Care Home: The Limes

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What the care home does well The Limes offers residents a comfortable, homely, safe, and well maintained home environment. Residents have access to any equipment that is needed to support their mobility and promote independence. Residents have the opportunity to go on trips outside of the home, in the home`s mini-bus. Comments from residents and visitors confirmed this and one resident told us "I am very happy here, all the staff are helpful and kind". A visitor told us "I find the home a happy environment, staff and residents always seem happy". What has improved since the last inspection? The home has an ongoing programme for improvement and refurbishment. Since the last inspection the new dining room/conservatory has been completed and the garden has been landscaped to provide seating areas for residents. One of the bathrooms has been fitted with an assisted bath and ceiling hoist and a shower room fitted. The home are currently in the process of relocating the kitchen nearer to the dining room. What the care home could do better: The home must ensure that regular inspections of the service and quality of care provided, are carried out. This is a regulatory requirement (Regulation 26 of the Care Homes Regulations 2001). This would also ensure that the service demonstrates; what they do well, what they could do better, and where improvements are being made. Regular inspections of the service would have picked up issues for improvement that have been identified in this inspection of the home and where the home is not meeting regulatory requirements: The home must ensure that any risks to residents are assessed and managed with clear guidance for care staff on how risks or events are to be managed. Where it has been identified that bed rails need to be used, the risk must be assessed, reviewed and agreed with all parties, in line with current best practice guidance. Medication must be securely stored at all times. The storage of controlled drugs must meet the amended regulatory requirements for care homes. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Limes The Limes 43 Foreland Road Bembridge Isle of Wight PO35 5XN     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: Annie Kentfield     Date: 2 4 1 1 2 0 0 8 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 30 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 30 Information about the care home Name of care home: Address: The Limes 43 Foreland Road The Limes Bembridge Isle of Wight PO35 5XN 01983873655 01983874170 the.limes@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Susan Jennifer Betteridge,Mrs Alison Neve-Dewen Name of registered manager (if applicable) Mrs Lynne June Preston Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 38 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Physical disability - PD Date of last inspection Brief description of the care home The Limes is a period building that has been converted and extended to provide personal care for older people. The home is located in an attractive residential area of Bembridge. There is some off road parking for visitors or on road parking to the front Care Homes for Older People Page 4 of 30 care home 32 Over 65 0 32 0 32 0 32 Brief description of the care home of the building. The accommodation offers a range of mostly single rooms on 3 floors, all with en-suite facilities. The building is accessible and there is a passenger lift to access the upper floors with a mezzanine area that is accessible by stairs. Residents have access to a range of communal rooms including a large and atractive dining room/conservatory. There is a private garden area and access to outside seating. The weekly fees vary according to the room occupied and the level of care provided. There are additional charges for chiropody, hairdressing and toiletries. Care Homes for Older People Page 5 of 30 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: We made an unannounced visit to the home on 24 November 2008. This was with one inspector (Annie Kentfield) and the visit lasted for 7 hours. Before the visit we sent surveys to 10 residents, 10 staff and 3 health and social care professionals. We received completed surveys from 9 residents, 6 staff and 2 health care professionals who visit the home. We also received the annual quality assurance assessment (AQAA) from the registered manager. This is a self assessment that all services complete and gives us information on what the service does well and where they plan to make improvements. The AQAA also gives us some numerical and statistical information. During the visit we spoke to some of the residents in the privacy of their own rooms and in the communal areas. We spoke to the registered manager, deputy manager and Care Homes for Older People Page 6 of 30 the responsible person for the home, and looked at a range of records in the home, including care plans, medication records, staff training and recruitment records and some of the health and safety records. 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 30 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 30 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. Residents can be confident that the home will have made an assessment of their care and support needs before moving in. Residents are provided with information about the home and the services provided. Evidence: The home has a printed brochure about The Limes with photographs of the home and a map of the location. The brochure states that residents are encouraged to visit the home or stay for a trial period before making the decision to move into the home. When we spoke to some of the residents they confirmed that they had been able to visit the home before moving in, other residents told us that they had been helped to choose the care home by friends and relatives. Residents are encouraged to bring their own items of furniture and personal possessions to make their bedroom homely and personal and this was confirmed when Care Homes for Older People Page 10 of 30 Evidence: we spoke to some