feedback to the Acting Manager. We explained that there were improvements however we identified shortfalls in this random inspection. We issued an immediate requirement to ensure that people were given their prescribed medicines correctly. Following our visit to this service we received a response from the provider telling us that protocols have been put in care plans so that all staff understand when and how people should receive their as required medication. We have been told that care plans now contain additional information in regards to what the medication is and the side effects. To ensure that medication records are accurately maintained and record exactly what has been given all medication trained staff have been informed to use the correct codes and document all actions on the reverse of the MARR sheet to explain the actions taken. Competency Tests for all the Medication Trained Staff have been arranged and a meeting has taken place with staff to re enforce procedures. This will ensure safer medication practices within the home. Safeguarding and Notifications. Information received from a recent safeguarding indicated that the service was not notifying the commission of accidents or incidents that affect the safety and wellbeing of people living in the home. During our visit we looked at records in the home to see how the service was managing notifications and identify if the home is clear when an incident needs to be referred to the Local Authority as part of the local safeguarding procedures. There is evidence of a number of accidents and incidents that have not been notified. The accident book was looked at and we saw that a number of recent accidents had occurred which we should have been notified about. For instance one person had fallen out of bed. One person had a fall whilst trying to sit into a wheelchair. This same person had a second fall. One person fell and the paramedics were called. We looked at the accident book for 2009 and saw someone had received an injury to their eyebrow through falling and hitting the bedside table. This same person had a Care Homes for Older People Page 8 of 20 second fall resulting in an injury to the side of his head and the paramedics were called. A lady was found on the floor with bruising to the left side of her face. Some of these accidents had no record of treatment or outcome recorded. None of them had been notified as per statutory reporting requirements. We asked why these had not been reported. The acting care manager told us she thought that notifications had to be made for deaths. We did see that a number of notifications had been made which related to people who had died. We also saw that some notifications had been made relating to injuries received through falls or being hit by another person living in the home. From this information we could see that the reporting of accidents was inconsistent and that there is a lack of understanding of regulations. In summary accidents are being recorded in the accident book but are not consistently notified as per statutory reporting requirements. We consider that Regulation 37 has not been consistently complied with. We discussed with the acting manager the importance of notifying us of accidents and other events that affect the welfare of the people being cared for. A requirement is made under regulation 37 for the service to notify us of all accidents or incident that affects the welfare of the people being cared for to ensure people are effectively safeguarded. Since our visit to the service we received notification of an infectious disease. We consider that the service is working towards compliance but we will continue to monitor compliance as part of our regulatory activity. We saw from daily recordings that there had been a serious incident where a vulnerable person had left the building. The records showed that this person attempted to leave the building through the fire door at 2 a.m. setting off the fire door alarm. The incident escalated at 5a.m. and resulted in the night staff being locked out through the door slamming behind them. The person was described as agitated and aggressive hitting out at the staff. The police were involved. This incident had not been notified to us or referred to the Local Authority as part of the local safeguarding procedures. We talked to the acting manager about this incident. She was not able to offer an explanation as to why this had not been reported. We cannot be sure the service knows when an incident needs to be referred to the Local Authority as part of the safeguarding procedures. To ensure people are effectively safeguarded a requirement is made under regulation 13. Effective systems must be implemented to ensure all safeguarding issues are referred to the Local Authority safeguarding unit. This will ensure any incidents are effectively managed and people are protected. The training matrix showed that staff has not had training to enable them to work safely when managing behaviours and managing the situation of being locked out of the building. There needs to be more robust management and analysis of accident and incidents to ensure these are notified and reduced. The knowledge and competence of the acting manager and the senior team members needs further development to ensure their understanding of current legislation and ability to apply it to their practice in this area. Environment We had information that standards of infection control and cleanliness within the home had deteriorated and that the stair lift was regularly not working. We viewed the communal areas and bathrooms and some of the bedrooms. We found all areas clean and well maintained. There were no unpleasant odours. We looked at the bed sheets and bed Care Homes for Older People Page 9 of 20 clothes and found these were clean and fresh. We looked into some of the wardrobes and chest of drawers and saw that clothes had been laundered and put away tidily. We spoke with care staff and management about the laundry and were told that care staff does the laundry on every shift. We noted that this impinges on care staff providing direct care and should therefore be reviewed with a view to have either extra care staff or a laundry dedicated staff. We talked to care staff and management members of the team about the cleaning arrangements. We were told a cleaner is employed five days a week but not at the weekends. This means that care staff also has to undertake these tasks at the weekend which compromises their time to provide direct care. We saw that in one bedroom the headboard was not fitted to the bed and this needs to be rectified. We saw that two of the divan bed bases had old staining to the outside this is an infection control risk and steps must be taken to ensure beds are cleaned or replaced to ensure acceptable