Care Home: The Old Vicarage

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well The home cares for the residents in a person centred way with each resident known well and their likes, dislikes and preferences documented. Every resident seen appeared well groomed and chatty. Plenty of smiles were observed and those who were spoken to and comments received from surveys all say positive remarks about the care, food and staff at this home. The home has a number of long term staff who are key workers and know their residents well. This is also mentioned by the residents who have a good rapport with the staff. Meals are enjoyed by a number of residents but a choice at meal times would improve this part of the service further. The home is good at celebrating special events and birthdays with residents reflecting with us the events that happen on these special days. The health and medication in the home is well managed and residents health needs are shared timely and appropriately with the outside health professionals. The staff team works well with this local health team and have developed their own skills in health needs of the residents such as wound care and catheter care. The Manager audits the medication in the home on a monthly basis and deals appropriately with any discrepancy. What has improved since the last inspection? More is trying to be done to stimulate residents with trips out held during the better weather last year and more social history and social care notes placed in the persons care plan to encourage activities. The decoration and refurbishment throughout the home is improving the environment for residents. The old shed outside has been replaced by a new one to house freezers and electric buggies. Old furniture has been removed in some rooms and new has been purchased. Some areas have had new carpets with further areas planned for replacement during 2010. The systems for staff rotas has been improved with records easily available. Staff now have development files to record supervision, appraisals and store training certificates. There is now a fire assessment in place for the whole building and fire requirements are up to date following the Fire Officers visit. The Manager has gained her Registered Managers Award completing the work and receiving her certificate in July 2009. What the care home could do better: The home needs to improve the monitoring of systems and equipment in the home to ensure health and safety for residents and staff is protected. Some form of training matrix would help the Manager keep up to date with staff training and ensure all topics that are mandatory are completed. Residents own money needs to be managed well and records robust to ensure no mistakes can happen. Key inspection report Care homes for older people Name: Address: The Old Vicarage Warren Road Hopton On Sea Great Yarmouth Norfolk NR31 9BN     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: Ruth Hannent     Date: 1 5 0 1 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 28 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 28 Information about the care home Name of care home: Address: The Old Vicarage Warren Road Hopton On Sea Great Yarmouth Norfolk NR31 9BN 01502731786 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Estateband Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The total number of people accommodated shall not exceed twenty (20). Twenty (20) older people of either sex may be accommodated. Two (2) older people who have dementia and are named in the Commission`s records may be accommodated. Date of last inspection Brief description of the care home The Old Vicarage is in the village of Hopton-on-sea, between the coastal towns of Great Yarmouth and Lowestoft. It is sited in the centre of a holiday caravan village that is densely populated at certain times of the year. There are local amenities and the beach within walking distance of the home and a public transport service that provides a link to the main towns. The home is a two storey detached Georgian house with a newer extension. It provides Care Homes for Older People Page 4 of 28 Over 65 2 20 0 0 1 1 0 2 2 0 0 9 Brief description of the care home residential care and accommodation for up to twenty older people. The home stands in its own grounds of approximately two acres mostly laid to lawn, which is partially accessible to the front of the home. There is parking to the front of the home. There is a passenger lift to the first floor to make access easier for people. There are three lounges of different sizes, a dining room, two bathrooms containing adapted bath, washbasin and toilet on each floor, two toilets on the ground floor and one toilet upstairs. There are nineteen single and one double bedroom. The range of fees is from up to £370 per week for a single room. There are additional charges for private chiropody, hairdressing, newspapers or personal spending. There is an additional charge for some outings and for staff escorting people to the hospital or local surgery. This is all set out in the guide to the home. Care Homes for Older People Page 5 of 28 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: This Key Inspection took place using evidence gathered from information sent prior to the visit and evidence gathered at the visit to the home. The Manager had completed an AQAA (Annual Quality Assurance Assessment) that gave us information about the service. This document tells us what the home does well, what they could do better and what has improved over the past 12 months. We also received information from surveys that had been completed by 5 relatives, 5 residents, 1 health professionals and 3 staff. We looked at notifications that had been sent to the Commission throughout the year and any other information that may be relevant. The visit to the home took place over 6.5 hours where reports, records and documentation was looked at, residents and staff were observed and spoken to and a tour of the building took place. