Care Home: The Oaks Care Home

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What the care home does well We saw evidence of visitors being welcomed into the home on the day of the inspection. One relative told us "They always phone me if my relative needs me." Another said "If there are any problems they will always come and tell us." We saw many examples of positive interaction with people living in the home and the staff during the inspection. We observed the staff care team to be friendly, enthusiastic and knowledgeable about what they were doing. We received many positive comments about the staff working in the home from relatives and these included, "I cannot fault the communication with staff. They are so helpful. Nothing is a problem to them" and "The staff are excellent", "I have been very confident that staff have the right skills and experience", "The staff all get on well together, I think this is very important to the running of the home and I think it is possibly as good as it can get." What has improved since the last inspection? The home has introduced a `hydration bar` to each dining area and these are filled with juice chosen by people living in the home and contain essential nutrients. There is an annual review completed for each person living in the home, which incorporates the outcomes of the National Minimum Standards of care. The review is completed with each person and their relatives, if appropriate and are attended by one of the management team. The record of the review is kept within the individuals care plan. What the care home could do better: The lack of up to date information within some plans of care means some people`s needs are not fully met and they are not fully protected from risks. Medication procedures are generally safe but there are some some shortfalls in procedures that should be followed. Any allegations of abuse or disclosure of information must be followed up in line with the local current safeguarding procedures. The registered person must inform the commission, without delay, of any event in the care home, which adversely affects the well being or safety of any service user. Key inspection report Care homes for older people Name: Address: The Oaks Care Home Campbell Street St Anns Nottingham NG3 1GZ     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: Lynda Dyer     Date: 0 5 0 2 2 0 1 0 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 Oaks Care Home Campbell Street St Anns Nottingham NG3 1GZ 01159159013 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: deborah.hall@nottinghamcity.gov.uk www.nottinghamshire.gov.uk Nottingham City Council care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Any persons admitted in the category of Dementia and under 65 years must be over 55 years and be accommodated in the short stay areas of the home. Nottingham City Council is registered to provide accommodation and care at The Oaks for up to a maximum of 33 persons in the following categories: Old age, not falling in any other categoryy (OP) Dementia over 65 years (DE(E) Dementia (DE) up to 4 people. Date of last inspection Brief description of the care home The Oaks is a Registered care home, which provides personal care and accommodation for thirty-three older people. The home is owned and managed by Nottingham City Social Services and is located in the St Anns area of Nottingham approximately one mile from the city centre. There are shops, public houses a post office and other services within a few hundred yards of the home. The Oaks is situated on two floors with a shaft lift to allow residents to reach the upper floor, if they are unable to manage the stairs. All of the bedrooms are single bedrooms with ensuite Care Homes for Older People Page 4 of 30 Over 65 0 33 4 0 Brief description of the care home facilities. Within the Oaks there are eight beds which are specifically for intermediate care - this is short term care (usually no more than six weeks) for people who may have come out of hospital, and need additional help to regain their independence, or help in self help skills, before returning to live in their own homes. There are also four assessment beds, where individuals can be assessed as to whether they require residential care, domiciliary support, or can return home, again these assessment beds are short-term. The home has a well-maintained garden area at the rear of the building, which is accessible to all service users. An application to vary the registration has been made, so that the Oaks would be able to take people who have dementia. This application is currently being processed by the Commission for Social Care Inspection. Fees: The fees are assessed on an individual basis, and differ according to circumstances. 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: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last time we visited this service was October 17th 2006. We, as it appears throughout the Inspection Report refers to The Care Quality Commission. One inspector carried out an unannounced site visit to the agency, which took place over a period of 6.5 hours. The Registered Manager and the team leader assisted us during the site visit to the home. Care Homes for Older People Page 6 of 30 We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service, this is called an Annual quality assurance assessment (AQAA). When we received the AQAA from the manager, it was slightly outside of the timescale we had set for it to be returned. It was incomplete and did not give us all of the information we had asked for. We asked the manager to provide us with this missing information and she gave us a date by which the information would be supplied. This timescale was missed and the manager was asked again to supply the information. We also sent out surveys called, have your say, to people who use the service, staff that work there and relatives. This meant we could get an idea of what people thought about the way the home was run. We received completed surveys back and we have included some of the comments in this report. We have not included comments that could identify the writer as we want people to feel they can be open about the way they feel the service is run. We also reviewed all of the information we have received about the home since we last made a visit to them and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking, which involved us choosing two people who use the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. We spoke with the manager, four members of staff, five people who live in the home and one relative to help us to form an opinion about the quality of the service being provided to people. We read documents as part of this visit and looked at the environment and facilities of the home to form an opinion about the health and safety of people who use the service. 