infection control procedures are maintained. We were told that one person needs the hoist to safely transfer to bed but that it was difficult for staff to get the hoist under the divan bed. This needs to be risk assessed and if necessary an alternative bed purchased. We saw from the accident book that one lady had a fall from her bed. We saw that this is a divan bed. We asked staff if the divan bed is an appropriate height for the lady but there was no risk assessment or analysis of the accident to inform if the bed was appropriate. This is needed to ensure risk assessments identify clearly the support and equipment needed to keep the person safe. We viewed the toilets which were clean and odour free. There were no privacy locks which need to be provided to promote privacy and dignity. We noted that cleaning chemicals were appropriately secured and that there were no trips or falls hazards around the building. We saw that some remedial improvements had been carried out such as replacing kitchen worktops and backing. Hand basins had new sealant around them and the ceiling had been repainted. The back door had been replaced improving security. Fridge 4 and Freezer B looked corroded and rusted to the front and replacements should be considered to ensure food safety standards and hygiene. We noted that the small boiler room needs to be boxed in where the boiler was removed and we were told plans are in place to do this. The stair lift was observed to be working on the day we visited. We discussed the concern that this was regularly out of order. We saw the maintenance records for this which showed that there had been regular faults which had been reported to the contractor and repaired. We saw that these had been reported in a timely manner. The home looked clean and comfortable and provides a pleasant environment for the people who live there. However there are some minor works to be addressed as reported. More significantly there is a need to review the current arrangements for cleaning and laundry tasks to ensure that there is sufficient care staff available for direct care. We looked at the training matrix and saw that the majority of staff has completed infection control training. We also noted that care staff is involved in the handling and preparation of the tea. The training matrix shows that only one staff has current food hygiene training. All staff who handles food must have the training to ensure food safety standards. Care Homes for Older People Page 10 of 20 Staffing. Concerns had been expressed that there were inadequate numbers of staff who lacked the skill in meeting assessed needs. There has been a turnover of staff since our last inspection visit in January 2009. At that time the majority of the staff team had also completed mandatory training equipping them with the skills to undertake their care role responsibilities. At this visit we were told that several staff had left the home and new staff had been recruited. We saw the training matrix that showed the majority of staff has completed NVQ level two training which ensures they have competency and understanding of relevant areas of their role. As already stated in this report we identified that there are some gaps in mandatory and specialist training that is relevant to the service provision. We also noted that in addition not everyone had up to date fire safety training or training in managing behaviour that challenges. The service must ensure that a review of the staff team training needs is undertaken. A requirement is made to ensure all staff receives mandatory training. This will ensure that staff has the skills and competencies to meet the welfare of the people they support. We found that there was no evidence that staffing numbers were based on dependency levels. Staffing rotas must take into account the assessed needs of the people. Staff were able however to provide a verbal profile of the needs of the people. This indicated some people needed a higher level of support which can impinge on the availability of staff to others. Care staff also undertakes cleaning and laundry tasks and the preparation of tea. This further reduces their availability. We saw that in one recent review a relative commented that there is not enough staff on shifts and that staff are overworked. We asked if these comments had been acted upon but saw no evidence of responding to the issues raised. This indicates either the service does not recognise the concern or does not take the views of people seriously with a view to improving the outcomes and quality of life of the people they support. We cannot therefore be sure that there are adequate numbers of staff to meet the needs of the people. We saw that staff are very busy and sometimes forget to update the records with important information. These factors indicate that staffing levels may not meet the needs of the people and their health and welfare could be adversely affected. A requirement is made to review staffing ratios and dependency levels. Management. An acting manager takes day to day responsibility of the home. She told us she has ten years experience of care work some of this time as a senior at a previous home. She has worked at The Keepings for four years. Following a few months in the deputy position she became acting manager which she has continued since December 2008. She has just completed NVQ level 4 in management and has had periodic training to update her knowledge and skills. The acting care manager is not registered with us. There has been no active attempt to register a manager for over a year. We have not received an application to register the Care Homes for Older People Page 11 of 20 acting care manager. The acting manager stated it is her intention to discuss this with the owner. The acting manager is supported by a team of senior care staff and a deputy. We saw no evidence of senior or management meetings to indicate how management tasks are prioritised. We saw that the acting manager works on shift alongside care staff. We observed that she is committed to making improvements and recognises where the shortfalls are. We saw she has very little time to undertake the required management tasks to ensure the improvement and development of systems. This report identifies there needs to be more robust monitoring of the care practice and compliance with policies and procedures. Shortfalls were identified in record keeping and risk assessments required further development. There needs to be more robust management and analysis of accident and incidents to ensure these are notified and reduced. Safeguarding issues must be referred to the Local Authority safeguarding unit. We identified that there are some gaps in mandatory and specialist training that is relevant to the service provision. We cannot be sure that