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to improve the monitoring of systems and equipment in the home to ensure health and safety for residents and staff is protected. Some form of training matrix would help the Manager keep up to date with staff Care Homes for Older People Page 7 of 28 training and ensure all topics that are mandatory are completed. Residents own money needs to be managed well and records robust to ensure no mistakes can happen. 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does offer information about the service,assess potential residents needs and has a trail period to enable the person to decide if the home is able to manage their needs. Evidence: During this inspection visit we walked around the home and noted the most recently updated Service Users Guide in each bedroom that had been completed in 2009 with all the up to date information added to the document from the kind of care and support offered to the fees charged or how to make a complaint. This document was in large bold print and in plain English making it an easy read. In the staff office the care plans are stored and a most recently admitted resident had a pre-assessment document in the care plan file giving brief details on the kind of support and care this person would require. The information written was enough for the home to make a judgment on these requirements and assured they could meet Care Homes for Older People Page 10 of 28 Evidence: the needs. On walking around the home and meeting a number of residents no-one appeared inappropriately placed. Each new resident has a trail period and noted was the 4 weekly review carried out by the Social Worker, resident and home staff before the person is made permanent. Although not looked for during this inspection the residents tell us in their surveys that they do have a contract and the Manager informs us in the AQAA that all residents have a contract of the terms and conditions of the home. The home does not offer an intermediate care service. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home have improved the records on care plans, health care details and medication. Consideration needs to be given with what conversations are appropriate when staff are on duty. Evidence: Each resident has a care plan with information about the care required. Four of these care plans were picked at random and inspected. The pre-assessment of need, risk assessments documented when a need is identified, personal, health and social support records and charts to monitor residents such as the MUST tool, fluid intake and weight charts were all listed. One concern, sent through on a survey form by a family member was of the lack of choice for meals and the possible weight loss of their relative. All weight charts were seen in the four care plans and all weights were static or rising slightly. On discussion with the Manager it was evident that the staff keep a close eye on food intake by residents and with training certificates seen and details discussed with staff about their recent training in nutrition there does not appear to be a concern about dietary requirements. There was no evidence found that a resident was losing weight. Care Homes for Older People Page 12 of 28 Evidence: The health care needs are supported by the local GP practice with District Nurses attending regularly for both dressings and to administer insulin. The home is working with these nurses to improve their knowledge in health and are due a session on diabetes shortly. The GP had returned a survey with comments such as, the home communicate well with the surgery and provide individual care. It was noted in the diary and also in care plans, dates for specialist appointments and records written in the daily notes of any interaction by the community medical team. One resident was receiving care in bed and although this person had been very unwell was now recovering. The District Nurse commented during our inspection visit how much the home had been offering good care for this person as they had not expect an improvement. The medication in the home is locked in the office with a separate smaller secure cabinet for controlled drugs. This medication was checked and corresponded with the controlled drugs record. Medication administration charts were also checked and all signatures were in place for the last 4 week period. Each person now has a photograph in front of these charts and detailed clearly is their name, date of birth and any personal allergies. One small area of concern was shared with the Manager over the details written by the pharmacist on the two days a medication should be given. Listed was Tuesdays and Thursdays yet the days written on the chart were Tuesdays and Saturdays. It was also noted that the night medication for one person had been recorded as not given on the front of the chart three times but the reason why, which should be recorded on the back of the chart, had only been completed on one occasion. The returned medication is recorded and the pharmacist signs the documentation. Staff informed us that they recently completed a medication training and all areas of the medication room were neat and tidy with temperature charts noted to have been completed daily for the room and fridge readings. The AQAA informs us of the regular monitoring of the medication process and that a full audit is carried out and recorded on a monthly basis. Throughout the day the staff were noted to be interacting well with residents and respectfully knocking on bedroom doors before entering. Residents comments on surveys and told to us on the day of this inspection tell us that the staff are kind and supportive. I never have to wait long