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: 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 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. People that are admitted to the home have their needs assessed prior to admission, which means staff, will be able to plan for their individual needs. People assessed and referred solely for intermediate care are supported to maximise their independence and return home. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that prior to any placement being agreed, the team establish whether the needs of an individual can be met at the Oaks. An assessment is sought and the individual is given the opportunity to visit the Oaks to enable them to make an informed choice of whether they wish for the placement to go ahead. If this is not achievable, a member of the Oaks team will visit the individual to discuss the service and provide information in the form of a Welcome Pack. We looked at the records of the most recent admission and the records contained Care Homes for Older People Page 10 of 30 Evidence: evidence that a full needs assessment had been completed prior to admission to the home. We spoke to staff working in the home and they told us that they always got to know about the needs of people before they moved into the home. One person living in the home told us that they did not receive any information about the home before deciding to live there. They said, I had no information but I am pleased with the home. The Oaks have eight bed specifically identified as being for intermediate care - please see the brief description of the service for a description of what intermediate care is. The intermediate care beds are dual funded in that the Health Authority as well as Social Services are involved, and provide Physiotherapy and Occupational Therapy to people. We case tracked one person on the intermediate unit and we spoke with them about the admission process and the support they were being given. They told us that they had received information about the home and what services it offered and that there was a welcome pack that was kept in their bedroom, with information on the service, advocacy available, payment of fees and how to complain. They said that they felt well cared for and that they were being supported to undertake tasks to try and regain the skills needed to return home. We looked at this persons care plan and it contained relevant risk assessments and evidence of input from external health specialists. There was a programme in place to support this person to regain their ability with daily living skills in the hope that they would return to their own home. One relative commented, They make the experience of being in rehabilitation a good one by the staff being friendly and welcoming. The transition from Hospital to rehab is difficult and the staff were great with my relative, making them feel reassured. One member of staff told us, It is like a first class hotel on the re-hab unit unit. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of up to date information within some plans of care, some peoples needs are not fully met and they are not fully protected from risks. Medication procedures are generally safe. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that each person living in the home has an individual care plan, which is reviewed on a regular basis and recorded in daily. They told us that the plan includes information relating to the health and personal care needs of the individual including how the team at the Oaks can meet these needs to ensure independence and choice. They said that the plans are essential in ensuring the appropriate service is delivered at all times. They also told us that the management team are trained in the receipt, recording, storage, handling, administration and disposal of medication and facilitate medication reviews for service users where required. We looked at the care plans of two people living in the home on a long term basis. We found that not all of the information in the care plan was current to the persons needs. Care Homes for Older People Page 12 of 30 Evidence: One persons care plan held information stating that there were not any risks around skin integrity. The entries in this persons daily records showed that they had developed a sore three times over a period of time. This had not triggered staff to implement a risk assessment or plan, detailing what action staff should take to prevent further sores developing. Parts of the care plan had not been reviewed since 2007. There was a nutritional risk assessment in this persons care plan that stated that they were at risk due to poor appetite and weight loss. The action plan told staff to weigh this person weekly but records showed that this person had not been weighed for almost three months. We spoke with the manager about this and she said that this the risk assessment should not have been in this persons care plan as there was no nutritional risk. She also told us that the staff did not weigh people weekly unless there was a great risk and that this person should now be weighed monthly. The manager could not give a reason why this person had not been weighed for almost three months. We looked at a second care plan and we found that although this person had fallen three