of the residents in the privacy of their own rooms. Residents are provided with a detailed service user guide and there is a copy in each bedroom. This provides residents with details about what services and facilities the home provides. The manager told us that the home is aware of residents individual communication needs and would provide the service user guide in other languages or formats if this was requested. The service user guide outlines the process for assessing the care and support needs of prospective residents to ensure that The Limes is able to provide suitable care and support for new residents. We looked at the assessment for a resident who had moved into The Limes very recently. The home has a system that gathers basic information about care needs and when a resident decides to stay in the home, a more detailed assessment is completed including personal and health care needs, social and psychological care needs, and a brief life history. This ensures that care staff have clear information and guidance on how residents care needs must be met. The service user guide states that in the case of emergency admissions to the home we will take the care manager or relatives assessment of care needs and carry out a more detailed assessment ourselves to see whether the home is suitable. Care Homes for Older People Page 11 of 30 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. Each resident has an individual plan of care and residents have their health and personal care needs met. The service must ensure that where risks to residents have been identified, these are clearly recorded with a plan of how the risk or event is to managed or minimised. The home has a medication policy and procedures for ensuring that residents receive their medication, as prescribed. This must be reviewed to ensure that medication practice in the home meets current good practice guidelines and regulatory requirements with regard to the storage of controlled drugs. Residents medication must be securely stored at all times. Evidence: Every resident has an individual plan of care that records how care is to be provided. The home uses a printed template system - standex. Residents are able to register with a GP of their choice. There is a weekly GP visit to the home for a general surgery Care Homes for Older People Page 12 of 30 Evidence: and residents are also able to access a GP at other times as required. Care plans provide evidence that residents have access to other health care services such as the community nurses, chiropodist, dentist, and hospital out patient appointments. Whilst we were in the home, staff were arranging a dentist appointment, at the request of a resident, who was experiencing some difficulties with dentures. We received surveys from two health care professionals who visit the home who confirmed that the staff always seek advice and act upon it to manage and improve individuals health care needs. We looked at the care records for three people. The home has a system of reviewing care records daily or three monthly when any changes to care needs are recorded. However, in one care plan, parts of the care record were not up to date (bowel charts) and in another care plan, the risk assessment and management plan had not been reviewed to reflect changes in identified risks to that resident, and how this was to be managed, eg, how the risk of not taking prescribed medication would be managed. In another care plan, the records showed that the risks of using bed rails had been discussed and recorded in a general way. However, the risk and management of that risk must be clearly recorded, regularly reviewed and demonstrate that the risk management plan includes a health and safety risk assessment and review - in line with good practice guidance on the use of bed rails as a restraint. The home does not regularly record weight checks for each resident. However, the home has recently purchased sit on weighing scales and this will support those residents who are not able to stand on the scales. The manager told us that where the care plan identifies the need to monitor weight, weight records will be maintained. We looked at the procedures for storing, dispensing and recording residents medication. Most of the daily medication is stored in a locked trolley, however, the trolley was not locked to the wall. The manager confirmed by telephone the following week, that a lock had been fitted and the medication trolley is secure. The regulations covering the storage of controlled drugs in care homes have been amended and the storage in the home did not meet the requirements of the amended legislation. Following the inspection, he manager has confirmed that the home has installed appropriate storage to meet the regulatory requirements with regard to controlled drugs. Care staff who dispense medication have received training in the safe administration of medication. We observed medication practice at lunchtime and staff dispensed medicines to residents and signed the medication administration record as each medicine was given. The AQAA told us that the home have introduced a new medication system and have reviewed the systems for recording medication that is prescribed to be given as and when needed. The manager told us that she will be requesting and working with GPs to review all medication, in line with good practice Care Homes for Older People Page 13 of 30 Evidence: recommendations. The manager and deputy manager told us that the care staff are able to provide palliative, or end of life, care if and when this is needed. Good practice guidance is available on the Commission website, there is also specific training available for care staff. The advantage to residents of having agreed end of life care pathways is that care can be agreed and co-ordinated, providing clear guidance for care staff, and consistency of care for residents. The manager confirmed that end of life care pathways will be developed and recorded in individual care plans. When we spoke to residents and received feedback in the surveys from residents and health care professionals, comments