for help and they are a caring staff team were some comments mentioned. A couple of relatives did comment that the conversations were sometimes a little inappropriate and this was shared with the Manager who believes the staff member this refers to may have left and hopefully the existing staff both when talking with other staff or to a resident are conscious of who may be listening. Care Homes for Older People Page 13 of 28 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 home does try to promote activities but staff work more on a one to one basis to met the social needs of the residents and try and encourage friends and families to be involved. Although meals are good the offer of choice at the time of eating is not obvious. Evidence: Although the AQAA states that daily activities take place there was nothing planned on the day of this inspection visit. The residents appeared content, smiling, holding conversations and singing with each other. There was little stimulation offered during the afternoon. The staff, on asking, state they do ask the residents to take part in different activities but often find resistance. There are plenty of photographs to see of special events that do take place and through the summer the home did have trips out. Only the day before this visit the home held a party with a buffet for a resident who was 101. It was noted how entertaining and how much enjoyment was taken from the resident dog who appeared in the lounge. Conversation and smiles with lots of petting took place and involved everyone. The Manager showed us a detailed social history for a couple of the residents and then Care Homes for Older People Page 14 of 28 Evidence: a list of ideas to use to prompt interaction with the residents with day to day activities. The home is trying to encourage residents but state it is not always easy. Although planned activities are not always happening the residents appeared happy. One person talked and showed us her daily diary, another showed us what they were reading and three others were having a sing song. I play scrabble sometimes and I like going out with my family was one comment and surveys received prior to this visit had three people saying they always have activities with one saying sometimes. It was noted in the daily records written by the staff that social support is beginning to be recorded and details on the persons wellbeing was being considered. The AQAA tells us that two residents attend a club outside the home and that three residents have mobility scooters and will go out in the better weather. According to the Manager visitors are welcome and this was echoed by the residents who say we have special days when families are invited and anyone can visit anytime. The signing in visitors book has been completed regularly by visitors to the home and a few relatives have completed the surveys with the residents. On the day of this visit the meal was fish and chips with mushy peas followed by bananas and custard. Although there was no choice offered on the day, according to the Manager, residents can have an alternative if they require with eggs and ham available on this particular day. An example was given of a person who does not like chips so mashed potato was given. The meal observed was offered in suitable sized portions according to the likes of the residents. Residents comments in the surveys state good meals and varied diet. There was a choice of various juices with the meal and some people chose to eat in their room. It was noted that one resident was taking ensure drinks to compliment the small intake of food and the slow improvement in the diet intake was seen written in the daily records. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents and families now have access to the procedure in easy read format on how to complain if they so wish. Procedures are in place and staff have the knowledge to ensure residents are protected from abuse. Evidence: The home, until recently, had not made it clear for residents and families on how to complain if they were unhappy. This was also mentioned in some surveys received from relatives back in September 2009. The Manager has now placed a new brochure in each residents room that has clear information on how to complain. Residents say they know who to talk to if they have any concerns and have no problems in talking with the Manager if they wish. The Commission has not received any complaints and nothing has been recorded in the home. The Manager informs us that she has an open door policy and anyone can discuss their concerns at anytime. This is also mentioned by the residents when having a conversation after lunch on the day of the inspection. I have no problem in talking to Jill or any of the girls if I have a concern was stated. The staff spoken to during this visit talked of the training offered by Norfolk County Council on The protection of vulnerable adults. The certificates were seen of two staff and both these carers were able to talk about the possible signs of abuse. Each new staff member completes a CRB disclosure form and the home does not allow them to Care Homes for Older People Page 16 of 28 Evidence: work with residents until this clearance and 2 adequate references have been returned. The latest staff recruited, personnel files were checked for these papers and all were in place. