Care Home: The Noel

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What the care home does well Residents receive care from a stable and consistent staff team and the routines of the home are informal and flexible to meet individual needs. Residents` choices and preferences for how they prefer to receive their care, what they would like to eat and what social activities they like to do, are respected by the manager and staff. A relative of a resident told us under `what does the service do well`: `The home treats all residents as individuals, allow them to maintain independence for as long as possible, staff are always on hand to assist, long serving staff who know the residents well.` The home is small with a friendly and homely environment and residents have their own bedrooms with access to a pleasant and sunny communal sitting/dining room that enjoys sea views. What has improved since the last inspection? Since our last visit in June 2009 the registered manager has reviewed and changed the organisation of residents` medication to ensure that residents receive their medication in a safe and organised way. Most of the care staff have received training updates in manual handling, health and safety, and fire safety. Individual plans of care have been reviewed and updated and are person centred. Improvement has been made to the record keeping and organisational systems in the home. What the care home could do better: In the interests of residents receiving their medication as prescribed; care plans must contain written guidance for care staff on why and when some medications should be dispensed when they are prescibed to be given `as and when required`. Improvements must be sustained and embedded in practice in the home for the benefit of people living in the home. The registered manager must ensure that staff receive training and supervision appropriate for the work they do. This must include a training plan that is drawn up following an assessment of staff development and training needs. All training that is delivered must be recorded to demonstrate that training has been completed and staff records kept up to date. Supervision must be planned and regularly arranged for all staff, and signed and recorded. The registered manager must demonstrate that practice in the home is regularly monitored as part of the home`s quality assurance systems. This would mean that action could be taken to meet legal requirements before regulatory requirements are made, and ensure compliance with legal requirements in a managed and sustained way. Key inspection report Care homes for older people Name: Address: The Noel St Boniface Road Ventnor Isle Of Wight PO38 1PN     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: Annie Kentfield     Date: 2 9 0 9 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 30 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 30 Information about the care home Name of care home: Address: The Noel St Boniface Road Ventnor Isle Of Wight PO38 1PN 01983852292 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miss Sandra Vivienne Phillips care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 12 The registered person may provide the following category 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 category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Noel is a residential care home providing care and accommodation for up to 12 older people. The home is owned and managed by Miss Sandra Phillips. The home is a period three-storey (including basement) detached house in Ventnor, near to the town centre, with its shops and amenities. Accommodation for the residents is arranged over the ground and first floors and a stair lift assists with access to rooms on the first floor. Rooms at the front enjoy fine sea views and those at the rear face St Boniface Down. The home is registered to accommodate 12 older people, but the manager prefers to provide single room accommodation and therefore limits the occupancy to 8. Double rooms are used only if residents choose to share. There is off road parking to Care Homes for Older People Page 4 of 30 Over 65 12 0 0 4 0 6 2 0 0 9 Brief description of the care home the front of the building. A stair lift is available to assist those with mobility difficulties to negotiate the steps up to the front door. Information about fees and any additional charges are available from the home. 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: 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: We made an unannounced visit on 29 September 2009 between 10am and 4.30pm with two inspectors. A specialist pharmacist inspector looked at the medication procedures in the home and a regulation inspector looked all other records including care plans, staff training records and some health and safety records, and spoke to all four of the residents, 4 members of staff and the registered manager. Evidence was also gathered from the Annual Quality Assurance Assessment that we received from the home in January 2009 and from surveys that we received from 3 residents, 3 members of staff and two relatives of residents. We spoke to Social Services Safeguarding Team for the outcome of a recent safeguarding investigation of the home. We visited the home in April 2009 to monitor compliance with a regulatory requirement about medication procedures in the home. We issued a statutory requirement notice Care Homes for Older People Page 6 of 30 because the registered manager had not complied with the requirement. We visited the home in June 2009 to monitor compliance with the statutory requirement notice. We found in June 2009 that sufficient action had not been taken to demonstrate that residents were safely receiving their prescribed medication. A regulatory requirement for staff to update their manual handling training had also not been met within the agreed timescales. We sent a warning letter to the registered manager because of our concerns about the failure to comply with legal requirements and the subsequent risks to the health, safety and well being of residents in the home. We also asked the registered manager to vountarily agree not to admit any new residents to the home until the registered manager was able to demonstrate that a consistent level of care could be provided and legal requirements complied with. The visit of September 2009 demonstrated that action has been taken to ensure that medication procedures in the home are organised and safe, and action has been taken to ensure that most of the staff have updated their training in safe moving and handling practice. