Care Home: Two Gates House

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What the care home does well This random inspection was conducted with full co operation of the registered manager and provider. Proactive improvements had been made to the environment, such as new carpets, redecoration and attractively rear landscaped garden. The home was clean, free from offensive odours, appropriately decorated and well maintained with good quality furnishings and furniture. People living at the home told us food was good and staff were caring and friendly. The staff were friendly and made efforts to talk to people living at the home in a reassuring manner and at a level and pace that people understood. Recruitment and selection procedures were robust and safeguard the people living at the home. What the care home could do better: There must be closer liaison with health and social care professionals during the assessment process in order to obtain information, so they have details about people`s past medical history and assessed needs. Care plans and risk assessments must be comprehensive with details about the support people require, so care is person centred and each person`s needs are met in a consistent manner. Daily records must be more detailed and accurately reflect care provided and identify concerns and people`s health, social and psychological welfare, to ensure effective monitoring. The pressure settings on pressure relieving mattresses should be recorded in care plans and diligently monitored so that they are effective and comfortable for people needing touse them. Weight loss must be carefully monitored and fluctuations must be investigated. Records of health and social care professionals visits should be on a separate sheet and include the reason for the visit and outcome, so that care can be monitored and followed up effectively. The assessments of risks related to falls and use of bedrails must include all risks associated with the person and consideration should be given to all measures to minimise the risks. Staff appropriate training relating to the health conditions of people living at the home to enhance their knowledge and understanding of peoples need`s and ensure each person is supported effectively. The medication system must be improved to ensure safe storage and administration so that people receive their medication prescribed as prescribed by their doctor. Staff supervision and competency assessments should be undertaken regularly, so that staff receive the appropriate support, development and direction to provide good quality care for people living in the home. The quality assurance systems should be developed further with the development of audits, meetings etc, to improve the process of feedback and continuous development. Random inspection report Care homes for older people Name: Address: Two Gates House 42-44 Two Gates House Two Gates Lane Colley Gate Halesowen B63 2LJ one star adequate service 26/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Edwards Date: 0 9 0 6 2 0 1 0 Information about the care home Name of care home: Address: Two Gates House 42-44 Two Gates House Two Gates Lane Colley Gate Halesowen B63 2LJ 01384567448 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Reshma Wellington Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wellmun Care Limited care home 28 Number of places (if applicable): Under 65 Over 65 28 28 dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 28 0 2 6 0 6 2 0 0 9 The home is a large, detached; two storey building that has recently been extended. It is situated two miles from Halesowen town centre and is within walking distance of local shops. There is off road parking to the front of the building with a large garden to the rear that has recently been landscaped with patio and seating for use when the weather permits. They provide care and accomodation for elderly people who require support. The service does not provide nursing care. Accommodation comprises twenty six single bedrooms and the majority of them have en-suite facilities. There are Care Homes for Older People Page 2 of 19 Brief description of the care home two bathrooms on each floor; two have assissted baths and two have showers, so people have a choice of bathing facility to meet their needs. There are two lounge/dinging areas on the ground floor providing people with a choice of areas to sit. A passenger lift enables people to access all areas of the home and the home has a range of equipment to assist people with reduced mobility e.g. portable hoists, hand rails, toilet seats. There is a leaflet, service user guide, statement of purpose and web site providing inforamtion for people who are considering moving into the home. People are advised to contact the home for up to date information about fees. Care Homes for Older People Page 3 of 19 What we found: We, the Care quality Commission (CQC) undertook this random inspection visit to monitor standards of care at the home, which had been rated as Adequate at the last key inspection on 26 June 2009. This random inspection was unannounced, which meant the home was not given notice of our visit. We spent a day at the home and looked at the medication systems and health care records and how peoples healthcare needs were being managed. We also looked at how people were supported and given assistance to promote their health and well being. We looked at the management systems, including staffing arrangements, how complaints were managed and how people at the home were safeguarded. We briefly looked around the premises, including communal areas and a sample of bedrooms. We spoke to people who were able, and to staff and visitors. We observed interactions with people without verbal communication. At the previous key inspection a large number requirements were issued to improve medication systems. We looked at a sample of the medication held at the home. There were some improvements and some areas of good practice, such as a revised medication procedure, basic audits and photographs with the MAR (Medication Administration Records) charts, which reduced the risk of medication being given to the wrong person. However there was a lack of compliance with the previous requirements in some areas. We noted that not all staff administering medication had received accredited medication training and the staff signature sheets needed to be updated. The protocols for the administration of as and when