there are adequate numbers of staff to meet the needs of the people. A review of staffing ratios and dependency levels is needed. It is recommended that a review of all areas is undertaken and positive action taken with appropriate support for the acting manager to ensure effective systems are developed and put in place to ensure the well being of everyone living in the home. What the care home does well: What they could do better: There is a need to improve record keeping and ensure records are updated. People at risk of falls must have a risk assessment to identify how this will be minimized. Some risk assessments require further details such as the equipment used to support people and the numbers of staff. There needs to be more robust management and analysis of accident and incidents to ensure these are notified and reduced. Safeguarding issues must be referred to the Local Authority safeguarding unit. We identified that there are some gaps in mandatory and specialist training that need to be planned for. A review of staffing ratios and dependency levels is needed to ensure there are adequate numbers of staff to meet assessed needs. There needs to be effective management time to oversee the running of the home and ensure care practices are monitored improved to ensure the well being of everyone living in the home. Care Homes for Older People Page 12 of 20 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 2. Care Homes for Older People Page 13 of 20 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 The service must make 28/05/2010 arrangements to ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines, including the reasons to give medicines when required and what constitutes needed for the named person. This is to ensure that there are clear directions for care staff to give medicines prescribed when required and to ensure the care plans are kept up to date with healthcare information. 2 9 13 The service must make 28/05/2010 arrangements to ensure that medication administration records are accurately maintained. The reasons for non-administration of medication are recorded by the timely entry of an appropriate code or entry on the medication administration record; that the meaning of any such codes are clearly explained on each record; and that the person administering the Page 14 of 20 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action medication completes the medication administration record in respect of each individual person at the time of administration. This is to ensure that the care service maintains accurate records of medicines administered to people including reasons for non administration of prescribed medicines. Care Homes for Older People Page 15 of 20 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 A review of individual risk 20/08/2010 assessments for each person must be undertaken to ensure they accurately reflect the risks and outline the steps to minimise the risk. This will ensure appropriate action is taken to reduce risks and protect people from harm. 2 18 13 Effective systems must be implemented to ensure all safeguarding issues are referred to the Local Authority safeguarding unit. This is to ensure people are effectively safeguarded from harm. 20/08/2010 3 27 18 A review of the number and 20/08/2010 deployment of staff should be undertaken and appropriate action taken to ensure there are sufficient staff on duty at all times to meet the needs of the people living in the home. Page 16 of 20 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 is to ensure that staffing levels are appropriate to the assessed needs of the people cared for. 4 30 18 Ensure all staff receive 06/09/2010 mandatory training. Develop an effective training plan with proposals to address the gaps in mandatory training. This will ensure that staff has the necessary skills and competences to meet the assessed needs of the people being cared for. 5 30 23 All staff should receive 06/09/2010 updated training in respect of fire prevention to ensure staff skills remain up to date and that they have knowledge of current good practice. This is to ensure people are protected in the event of a fire. 6 31 8 The proprietor must ensure a 06/10/2010 manager is registered with the Commission. This is to ensure effective leadership and management systems are implemented in the home to safeguard people. 7 38 37 Any accident or event that adversely affects the well being or safety of people 20/08/2010 Care Homes for Older People Page 17 of 20 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 must be appropriately notified to the Commission. This is to ensure the safety and protection of people. 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 7 Daily records and other records relating to the care of individuals should be consistently updated to reflect the care provided and follow up of any concerns relating to the individual. Care plans must include all areas of need and outline in detail the action required by staff to meet peoples needs effectively. These must be updated as needs change. Review manual handling risk assessments to ensure they include the numbers of staff needed to provide safe support and the name of the specific equipment used. There should be a system for reviewing recording and dealing with all informal complaints or concerns with a view to continual improvement. This includes comments made in reviews. Re fit headboards to beds. The boiler room requires plaster work. Divan bed bases need to be hygienically cleaned or replaced due to staining. Consider the replacement of fridge 4 and freezer B due to external corrosion. People should be provided with privacy locks on bathroom and toilet doors. Review the current domestic and laundry support to the home. Staff should be provided with training specific to meeting the assessed needs of the people they care for. This includes dementia care and mental health. Staff should Page 18 of 20 2 7 3 8 4 16 5 19 6 7 8 19 27 30 Care Homes for Older People 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 have training opportunities in managing behaviour that challenges and tissue viability. 9 10 32 33 Regular Management meetings should be implemented to ensure improved communication and direction. It is recommended regular visits are undertaken by the proprietor or their representative to assess the quality and standards of the home. A report should be written following visits and made available in the home for inspection. Implement analysis of accidents and incidents to ensure people are protected from avoidable harm. Ensure follow up action is taken such as referral to health care for blood pressure. 11 38 Care Homes for Older People Page 19 of 20 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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