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: In the interests of residents receiving their medication as prescribed; care plans must contain written guidance for care staff on why and when some medications should be dispensed when they are prescibed to be given as and when required. Improvements must be sustained and embedded in practice in the home for the benefit of people living in the home. The registered manager must ensure that staff receive training and supervision appropriate for the work they do. This must include a training plan that is drawn up following an assessment of staff development and training needs. All training that is delivered must be recorded to demonstrate that training has been completed and staff records kept up to date. Supervision must be planned and regularly arranged for all staff, and signed and recorded. The registered manager must demonstrate that practice in the home is regularly monitored as part of the homes quality assurance systems. This would mean that action could be taken to meet legal requirements before regulatory requirements are made, and ensure compliance with legal requirements in a managed and sustained way. Care Homes for Older People Page 8 of 30 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 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 10 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures have been reviewed to ensure that new residents have their care needs assessed before they move into the home to ensure that the home is suitable and can meet their care needs. Evidence: We visited the home in January, April and June 2009 and the Local Authority also carried out a contractual audit of the home. These visits resulted in a number of requirements and recommendations being made about all aspects of practice in the home. The home was unable to admit any new residents until the improvements were in place. We found in September 2009 that the registered manager has taken action to meet the requirements and recommendations and as a result the home is now able to admit new residents if an assessment has been carried out and the home is able to meet those assessed care needs. However, the regulatory requirements were not met in the timescales that were given. Care Homes for Older People Page 11 of 30 Evidence: This means that the management systems are not organised and effective and the manager did not take prompt action to improve practice in a timely manner. The registered manager must ensure that improvements to the way that the care needs of new residents are assessed are sustained and embedded in practice in the home to ensure the safety and well being of people living in the home. Improvements have been made to medication procedures to ensure that residents receive their medication, as prescribed, at all times. These improvements must also be sustained and embedded in practice in the home. The manager has arranged for staff to receive training updates in safe moving and handling; this was a regulatory requirement from January 2009. Most of the staff have refreshed their training but there are some staff who have not yet attended a training update. The manager told us that further training will be arranged for part-time staff. Although the opportunities for staff training and supervision have improved, some of the training carried out has not been recorded and we have made a regulatory requirement for the manager to produce a realistic staff training plan based on an assessment of staff training and development needs. Some formal staff supervision has been arranged and this needs to be planned and carried out on a regular basis. Staff have not yet received any training about the new Mental Capacity Act and how this may affect residents living in the home. Care Homes for Older People Page 12 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. People living in the care home have a plan of care that provides guidance for care staff on how people wish to receive their care. People have access to health care specialists to ensure their health care needs are met. The systems for the safe administration of medicines have improved and demonstrate that people receive their medication, as prescribed. Evidence: Since the last key inspection the safe handling of medicines has been assessed by a commission specialist pharmacist inspector. They visited the home on 28 April 2009 and found that it was not possible to tell if people were getting their medicines as prescribed due to the poor standard of record keeping. A statutory requirement notice was served on the home and we visited on 4 June to monitor the homes compliance with the notice. Again the records and medicine supplies were not able to show that people were receiving their medicines as they were prescribed by their doctors. Care Homes for Older People Page 13 of 30 Evidence: The safe handling of medicines was assessed at this inspection by a commission specialist pharmacist inspector. We found that the standard of record keeping was much improved and people could be seen to be receiving their medicines as their doctor prescribed. Clear records were being kept of medicines coming into the home and of the balance of any medicines brought forward from one four week