needed (PRN) medicines were not sufficiently detailed. The protocols did not always correspond with the MAR charts. There were no care plans giving details of what would trigger the administration and no evaluations of efficacy of medication administered. This meant there was no assurance people received their medication appropriately to promote their health and well being. We also noted that some handwritten entries on MAR charts had not been signed and witnessed by two trained staff, which increased the risk of errors. There were a number of printed instructions on MAR sheets, which were as directed. These did not give sufficient guidance to staff working in the home and should be clarified with the prescriber or pharmacy provider. The bottles of liquid medication were sticky, as were some of the shelves in the drugs trolley. We discussed the need to maintain the drugs trolleys in a clean condition to maintain good standards of hygiene and infection control. We also recommended that internal and external medicines should be stored separately to avoid contamination. We saw opened containers of eye drops, labeled discard 28 days after opening, without a date of opening. This meant that medication could be administered after it had passed its safe date to be used. We also saw opened containers of creams in the drugs trolleys, which were past their use by date. Additionally liquid antibiotics, which were labeled to be refrigerated, were found stored in the drugs trolley at room temperature. We saw that two people had been prescribed powerful antibiotics, but the signatures and codes for non-administration on the MAR charts did not demonstrate that the medicines were administered in accordance with the doctors instructions. For example medicines prescribed to be given four times daily were sometimes only given once daily with codes Care Homes for Older People Page 4 of 19 for asleep or refused recorded at other times. There was no evidence these instances had been discussed with the manager or the persons doctor. One person also prescribed Nystatin oral drops had only received 18 doses over 10 days, instead of 30 doses prescribed over seven days but the MAR chart had been signed as course completed. This medication was usually prescribed to treat oral thrush, a painful condition in the mouth. We spoke to the relative who told us that the person, cared for in bed, was reluctant eat. The acting manager acknowledged that there were no short term care plans in place for the people requiring medication for limited periods. We looked at a sample of care records and noted that there was no oral care plan, where mouth care was required or evaluations to monitor infections had resolved. We noted that the staff were not always recording carried forward balances of medication stocks on the MAR sheets, which meant that the accurate auditing of medication dispensed in original containers could not be easily carried out. An example was Warfarin, where the MAR chart showed, 56 3mg tablets had been received and 24 signatures had been entered to indicate a dose had been administered but when we checked the stock of medication remaining there were 44.5 tablets in two containers. In addition the person should have received 1.5 tablets twice each week but the majority of entries did not show the variable dose. The provider was present and confirmed our findings. He investigated the discrepancies with a senior carer who stated that there was a carried forward balance of stock, which had not been recorded. There was no assurance that this person had received their anticoagulant medication to prevent blood clots as prescribed. This meant that there were no assurances that people were always receiving their medicines as prescribed by their doctor. The registered manager acknowledged that competency assessments had not been carried out to ensure staff training was adequate and staff were knowledgeable about the medication they were administering. We looked at the storage and administration of controlled drugs, which was generally satisfactory, with all records and balances of medication accurate. This meant that people requiring these powerful medicines were receiving them as prescribed by their doctor. However Fentanyl Patches prescribed for someone on 30 November 2009 but discontinued on 4 December 2009 had not been appropriately disposed of and were still stored in the controlled drugs cabinet. The temperature records for the rooms where medication was stored in drugs trolleys were not up to date. Furthermore the provider acknowledged there were no temperature records for the room where medication stocks and the controlled drugs were kept. There was no external ventilation for the room, which felt very warm. This meant that the providers were not demonstrating that medication was consistently stored according to manufacturers instructions, which could result in medication not being efficacious to maintain peoples health. Robust records must be maintained and an effective air cooling or air conditioning system should be considered. We looked at a sample of care records for people living at the home. At the previous inspection we had reported that each person had a care plan, which was a typewritten Plan of Action. These could be improved with specific detail to make them more person centred. They were updated by the registered manager retyping the entire plan of action each month, rather than recording regular monthly evaluations. This had been discussed at the previous inspection in June 2009. We looked at the care records for a person Care Homes for Older People Page 5 of 19 admitted to the home two days prior to the inspection. Although this was a planned admission there were areas of the assessment record where information was incomplete and there were no risk assessments or care plans in place. This meant that staff did not have sufficient written information and guidance to meet the persons needs. At the previous inspection we reported that risk assessments had been completed in respect of manual handling, tissue viability, (skin care) nutrition, falls and bed safety rails. At that time we noted that risk assessments for use of bed rails were general risk assessments and did not highlight the various aspects to be taken into consideration when considering bed rails for the safety of people in bed. The provider had subsequently been served with an Improvement Notice by the Environmental Health Officer