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, bright and homely with areas of refurbishment that make it comfortable. The safety of some areas such as water temperatures need to be improved. Evidence: The home is a converted older property that has many different sized rooms. There are three lounges, two of which have recently been refurbished with new decor, chairs and carpet. Some corridors and bedrooms have also had new carpets and the Manager informs us more carpet is due for corridors where staining has occurred. Outside of the property there is a garden that is not so suitable for walking in due to the uneven ground and would benefit from a nice terrace patio for easy access for residents in the good weather. The Manager has on site a skip so all the replaced chairs from the lounges and some bedroom furniture can be disposed of. There is also a new shed in the grounds that is now used to house the freezers, vegetables and two of the electric scooters. The original shed, that was part of the requirement in the last inspection, is now not used and will be removed in the next year. The week before this inspection visit (13/01/10) the home had received a visit from the fire safety officer who had three action points to be achieved. These were extra Care Homes for Older People Page 18 of 28 Evidence: hinges on the front door, more running men on fire exits and the servicing of the fire extinguishers. All these actions were carried out by the Manager immediately with the extinguishers serviced the next day and the last of the running men on exits being placed by the handyman on our arrival for this inspection. The fire safety certificate is now on display. The Manager has also completed the fire risk assessment for the building which was checked by the fire safety officer and found correct. Although the home does not have en-suite facilities there are adequate bathrooms and toilets to cater for the needs of the 20 residents. Each room has a hand wash basin and for residents who require them a commode is placed in the room for night time use. Bath hoists are used and the home does have a mobile hoist but have no residents requiring this equipment at present. The individual bedrooms vary in size. In total ten room were looked at with everyone appearing clean, tidy and with fresh towels and flannels placed by the basins. Personal belongings were in the room making them homely and welcoming with photos, wall pictures and ornaments. Radiators are covered for safety and temperature control valves were on each one. Concern was shared with the Manager and also the handyman of the temperature of the water coming from the bathroom tap on the ground floor which was scalding to the touch when running and was only adjusted by a second tap used for the temperature control valve. There were no thermometers to check the temperature of the water and no records to show staff check the water temperature before each resident takes a bath. The home has no building maintenance book for checking regularly water temperatures nor other areas within the home such as emergency lighting. The Manager has created a file for all equipment that has received a service from outside contractors and seen were the work sheets/invoices for the gas, electric, fire, PAT testing. Care Homes for Older People Page 19 of 28 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 residents are cared for by a competent team who are qualified and trained to do their job but updates on some training would improve the service further. Recruitment is carried out correctly to ensure residents are in safe hands. Evidence: On the day of this inspection there were 4 staff on duty caring and cooking for 19 residents. One left at the end of the morning leaving 3 for the afternoon. During the night there had been 2 waking night staff with another new staff member shadowing. In the last inspection the copies of rotas could not be found. On this occasion the rota folder was clear with the past month showing each shift had been covered by the correct number of staff to care for the number of residents in the building. Comments from residents are positive about the care staff team and say they are helpful and friendly and they look after us very well. Many of the staff have worked in the home for many years. The 3 spoken to had all been working there between 6 and 10 years. They tell us that staff are encouraged and supported to achieve their NVQ 2 qualification with all but 4 staff holding this award and these 4, who are newly recruited, are now booked on the course. Certificates of all the staffs NVQ2 and NVQ3 are on display in the corridor. The 4 new staff have a personnel file that is held in a locked drawer in the office. Care Homes for Older People Page 20 of 28 Evidence: Three were looked at during this inspection. All three had the relevant paperwork and seen was the CRB disclosure certificate, 2 references, 3 forms of identification, application form and copies of terms and conditions. Induction documentation was in place with details written by the manager and the new recruit to evidence understanding during the induction process and will be used towards achieving the NVQ qualification. 3 staff were spoken to during this visit and discussions were held about the training and support offered, enabling them to carry out their duties competently. All 3 gave a list and showed us the certificates achieved of training and development. Certificates were seen of abuse awareness training, food hygiene, fire, MUST and dementia care. The home is also working closely with the District Nurse team and have already had sessions on wound care and catheter care with diabetes due shortly. A discussion was held with the Manager and Senior around the Mental Capacity Act training. Some staff have attended this course but due to the complexity of the subject a refresher in the home is required to be clear about this subject and needs to be booked. Some certificates were filed but some dates are showing that an update is required. The Manager has no training matrix which would be a tool to ensure staff do not slip through the net and miss training sessions. It was also noted that training certificates that were from a previous year were sitting on the Managers desk and should have been in order in a staff members file. A number of concerns on what