confirmed that care in the home is provided with respect for privacy and dignity at all times. One person told us the manager is very aware of privacy and dignity and actively addresses these issues. A resident told all the staff are very helpful and kind. Care Homes for Older People Page 14 of 30 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 offered a choice of social and leisure activities including the opportunity for trips outside of the home. Emphasis is placed on providing a choice of wholesome meals served in an attractive setting. Evidence: The brochure for the home states that visiting hours are unrestricted and visitors, including children and pets, are welcome at any time. This was confirmed in the comments received in the surveys from residents, staff and visitors. The home offers a programme of activities Monday to Friday and on Sundays there is a film show with a DVD showing of films that appeal to the residents, the staff also arrange snacks or popcorn for this. The activities include arts and crafts, reminiscence, gentle exercise, singing and manicures. There is a communion service in the home each month and the manager told us that residents can be taken to church services if requested. The home does not provide specific activities for those residents who have some cognitive impairment or are not able to leave their room, however, the manager told us that staff aim to offer more individual time with those residents who are not able to, or dont want to, take part in the social activities. This is an area that the Care Homes for Older People Page 15 of 30 Evidence: home has identified for improvement and the AQAA tells us that plans for improvement are encourage staff to motivate residents to participate in activities. The AQAA could have provided more detail on how this will take place. We spoke to one resident who told us that they had recently enjoyed a trip to a local garden centre. The home has a minibus and there are regular outings with a member of staff, on Wednesdays. In the warmer months, residents are able to enjoy sitting outside in the garden and paved seating area. The manager told us that residents had enjoyed summer barbecues and garden tea parties this year. Seasonal events are arranged and a christmas party is arranged for December with entertainment and seasonal food. Residents are offered choices for all of their meals and we spoke to two residents in the dining room who told us that the food is very good and they could have whatever they liked. Residents are consulted daily about the menu choices for each day. The new dining room offers residents a spacious and attractive area to take their meals, or residents can have meals in their room if they prefer. During the lunchtime period we observed staff providing gentle attention and support to those residents who required this. Attention is also paid to making meals an enjoyable experience for the residents, for example, using tablecloths and table linen, vegetables in a large serving dish, and providing a choice of deserts each day. Care Homes for Older People Page 16 of 30 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. Residents are protected from the risks of harm or abuse by the homes policy and procedures for safeguarding residents. The home must ensure that all staff receive regular training and updates in the safeguarding policies and procedures. The home has a written complaints procedure that is available for residents and visitors to read. Evidence: The complaints procedure for the home is made available in the service user guide. There are no complaints recorded and we have not received any complaints about the home. Feedback from residents, in the surveys, indicated that residents would speak to someone in the home if they had any concerns or comments to make. Since the last inspection there has been one safeguarding referral with regard to the safety and well being of one resident. This was investigated by Social Services using their agreed safeguarding procedures but the allegations were not substantiated. The protection of residents in the home is set out in the policies and procedures and all staff have to sign to indicate that they have read the homes policies. In addition, staff are offered training in how to recognise potential harm or abuse and what their responsibilities are to protect residents in the home. The training records show that some of the staff have completed safeguarding training. The AQAA tells us that the manager has identifed this as an area for improvement and states that the home plans to ensure that all staff receive safeguarding training. However the AQAA does not give Care Homes for Older People Page 17 of 30 Evidence: a timescale for the home to achieve this. The manager told us that residents open their own post unless there is a representative/advocate or solicitor to do this for the residents. The manager is aware of the new mental capacity act and plans to arrange training for the management and staff so that practice in the home meets the code of practice for the new legislation. Care Homes for Older People Page 18 of 30 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. Residents live in a clean, comfortable and safe home environment. The home has an ongoing programme of repair, decoration and refurbishment. There are policies and procedures in place to minimise the risk of infection or cross infection. Evidence: When we looked at all of the communal areas and some of the bedrooms and bathrooms we found all areas of the home to be clean, tidy and pleasant. Comments from residents in the surveys confirmed that the home is always clean. The home employs cleaning and laundry staff. Residents have access to any equipment that is needed to support mobility and the first floor bathroom is fitted with a ceiling hoist and an assisted bath. The home has sluicing facilities and this room is kept locked for safety. The laundry washing machine is fitted with a disinfecting system to ensure good practice in infection control. The laundry room also has tiled and easily washable flooring. The home has a labelling