relating to the safe use of bed rails. The provider assured us that the Environmental Health Officer was satisfied with compliance at a recent visit to the home. The provider had removed the majority of bedrails and there were only one set of bedrails in use for a frail person cared for in bed. Although risk assessments relating to bedrails had improved not all aspects of risks relating to each person were included. For example, though extra height bedrails had been provided and bedrail bumpers were in place, we were told by the relative of the person in bed that she was frequently found with her legs over the bedrail. This was not recorded as part of the risk assessment. Similarly there was insufficient evidence to show what other control measures, such as lowered beds, crash mats, had been considered for other people at risk of falling where bedrails were not used. We saw that people had access to health care professionals such as GPs, dentist, ophthalmic and chiropody services. We saw that district nurses were involved in the care of people with pressure ulcer wounds. However the homes daily records did not adequately show how staff were providing appropriate care for people vulnerable to pressure ulcers or diabetes. We saw a risk assessment scored at high risk but did not identify the person had pressure ulcers. The generic risk assessment recorded pressure relieving mattress and cushion at all times, but did not specify what sort of pressure relieving mattress or cushion or how they should be monitored and checked. The persons nutritional risk assessment was scored low risk, although there was recorded weight loss. District nurses notes advised to go to bed for 2 hours each afternoon, position changes during day every half hour, night staff to do two hourly checks. There was no record to show position changes. The registered manager acknowledged that there were no change of position charts or detailed food and fluid charts for people with pressure ulcers, or at risk of developing skin damage or with poor appetite or weight loss. We looked at a sample of pressure relieving equipment including overlay and replacement mattresses provided for people at risk of pressure damage to their skin. Risk assessments were not sufficiently robust to ensure that the mattresses were used appropriately. Examples were pressure settings on pressure relieving mattresses were not recorded and were not generally understood. We saw a pressure setting for 110kg on an AlphaExcell mattress but the persons body weight was around 44kg. This meant that the mattress might cause discomfort and not be effective in preventing tissue damage. We heard another person complaining about back pain and not sleeping because of their mattress, which was very uncomfortable. We viewed the bed with the registered manager and noted that the mattress, which was an overlay to be used with the existing mattress, Care Homes for Older People Page 6 of 19 had been placed on the bed base constructed of wooden slats. We were told that the person had complained that the bed was too high with the original mattress and the overlay mattress. The management need to offer other alternatives to this person and discuss the pressure relieving arrangements with relevant health care professionals. We noted that generally for people with fluctuating weight advice was sought from the doctor and community dietician. The registered manager told us the staff had not received specialist nutrition or diabetic training and acknowledged that additional training would be beneficial to enhance skills and knowledge, improving the care for people with poor nutrition or diabetes. We heard people in the new wing make requests for water to drink at least three times during the inspection visit. We asked the provider if cool drinks were routinely offered or made available for people to help themselves. He acknowledged water and other cool drinks were not routinely left available but stated they would be in future. We discussed discrepancies in records with the registered manager, such as information in risk assessments evaluated at low risk and weight records showing weight loss or pressure damage, which indicated high risks. She acknowledged that recording should be more diligent and consistent. We noted that when people could no longer be weighed there was no alternative method used to monitor their weight. We recommended that an alternative method of weight monitoring should be used, such as the Malnutrition Universal Screening Tool (MUST) and the Mid Upper Arm Circumference (MUAC) should be measured when people are unable to be weighed. We saw that there were records of daily routine preferences such as rising and retiring on individual care files and generally people we spoke to confirmed that they had choice in their daily routines. However we were shown records of a weekly bath rota with everyones names on a communal sheet. This method of record keeping was not compliant with the Data Protection Act and did not give sufficient information about care provided for each person. There were individual daily note sheets, which provided space for hourly observations, with sections for fluids and meals, bowels, GP, nurses, hospital visits and weight and BMI, but on a sample of records looked at, entries were very basic with most sections circled No and they were not signed by the person completing the entries. Three records for people with poor appetite, weight loss or pressure ulcers had no meals or fluids recorded for the whole of the previous day. The evidence to show each person had access to appropriate professionals was difficult to find and evaluate because a communal record of professional visits was used. This method of recording personal and sensitive information did not demonstrate compliance with The Data Protection Act and did not show appropriate action in relation to the good practice recommendations made at the previous inspection in June 2010. We also noted a letter dated 2009 from the GP on one persons care records relating to high blood pressure and the need for blood tests for cholesterol and kidney function. There was no indication as to whether the blood tests had been organised or whether there were any results. The registered manager was unable to confirm whether the requests in the letter had been actioned. Care Homes for Older People Page 7 of 19 Although the registered manager told us that tissue viability training was planned for