staff wear has been mentioned on the surveys returned to the Commission and needs to be considered by the Manager who should ensure the staff are dressed appropriately when carrying out their day to day tasks. Care Homes for Older People Page 21 of 28 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 Manager has improved a number of systems within the home but further improvement is required around the monitoring of health and safety to ensure residents and staff are working in an environment that is as safe as possible. Staff are supported with induction, appraisals and supervision that is focused on the needs of the service provided. There is not a robust system for managing the residents money and this must be in place to ensure their financial interests are safeguarded. Evidence: This Manager has been in post for a number of years and has now gained her Registered Managers Award (Certificate seen of July 2009). The staff and residents tell us that this Manager is approachable and supportive in any issues that may arise and she tells us that she has an open door policy and will listen and act on any concerns. She has a basic awareness of the National Minimum Standards and is using this Care Homes for Older People Page 22 of 28 Evidence: knowledge to develop the staff team in supervision sessions by including the NMS in the agenda for these 1 to 1 meetings. These are now planned regularly and evidence is now available in individual staff development folders where appraisals, supervision and training certificates can be found. The AQAA (Annual Quality Assurance Assessment) has been completed and does give us a reasonable picture of the service provided but has limited information on how the health and safety within the home is managed and monitored. No records are held for monitoring the building equipment such as water temperature checks to ensure the thermostatic valves are working, or checks on the working of emergency lighting if the power should fail. The handyman has no records of any building checks but the fire log of alarm checks was up to date and the building fire risk assessment is now completed as required at the last inspection. A discussion was held with the Manager over the quality assurance system used within the home. Although residents and staff have their say at meetings and do complete surveys, a full picture incorporating the views of stakeholders has not taken place nor has an annual development plan for the home been created from information gathered from all sources to improve the service delivered. On the day of this visit the residents personal allowance was checked and money from one residents plastic envelope was found to be missing. It was later discovered to be with the key worker who had the envelope signed and containing the money ready for shopping for the resident. This had not been recorded. Tighter systems should be in place to ensure residents money is stored, recorded and managed in a robust manner so mistakes cannot happen. The Manager does record all accidents and incidents and the records are held on file. Notifications have also been reported to the Commission as required by Regulation 37 on incidents within the home and these correspond with records held within the Commission. Improvements required from the fire officer, as mentioned previously have been acted on immediately and a certificate has been issued and is on display. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 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 19 23 All areas of building safety should be monitored and record held such as water temperatures Safety check records of all building equipment will ensure the home is protecting the vulnerable residents. 01/03/2010 2 19 23 Water temperatures should be checked by staff and records kept of the temperature of each bath. To ensure residents are getting into a suitably controlled water temperature of around 43 degrees 01/03/2010 3 33 24 The Manager should carry out an effective quality assurance monitoring system that will include all stakeholders. 01/04/2010 Care Homes for Older People Page 25 of 28 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 To review, develop and improve the service offered to residents. 4 35 16 A robust system should be in place to ensure mistakes cannot happen with the management of residents money. This will ensure that the system protects and safeguards the residents financial interests. 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 01/03/2010 1 2 9 9 If medication is not given the reason on each occasion should be recorded on the back of the MAR chart. The information written on the charts for residents should be followed fully or changed by the pharmacist such as the two days the medication should be given. The staff need to be aware of the conversations they are having within earshot of any other people in the home and ensure it is appropriate and correct. It would be advisable to show a choice on the daily menu that would offer a contrast with the main meal. The staff need to be dressed appropriately to enable the duties to be performed correctly. The Manager needs to ensure the staff have the understanding of the Mental Capacity Act and Deprivation Of Liberty. The Manager needs to consider a method to monitor and 3 10 4 5 6 15 27 30 7 30 Care Homes for Older People Page 26 of 28 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 plan in a timely manner the training for all staff to ensure training does not become out of date. 8 38 The manager needs to develop the recording systems for areas in health and safety to ensure the home is as free from risk as possible. Care Homes for Older People Page 27 of 28 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. 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. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!