times recently, this had not triggered staff to implement a risk assessment or plan detailing what action staff should take to prevent further falls occurring. The manager said that all care plans have a generic risk assessment in place for falls and that she did not know why there was not one present in this care plan. The manager produced a copy of the risk assessment that was placed into each persons care plan to manage the risk of falling. The action to minimise the risk of falls stated, Staff to be trained in health and safety and moving and handling. There was no specific action for staff to take to prevent this person falling. There is an annual review completed for each person living in the home, which incorporates the outcomes of the National Minimum Standards of care. The review is completed with each person and their relatives, if appropriate and are attended by one of the management team. The record of the review is kept within the individuals care plan. People living in the home that we spoke with said that staff cared for them well and always got a doctor for them if they were ill and one relative said, I feel the service is meeting all my relatives needs at the moment. We observed a member of staff administering prescribed medicines to people living in the home and they followed the correct procedures. We also looked at the medicine storage and systems in the home and there was evidence of some good practice Care Homes for Older People Page 13 of 30 Evidence: around the medicine procedures but we also found some shortfalls in procedures that should be followed. We observed staff respecting peoples privacy and dignity and people living in the home told us that staff were mindful of their privacy. 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. People that live in the home are given the opportunity to participate in recreational activities and maintain social contacts. People receive a nutritious and appetising diet with individual preferences being met. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that through their comprehensive care planning process they are able to identify the type of interests that need to be maintained to promote the health and wellbeing of all individuals. They told us that activities are carried out in groups and one to one sessions both in and outside of the Oaks, whether it be a movie night, paid entertainer, craft and cookery, farm trips, shopping, pub lunches, visits to family and friends or even a ride on the Nottingham Eye. The care plans of the people we case tracked showed information of their preferences about how they liked to spend their day and we saw people moving freely around the home on the day of the inspection. We looked at the activity plans of two people and although one of them did not enjoy getting involved in activities, staff were recording when activities were offered to this Care Homes for Older People Page 15 of 30 Evidence: person. The activity plan of the second person showed activities taking place including, arts and crafts, bingo, dominoes and cards. We saw evidence of activities taking place on the day of the inspection and staff told us that they always left the dining tables set up for activities. We spoke with staff about the activities and they told us that they felt there was enough on offer for people living in the home to do and that people were able to go out of the home, if only for a walk to the local shops. We saw evidence of plenty of visitors being welcomed into the home on the day of the inspection. One relative told us They always phone me if my relative needs me. Another said If there are any problems they will always come and tell us. We observed lunch and we saw that people were offered a choice of three meals and that the meal looked nutritious and appetising. The tables were laid with a choice of condiments and drinks for people and vegetables were put on the table for people to help themselves. There were various pleasant dining areas for people living in the home to eat in and one person had chosen to eat in their bedroom as they had not been well. Staff were available to give assistance to people who needed it. The home has introduced a hydration bar to each dining area and these are filled with juice chosen by people living in the home and contain essential nutrients. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for managing complaints are not robust enough to ensure that people have their concerns responded to appropriately. The arrangements for safeguarding are not robust enough to ensure people are fully protected. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that The Oaks follows the Nottingham City Council complaints policy and such information is passed onto the people living in the home and their family/friends via our information stand. They also told us that the team are trained during their induction and through corporate training in the safeguarding of vulnerable adults. The Commission has received one complaint about this service in the last twelve months and this led us to make a safeguarding alert and the complaint is being investigated by the Local Authority. The manager told us that the home has not received any complaints since we last visited. People living in the home told us in the surveys that they completed that they knew how to raise concerns and make complaints and staff told us that they knew how to respond to someone making a complaint to them. We saw the complaints procedure on display in the home and this was current, clear and accessible. It was written is Care Homes for Older People Page 17 of 30 Evidence: easy read and picture format and the manager told us that it was available in other formats on request. The complaints procedure does not include the details of how to contact the Commission. There is a poster displayed in the home with the telephone number of the Commission but it does not give our address or details of our role. Two relatives told us that they did not know how to make a complaint but one said, we have never raised any concerns, the general