staff to attend in July 2010, in response to the previous good practice recommendation that staff should be given training in respect of tissue viability and health conditions to enhance their knowledge and understanding of peoples needs, it was evident that further training and development was needed. We saw that people looked well presented and were dressed appropriately according to their preference. There was good interaction between staff and the people living at the home, with conversation at a level and pace appropriate for each person. We saw recent reviews conducted by social workers. The majority of comments were positive and included, staff are pleasant and treat X with respect; more than happy with care at Two Gates; always smartly dressed and well presented. People living at the home were complimentary saying, the food is very, always a choice, staff are helpful. We looked at the homes systems to deal with complaints. We saw that there was a complaints procedure displayed in the home included in the Service User Guide and displayed in each bedroom. The registered manager told us that there had been two complaints in the last 12 months, with issues such as, being kept waiting for attention. The complaints had been appropriately investigated and the registered manager had written to the complainants. We recommended that the letters of outcome should offer complainants a timescale to express satisfaction and contact details should they remain dissatisfied. The registered manager told us there had been two safeguarding referrals in the past 12 months, which had been resolved. We also discussed two further safeguarding alerts made by healthcare professionals relating to people with pressure ulcers requiring hospital admissions. The registered manager offered assurances that improvements were being made in accordance with professional advice. We saw evidence that district nurses were now involved in the care of each person with any pressure damage at the home. However the manager and staff did not always have detailed and accurate information about the pressure ulcer wounds and treatment plan. This is an area of communication, which should be improved. The home had policies and procedures to inform staff about abuse and responsibilities for reporting suspicions or incidents. All staff were receiving safeguarding training, mainly from the Local Authority training provider, so that they understood the lead agencys procedure Safeguard and Protect to protect vulnerable adults. We looked briefly around the premises and noted maintenance was being carried out to acceptable standards. There were improvements such as ongoing redecoration and provision of new furniture, as it became necessary. The providers told us about the improvements made since the last inspection; these included, new carpets and some new furniture, the exterior of the home and lounge had been redecorated, the rear garden had been landscaped and looked attractive, with paved areas and seating, a new Television and Nintendo WI and had been purchased, the menu had been revised following feedback from people living at home, now offering two daily choices at mealtimes. There was a new website providing comprehensive information for people wishing to know about the home and the provider was planning to install wireless internet Care Homes for Older People Page 8 of 19 connection, with a view to having a laptop for people in the home to use to keep in touch with relatives particularly if they live a distance away. We saw that there were 27 people accommodated at the home, on two units, with a range of diverse needs. We looked at copies of staff rotas and discussed the staffing levels with the registered manager in relation to occupancy and dependency levels. She was able to give us information about the people accommodated, to identify what their diagnosed conditions were and confirm the numbers of care staff to meet their needs. There were four care staff, including a designated person in charge of each shift from 7am to 9pm, with support from the manager, cook and cleaner during main part of the day. At night there were two waking care staff, with one person designated to be responsible for the shift from 9pm to 7am. We noted that though the managers name was on the staff rota there were no recorded hours for her shifts. The registered manager told us that there were 10 care staff with an NVQ 2 Award with five more staff undertaking NVQ level 2 training and two senior carers undertaking NVQ level 3 training. We looked at a sample of two personnel files of staff recently employed. The files were well organised with a recruitment checklist. The recruitment process was robust and provided safeguards for people living at the home. The Registered Manager, Reshma Wellington told us she qualified as a social worker in 2002 and had experience of care homes. She holds the National Vocational Qualification Level 3 in Care and is currently undertaking the Leadership and Management Skills Award; she informed us this should be completed by the end of 2010. Mr and Mrs Wellington own the limited company Wellman Care Ltd trading as Two Gates Care Home and the company has been registered as the provider since June 2006. Mr Wellington had started to undertake quality assurance checks and audits, particularly the management and administration of medication. He acknowledged our findings and informed us that though his audits had identified some areas where improvements were needed more effort was required to achieve compliance with regulations. The registered manager told us she had informal meetings with small groups of staff. There were no formal staff meetings or minutes for effective communication. There were no residents or relatives meetings. The registered manager told us that relatives were invited to care plan review meetings, though no-one had attended to date. The fire safety records appeared satisfactory and we noted that there were fire drills and additional fire training was planned for July 2010. We looked at the accident records and noted that there were 37 recorded accidents involving people living at the home since March 2010. We noted that there were people who had repeated falls, though we were told two of these people were no longer at the home. The registered manager acknowledged that there were no documented analysis and evaluations. This process would highlight trends and identify risks and should be used to