machine that prints a permanent and iron-on label for all clothing. This means that residents always get their personal items returned after laundering. Since the last inspection the home has completed the refurbishment of the dining room/conservatory. This is a large and attractive room for residents to take their meals and it is furnished with new tables and easy glide chairs. The home have just Care Homes for Older People Page 19 of 30 Evidence: started work on relocating the kitchen next to the dining room. Residents have access to a range of communal rooms that are attractively and comfortably furnished. Residents can choose to sit in a quiet room without TV if they want to. The home told us that there are plans for all bedrooms to be fitted with new flat screen and wall mounted televisions. The home has a room on the ground floor that can be used as a treatment room and is also used as a hairdressing room on one day each week. Bathrooms and toilets are fitted with liquid soap and paper towels to meet good practice guidelines for infection control. Staff have access to gloves, aprons and antiseptic hand spray. When we looked at some of the bedrooms residents confirmed that they are able to personalise their rooms as they choose and also bring items of personal furniture. Each resident has a jug of water or juice left in their room each day to make sure that residents have access to drinks at all times. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents in the home are protected by the homes recruitment policy and practice. Staff are trained and competent to do their jobs, however, the home should ensure that there is a system for regular prompting when updates to training are required. Evidence: We looked at the staff recruitment records for three members of staff and these demonstrate that the home has thorough recruitment procedures and new staff are suitable to work in the home. We found evidence that satisfactory checks were in place before staff started to work in the home. The staff rota indicates that there are usually four care staff on duty in the mornings, 3 staff in the afternoon and 2 staff at night. In addition to this, the rota includes the manager, deputy manager, cook, cleaner and laundry staff. On Wednesdays, there is an extra member of staff so that a member of staff is available to take residents out on trips in the minibus. Comments from residents in the surveys demonstrated that staff are always or usually available when help or support is needed. When we spoke to some of the residents in their rooms, we were told that there is an alarm call system and staff always respond when needed. We looked at the training and supervision records for three members of staff. All new Care Homes for Older People Page 21 of 30 Evidence: staff follow a planned programme of induction to care that follows the nationally agreed standards for care training. All staff have access to training in all areas of safe working practice and other health related topics such as dementia care, blood glucose monitoring, emergency life support, first aid, and safe medication administration. One record showed that a member of staff had received training in all areas of practice but had not completed training in safe moving and handling practice. Another member of staff had completed some training since starting in April of this year but had not completed all areas of training in safe working practice, including safe moving and handling. The manager explained that it is sometimes difficult to arrange training to fit in with the working hours for part-time workers. However, the home must ensure that all staff have completed all areas of training in safe working practice, particularly safe moving and handling, in a timely manner, and to ensure that practice is safe for residents and staff. The home provides ongoing opportunities for staff to achieve the national vocational qualification (NVQ) in care. The AQAA told us that out of 20 care staff, 12 people have already achieved an NVQ in care at level 2 and 4 people are working towards level 3. 6 members of staff have already achieved NVQ level 3 in care. The policy of the home is to ensure that staff are supported through regular supervision. This should take place every two months and also include an annual appraisal and team meetings. Records show that some supervision dates have been missed and two people had received formal supervision in May and then again in October. The manager told us in the AQAA that they plan to book supervision sessions in the diary for the whole year from 2009 to make sure that supervision does take place. Since the last inspection the home has appointed a deputy manager who is currently in the process of completing a national vocational qualification (NVQ) in care, level 4. The manager and deputy manager carry out staff supervision and have undertaken some training in being supervisors and hope to arrange further training. The supervision record is being reviewed at the moment to include more opportunity for staff to self-evaluate their own skills and competencies. The manager and deputy manager work in the home during the week and a senior member of staff is in charge at weekends. The manager told us that she comes into the home at other times, such as evenings or weekends. In discussion, it was agreed that it would be good practice for the manager to record these additional visits to the home to demonstrate that practice in the home is regularly monitored and reviewed to make sure that practice is safe for residents and staff at all times. The manager said she would do this. Care Homes for Older People Page 22 of 30 Care Homes for Older People Page 23 of 30 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 home is efficiently managed and there are systems in place to promote and protect the health and safety of the residents and staff. However, the service needs to develop robust systems for monitoring the quality of the service and this must include regular inspections of the home by the registered provider or their representative. Evidence: Since the last inspection