care for my relative has been very good. When we conducted an Annual Service Review in January, we received information from a relative, who told us that they did not feel their complaints had been listened to in regard to their relative losing things. We spoke with the manager about this and she said she would approach the relative directly. We examined two staff files and looked at the training matrix and there was evidence that staff are being trained in safeguarding vulnerable adults. We also spoke with staff about the procedures they would follow and they gave a clear account of the safeguarding procedures. On the day of the inspection one person living in the home that we spoke with, made an allegation about a member of staff. We asked the manager to contact the Nottingham County Council safeguarding adults team (SAMCAT) so that the correct procedures could be followed to safeguard this person. The manager failed to follow the local referral procedures for the safeguarding of adults and did not respond in a timely manner and this led to the Commission making the alert. 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. People live in a home that is clean and well maintained with procedures in place to prevent the spread of infection. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that the fabric of the building is maintained by an on-site handyperson and the Nottingham City Council maintenance and repairs department. They also told us that communal bathrooms and lavatory facilities all have hand washing facilities in place with hand paper towels available at all times. Anti-bacterial soap and hand gel are also available to prevent the spread of infection and that there is a comprehensive infection control policy in place. We set two requirements in this outcome the last time we visited the home and the first one was found to be met at this inspection and the second is more to do with health and safety and so we have addressed this in the management section of this report. On the day of the inspection, we found the home to be clean, well maintained and homely. There were a variety of lounge and dining areas, giving people living in the home a choice of where to spend their time. One relative told us, It is not like a care home, the way it is laid out is really homely. Care Homes for Older People Page 19 of 30 Evidence: We looked at the bedrooms of two people living in the home and we found that they were decorated to a good standard and were highly personalised with peoples own possessions and furniture. Some bedrooms had been recently decorated and there was evidence that the people living in the home had been given the opportunity to choose their own colour scheme. People living in the home told us that the home was kept clean and that they liked their bedroom. When we asked relatives what the home did well one relative said,Excellent service for cleaning individual rooms and dining areas, laundry and food. The home has systems in place to prevent the spread of infection. We saw evidence that staff have received training in infection control and we observed them putting these procedures into practice on the day of the inspection. 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. The home operates a safe staff recruitment process and staff are trained effectively in supporting people living there. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that new employees are only appointed following a full satisfactory Criminal Records Check and two satisfactory references are gained. They also told us that each new employee must complete the Nottingham County Council induction programme and then an extensive training programme is facilitated for each team member. We looked at the files of two members of staff working in the home and we found that they contained evidence that all of the required recruitment checks had been made prior to employment commencing. We spoke with staff and they confirmed that they had to wait for these checks before they started working in the home. The files also contained evidence that a recognised induction was being carried out on new staff. The home has a training matrix and this gave evidence of training being planned and delivered to staff. Some certificates of training were missing from the staff files that we viewed and the manager said this was due to staff not bringing them to the office to be photocopied. Care Homes for Older People Page 21 of 30 Evidence: Staff told us that they received training that helped them to meet the needs of people and that was relevant to their role. We saw many examples of positive interaction between staff and people living in the home during the inspection. We observed the staff care team to be friendly, enthusiastic and knowledgeable about what they were doing. We received many positive comments about the staff working in the home from relatives and these included, I cannot fault the communication with staff. They are so helpful. Nothing is a problem to them and The staff are excellent, I have been very confident that staff have the right skills and experience, The staff all get on well together, I think this is very important to the running of the home and I think it is possibly as good as it can get. Care Homes for Older People Page 22 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. Although there is evidence that the home is run in the best interests of the people that live there, procedures to safeguard people from risk are not always managed well. Systems for managing risks peoples financial interests are well maintained. Evidence: The manager worked in social care for over 20 years, with managerial experience for the last 10 years. They hold the recommended recognised qualification and have undertaken further training to keep them up to date with changes in practice and legislation. We asked the manager to complete an Annual Quality Assurance Assessment (AQAA). When we received the AQAA from the manager, it was slightly outside of the timescale we had set for it to be returned. It was incomplete and did not