medicines cycle to the next. When medicines were given to people there were no gaps or ambiguous entries in the records. The use of creams and ointments was clearly documented. When we checked the medicine supplies these matched the records for both medicines dispensed in blister packs and in manufacturers boxes. All medicines were stored securely for the protection of people who use the service. Care staff have been enrolled in a safe medication handling training programme. Two medicines were prescribed to be given only when needed. The records showed that these medicines were being offered and when they were given and when they were declined by the residents. Whilst the care plans, for the two people prescribed these medicines, were able to show that these people could express their wishes there was no detail to guide staff as to when these medicines should be offered to these people. Since the last visit to the home, individual plans of care have been re-written and these are person centred. We looked at the care plans for four residents and they contain details of the care needs of each resident and what peoples personal preferences and choices are as to how they wish receive their care, for example, one care plan contains details of how a resident likes to have their bath. Any risks are assessed, such as the risk of falling, with details of how the risk is to be managed. The care plans cover physical and psychological health care needs as well as social interests and support networks. Daily records of care provide details of the care provided and record when people see their GP or other health care specialists. We received comments from a health and social care professional who told us: the manager maintains good liaison with all health care professionals, and all of the residents are treated as individuals. Another person told us that residents benefit from a stable and long standing staff team who know the residents well. Care Homes for Older People Page 14 of 30 Evidence: We spoke to all of the residents during our visit and it was evident that people are encouraged to be as independent as possible, but staff are always on hand to assist when needed. The home has a call bell system and three residents showed us the call alarm in their bedroom and told us that staff always respond if they use the alarm system. When we visited the home in January 2009 we noted that staff in the home had not updated their manual handling training. Records show that training has now been updated for the manager and most of the staff. Care Homes for Older People Page 15 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. The lifestyle of the home is suitable for the needs, abilities and preferences of the residents. Emphasis is placed on offering fresh and nutritious meals for the residents. Evidence: We spoke to all of the residents in private and it was evident that the routines of the home are informal and flexible to suit the preferences of the residents. Care plans contain information about what people like to do for social and leisure activities and care staff respond to whatever people choose to do, for example, going out, or being read to, or playing games. Two people told us that they prefer to spend time privately in their own room, but were aware of any social events in the home and could join in if they wanted to. Visitors are made welcome and some visitors stay and have meals with their friends or relatives living in the home. The manager told us that she always checks with residents that they are happy to receive visitors, otherwise there is no restriction on people visiting. We saw photographs of a recent birthday party for a resident and friends and family were invited to the party. All of the residents told us that the meals are good. Meals and mealtimes are very Care Homes for Older People Page 16 of 30 Evidence: flexible and it was evident that residents can have drinks or snacks whenever they request this. People are asked each day what they would like to eat for each meal and alternative choices are always available. Fresh fruit is always available and we saw a large basket of fresh fruit in the kitchen that is offered to residents. There is a dining table in the sitting room or residents can have their meals in their own room if they prefer. We spoke to some of the residents in their own rooms and people had jugs of water or juice available. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living in the home are protected from the risk of harm or abuse. Record keeping has improved and any risks to the safety and well being of residents is assessed with a record of how risks are to be managed. Policies and procedures for safeguarding people in the home have been updated. Evidence: Since the last inspection of the home the registered manager has updated the safeguarding policy and procedures. The manager told us that safeguarding awareness training for staff is done in-house by the manager, although this has not been recorded and therefore could not be confirmed. We received comments from two relatives/visitors to the home who told us that the home always responds promptly and appropriately if any concerns are raised. The manager told us that the home has not received any complaints. The registered manager told us that she and the staff are aware of the Mental Capacity Act but staff have not received any formal training about how the new legislation may affect residents in the home, in practice. The manager told us that the home has a copy of the Mental Capacity Act - Code of Practice, but the manager was not sure if the home had any specific guidance on deprivation of libery safeguards and how these may affect residents. The manager told us that she would obtain the relevant guidance. Care Homes for Older People Page 18 of 30 Evidence: Since our last visit in June 2009 there has been a safeguarding investigation by Social Services Safeguarding