a deputy manager has been appointed who is in the process of completing the level 4, national vocational qualification in care. Both the manager and deputy manager have worked in the home for a long period and comments from residents and visitors confirmed that the management of the home is open and caring. Comments from staff confirmed that the manager is supportive and approachable. One member of staff told us the the manager has an open door policy. Residents told us that would feel confident about speaking to the manager or staff if they had any concerns. When we asked residents if they know how to make a complaint, one person said I would first go to one of the staff. Care Homes for Older People Page 24 of 30 Evidence: The manager and deputy manager have undertaken some training to update their own professional practice: in first aid, and safeguarding awareness. The manager told us that she had received a copy of the amended regulations for the storage of controlled drugs, but the service had not yet changed their procedures. Following the inspection, the manager confirmed that the home had installed appropriate storage to meet the new regulatory requirements. In discussion with the manager and deputy manager we recommended that the home should ensure that practice in the home is regularly monitored and reviewed in line with best practice guidance. All guidance is freely available to download from the Commission website for care professionals and care providers. The manager has systems in place to monitor the homes complaince with relevant health and safety requirements, we looked at a sample of records to confirm this including the records for the service of fire safety equipment, the fire safety log book, health and safety risk assessments, and other maintenance records. These were all up to date except the records for checks on the emergency call equipment. The policy of the home is to test the call system every month, but the last recorded check was 15/8/08. The manager said that this would be addressed. The home was inspected by the fire safety officer in May 2008 and some recommendations for improvement were made. The manager confirmed that the improvements have been completed and we also saw records of fire safety practice evacuation drills for January, June and July 2008. The home currently has a five star (maximum 5 star) food safety rating from the environmental health department. We also looked at the risk assessments for COSHH (hazardous materials) and these were up to date and kept in a locked cupboard with cleaning materials. However, this report has identified that the service must ensure that any risks to residents must be clearly identified and recorded with a clear management plan that is regularly reviewed, particularly with regard to the use of restraint, such as bed rails. Good practice guidance on assessing and managing risk, and the use of bed rails, is available on the Commission website www.csci.org.uk We received the annual quality assurance assessment (AQAA) from the home. The AQAA told us where the home has identified the need for improvements to the service, however the AQAA could have contained more detail on how improvements will be achieved. The AQAA could also provide more information on how equality and diversity is promoted and incorporated into practice in the home, for the benefit of the residents. The AQAA told us that the home has a policy on equal opportunities but did not tell us what the home does in practice. The manager has identified that the home needs to develop a policy and practice procedures to meet the requirements of new Care Homes for Older People Page 25 of 30 Evidence: legislation - The Mental Capacity Act. The manager told us that training for staff will be arranged. The home has a number of formal and informal systems for quality assurance. The deputy manager said that the home had recently asked residents and visitors to complete a satisfaction questionnaire. The home has responsed individually to any comments or issues raised in the questionnaires, but has not produced a summary of the outcomes for general inspection or viewing. The Care Homes Regulations 2001 require the registered provider (or home owner/s) to carry out a monthly inspection of the service and complete a written report of the inspection. At the moment, this is not being done. Although one of the trustees works in the home on four days each week, the home is not being regularly and formally inspected by the trustees. This inspection report has highlighted that there are some areas of practice in the home that are not complying with regulatory requirements or current best practice. These issues should have been monitored and reviewed by the registered provider or their representative as part of the homes own internal quality audit. Guidance on carrying out Regulation 26 inspections of the home is available on the Commission website. Care Homes for Older People Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Any identified risks to the residents must be recorded with clear guidance for care staff on how risks/events are to be managed and/or eliminated. Unnecessary risks to the health or safety of service users must be recorded and reviewed to protect people using the service. 28/02/2009 2 9 13 The registered person must 28/02/2009 make suitable arrangements for the safekeeping, administration and disposal of medicines received into the care home. Residents medication must be securely and safely stored. 3 33 26 The registered provider or 28/02/2009 their representative must carry out regular inspections of the service and prepare a written report on the outcome of this inspection. Page 28 of 30 Care Homes for Older People The provider must demonstrate that the standard of care provided by the home is regularly monitored and reviewed, as part of the quality assurance process and to comply with regulatory requirements. 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 Care Homes for Older People Page 29 of 30 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. 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