give us all of the information we had asked for. We asked the manager to provide us with this missing information and she gave us a date by which the information would be supplied. This timescale was missed and the manager was asked again to supply the information. Care Homes for Older People Page 23 of 30 Evidence: When we completed the Annual Service Review on the service in early January, we asked the manager to send us some notifications, which are a legal requirement. These notifications were in relation to referrals made under the Deprivation of Liberty safeguards. The manager called us later in January to ask where we wanted the information recording on the form and we advised her accordingly. When we visited the home for this inspection, in February, the manager told us that she had not yet sent the notifications. We subsequently had to remind her following the inspection and as yet, they have not been received. The staff were very complimentary of the manager and said that she met with them regularly to talk about how they were working and to give them support. We looked at the records of the visits from the operations manager and these were well documented and up to date with evidence of people living in the home and staff being spoken with. The manager showed us some satisfaction surveys that had been completed by people living in the home and their relatives, to get their views on how the home was run. These were not dated and so there was no way of knowing when these views were sought. One of the surveys looked at made reference to their being an odor of urine in the home but there was no evidence that this had been addressed with the person who raised the concern. There was a chart on the window in the main entrance with the results of the satisfaction surveys. This was not dated and there was no action plan in place to show what action the manager had taken as a result of comments made in the surveys. There is a meeting held once a month for people living in the home and we saw records of the last meeting. We looked at the personal spending money of one person living in the home and this was being well managed with a system in place that enables secure auditing of monies kept within the home. At the last inspection in 2006, the inspector noted that a recent recommendation from the Commission had not been acted on. The recommendation had been made with regard to an external and internal balcony that may pose a risk to some people living in the home. Care Homes for Older People Page 24 of 30 Evidence: The inspector in 2006 made a requirement that these balconies be risk assessed. We looked at this risk assessment at this inspection and found that the manager had referred the issue to the health and safety department. The advice of the health and safety department had not been recorded and the manager said they had advised notices be placed near the balconies to warn people of the risk. There was one notice in place on the door leading to the external balcony, which stated, Children must not go on to the balcony unaccompanied. There were not any notices in place warning of the danger to people living in the home on either the internal or the external balcony. The records of health and safety servicing and testing were inspected and these provided evidence that servicing and tests are all up to date. We also saw evidence that staff are trained in areas of health and safety. Care Homes for Older People Page 25 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 26 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 Care plans must be kept up to date with the current needs and risks to the individual. This will ensure people get the care that they need. 01/03/2010 2 7 13 Where a risk is identified in a persons care plan, surrounding pressure areas, falls and other specialist needs, a risk assessment must be implemented. This will minimise the risk of further sores or falls. 01/03/2010 3 7 13 Where a risk is identified in a persons care plan, surrounding pressure areas, falls and other specialist needs, a plan of what action staff need to take manage this risk must be recorded. This will ensure people get the care that they need. 01/03/2010 Care Homes for Older People Page 27 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 4 18 13 Any allegations of abuse or disclosure of information must be followed up in line with the local current safeguarding procedures. This will protect people from harm. 01/03/2010 5 31 37 The registered person must inform the commission, without delay, of any event in the care home, which adversely affects the well being or safety of any service user. This must include any medication errors that are made in the home. This means we are kept informed of incidents that may affect the well being of people living in the home. 01/03/2010 6 38 13 Notices must be placed on the internal and external balconies that warn people of the danger to people living in the home, in line with advice from the health and safety department. This will minimise the risk of injury to people living in the home. 01/04/2010 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Handwritten entries on the medication administration records must be signed by staff and witnessed with a further signature. Any external preparations and liquid medicines should be dated on opening to ensure they are not used beyond their shelf life. The address, telephone number and details of the role the Care Quality Commission plays with regard to the complaints procedure should be displayed in the home. There should be a current photograph of each staff member on their personnel file kept in the home. Certificates of training should be available for inspection in each staff members file. The system for reviewing the quality of care via the satisfaction surveys should be improved to include the date on which the review took place and details of any action taken, as a result of issues raised. 2 9 3 16 4 5 6 27 29 33 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). 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