Team. The concerns were about the management and organisation of the home and potential risks to residents living in the home. We have received confirmation that the investigation has been completed and although the concerns were not substantiated, a long list of recommendations were made with regard to health and safety, record keeping, maintenance checks and staff training and supervision. A temporary block on new residents moving into the home has been lifted. Care Homes for Older People Page 19 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. The home provides an environment that meets the needs of the people who live there in a comfortable and homely way. Evidence: Residents have their own bedrooms and these are comfortably furnished so that if residents choose to spend time in their room, they have tables and comfortable chairs, and bedside tables to use. We saw that some of the rooms that have become temporarily vacant; have been decorated and refurbished to a good standard. Bedrooms have a wash-hand basin and there is a bathroom and toilet on each floor with an assisted bath. The home does not have a passenger lift, but there is a stair lift to access the upper floors of the home. We observed staff assisting a resident to use the stair lift. Residents have access to a comfortable sitting room/dining room that enjoys pleasant sea views and a sunny aspect. The home is clean and warmly heated, the home employs a cleaner. The home has an infection control policy and procedures and we observed that toilets and bathrooms have appropriate hand washing facilities and there is anti-bacterial Care Homes for Older People Page 20 of 30 Evidence: hand gel available for staff, residents, and visitors to use. Staff have access to gloves and aprons as part of the homes infection control procedures. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care and support needs of the residents are met by a staff team that is consistent and experienced. The opportunities for staff training and development have improved but are not consistently organised. Evidence: The home has a staff team of 11 including the manager, care staff, cleaner and cook. The staff team is stable and work closely together as a team. The home has not employed any new staff since we last visited the home. Comments from residents and relatives confirm that people appreciate the care staff and the fact that the staff team is consistent and staff know the residents well. One person told is: Miss Phillips is fairly protective (in a good way) of her residents, and their well being is her and the staffs prime objective. In January 2009 we made a regulatory requirement that staff must update their moving and handling training to ensure that practice in the home is consistently safe for residents and staff. We made this requirement because moving and handling training had not been updated since 2000 for some staff, and some staff had not done accredited manual handling training at all. We looked at the current staff training records and this demonstrated that 6 care staff and the manager did a manual handling refresher course in July of this year. Other care staff who are part-time still Care Homes for Older People Page 22 of 30 Evidence: need to update their manual handling training. The manager told us that this would be arranged when staff were available to do it. The training records demonstrated that staff have also done some training this year in health and safety, fire safety and two people have updated their competency in blood glucose testing. All of the care staff are currently enrolled on a distance learning course for the safe administration of medication. Although the registered manager recognises that additional training for staff is needed and training updates should be arranged, the home does not have an organised and planned programme of training in place. This means that action is only taken to arrange accredited training for staff when a regulatory requirement is made, or recommendations have been made by Social Services during a review of contractual compliance. The manager confirmed that all of the care staff have achieved an NVQ (National Vocational Qualification) in care, at level 2. We were told that one person is planning to enrol to achieve an NVQ in care at level 4. The supervision arrangements in the home tend to be informal and ongoing and supervision is not recorded. However, the manager told is that she has started to arrange formal supervision agreements for all of the staff and two appraisals had taken place and had been recorded. The lack of formal staff supervision and appraisal means that the manager has not carried out a skills assessment of staff qualifications and competencies. Any informal training carried out by the manager has not been recorded or reviewed. The training records show that food hygiene training is out of date for one member of staff and the manager told us that this would be updated. Specific training for the cleaner has not been arranged and the manager agreed that it would be good practice for the home to demonstrate that cleaning staff receive training relevant to their role in the home, for example, in health and safety, infection control and COSHH (Control of substances hazardous to health) to demonstrate that staff are aware of their responsibilities for safe working practice and provide a personal development plan. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems are not consistently organised and effective, however, the views of the residents are listened to and acted upon. Effective systems for measuring the quality of the service are not in place and regulatory requirements have not been met in a timely manner. The health, safety and welfare of the residents and staff are promoted but this is sometimes compromised by poor organisation and poor record keeping. Evidence: The visit of September 2009 found that the registered manager has taken action to comply with legal requirements but this has not been done promptly and in a timely manner to meet the timescales given. For example: the regulatory requirement to ensure that staff have received updates of training in safe moving and handling was not met until July 2009 following our requirement in January 2009. Some of the parttime staff still have to update their training in this area. The registered manager did not take appropriate action to review medication procedures in the home promptly and within the timescales given. The registered manager does not regularly review the Care Homes for Older People Page 24 of 30 Evidence: practice in the home to ensure that legal requirements are being met. Improvements have only been made when enforcement action has been taken. The registered manager told us that following the inspection of January 2009 when there were three residents in the home; new residents were admitted but the home was not able to provide the level of care that the residents required and the residents moved to another care home. This means that the registered manager was not carrying out thorough pre-admission assessments to confirm that the care needs of new residents could be met. A safeguarding investigation by Social Services also highlighted concerns about the fitness of the registered manager to safely run the home for the residents and for a period new residents were not admitted to the home. The commission also recommended that the registered manager voluntarily agree to not admit any new residents until the manager was able to demonstrate her fitness and ability to meet the care needs of the residents in an organised and safe way. The registered manager told us that she has obtained evidence of her medical fitness but this has not yet been received by the commission. Improvements to the organisation and management of the home have been made and the home is now able to admit new residents subject to a pre-admission assessment of care needs. However, the manager needs to demonstrate that improvements will be sustained and embedded in the practice of the home and that practice in the home is regularly reviewed. The manager told us that she has started to develop some quality assurance systems but these need to be developed. Improvement has been made to record keeping to demonstrate that the home is complying with health and safety legislation. The manager told us that health and safety risk assessments have been reviewed and staff have undertaken general health and safety training. We saw evidence of this. The registered manager confirmed that action has been taken to meet other health and safety recommendations made by Social Services following a contract review. The recommendations covered all areas of health and safety and safe working practice. However, although the manager told us that some staff training in safe working practice has been delivered to staff, as in-house training, there are no records to confirm this. We looked at some of the health and safety records for fire safety. The fire alarm is tested weekly by the registered manager. A safety consultant does 3 monthly checks Care Homes for Older People Page 25 of 30 Evidence: on fire safety equipment, emergency lighting and safety doors. The manager told us that fire drills with staff have been carried out, but have not been recorded. This means that there is no recorded evidence that fire safety drills have been regularly carried out to demonstrate that staff are aware of emergency evacuation procedures in the event of a fire. The manager confirmed that risk assessments have been updated for the use of any cleaning chemicals or other hazardous substances in the home. The manager told us that the home has a copy of the Code of Practice for the Mental Capacity Act. The manager has not made any referrals for people to be assessed under the deprivation of liberty safeguards. However, staff have not yet received any formal training in the Mental Capacity Act to ensure that they are aware of how the legislation may affect people living in the home. The registered manager has taken action to demonstrate that the home is able to meet the needs of the four residents in the home. The manager must demonstrate that improvements will be sustained and progressed to ensure that the home is able to consistently meet the needs of greater numbers of residents. The registered manager must demonstrate that the service consistently complies with all legal requirements. However, the home does not have systems in place for regularly monitoring the quality of the service and checking that regulatory requirements are met in a consistent and organised way. 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 9 13 To record a plan of care for any medicines that are prescribed to be taken as and when required. Care staff must have clear guidance as to when, and why, these medicines should be dispensed to people. 13/11/2009 2 30 18 Ensure that staff receive training and supervision appropriate for the work they do. There must be a staff training plan following assessment of staff development needs. All training delivered by the manager must be recorded. Staff supervision must be planned, formalised, and recorded. 30/11/2009 Care Homes for Older People Page 28 of 30 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 3 33 24 Establish and maintain a system for evaluating the quality of the service provided. There is continuous selfmonitoring and audits based on a systematic cycle of review and action reflecting outcomes for service users. Policies, procedures and practices are regularly reviewed in light of changing legislation and good practice. 30/11/2009 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: 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). 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. 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