revise and update individual risk assessments to control or minimise hazards. She told us that she had monthly care planning meetings with seniors and accidents were reviewed informally. However from our brief evaluation we noted that a high number of accidents were reported during the very early morning hours and there was no evidence Care Homes for Older People Page 9 of 19 that this had been recognised or investigated. As previously highlighted the records regarding pressure ulcer care were not sufficiently detailed, such as information about the grade of the wounds and preventative measures. As a result appropriate Regulation 37 notifications had not been made to us. Furthermore Regulation 37 notifications were not submitted for medication errors or for people requiring investigations or treatment at hospital via the Accident and Emergency department, particularly in relation to accidents at the home. At the previous inspection in June 2009 we recommended that self auditing and evaluation should be reviewed, so that areas of improvement could be identified with appropriate action plans put in place to demonstrate a proactive approach and continuous development. As highlighted throughout this report to there were insufficient assurances of robust quality assurance systems to ensure that each person living at the home was receiving care to meet their needs in a consistent and person centred manner. What the care home does well: What they could do better: There must be closer liaison with health and social care professionals during the assessment process in order to obtain information, so they have details about peoples past medical history and assessed needs. Care plans and risk assessments must be comprehensive with details about the support people require, so care is person centred and each persons needs are met in a consistent manner. Daily records must be more detailed and accurately reflect care provided and identify concerns and peoples health, social and psychological welfare, to ensure effective monitoring. The pressure settings on pressure relieving mattresses should be recorded in care plans and diligently monitored so that they are effective and comfortable for people needing to Care Homes for Older People Page 10 of 19 use them. Weight loss must be carefully monitored and fluctuations must be investigated. Records of health and social care professionals visits should be on a separate sheet and include the reason for the visit and outcome, so that care can be monitored and followed up effectively. The assessments of risks related to falls and use of bedrails must include all risks associated with the person and consideration should be given to all measures to minimise the risks. Staff appropriate training relating to the health conditions of people living at the home to enhance their knowledge and understanding of peoples needs and ensure each person is supported effectively. The medication system must be improved to ensure safe storage and administration so that people receive their medication prescribed as prescribed by their doctor. Staff supervision and competency assessments should be undertaken regularly, so that staff receive the appropriate support, development and direction to provide good quality care for people living in the home. The quality assurance systems should be developed further with the development of audits, meetings etc, to improve the process of feedback and continuous development. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 11 of 19 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 All creams and eye drops must be dated on opening and discarded within appropriate timescales. To reduce the risk of cross infection. 27/07/2009 2 9 13 Staff must record the 27/07/2009 amount of medication at the beginning of each month. So that auditing of medication can take place. To ensure robust medication systems are in place 3 9 13 Staff must ensure the accurate administration and recording of all medication. So people receive the medication prescribed for them. 27/07/2009 4 9 13 Two staff must countersign all handwritten medication details. To ensure a robust checking system is in place and people receive the correct medication. 27/07/2009 Care Homes for Older People Page 12 of 19 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Each persons needs must be 01/07/2010 assessed by a competent person, be kept under review and be revised at any time as necessary in relation to any changes. This is to promote the health and welfare of each person. 2 7 15 To ensure that there are 01/07/2010 health care assessments, risk assessments and care plans, which include all of each persons assessed needs, the active involvement of the person / or representative; and are updated to accurately reflect all changes to health and needs. This is to promote the health and welfare of each person. 3 8 12 To ensure that special care records such as food, fluid balance charts, turn charts, and wound care records are maintained, with care provided appropriately recorded and monitored and 01/07/2010 Care Homes for Older People Page 13 of 19 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action updated. This is to promote the health and welfare of each person. 4 9 15 There must be care plans in place for the administration of as and when medication and staff must monitor and inform relevant healthcare professionals as needed. This is to safeguard each persons health and welfare. 5 9 13 All medicines must be stored 01/07/2010 within the temperature range instructed by the Manufacturer to ensure that medication does not lose its efficacy or become contaminated. This is to safeguard each persons health and welfare. 6 9 13 There must be appropriate and safe disposal of controlled drugs no longer required in timely way. This is to ensure controlled drugs are handled in accordance with Legislation 7 9 13 To ensure that all staff who administer medication are assessed as competent and their practice must ensure that people living at the home receive their medication safely and correctly. 01/07/2010 01/07/2010 01/07/2010 Care Homes for Older People Page 14 of 19 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure that the people who use the service are safeguarded. 8 9 13 To ensure that all persons 01/07/2010 living at the home receive their medication as prescribed by their doctor and the Medication Administration Records must be accurately completed to demonstrate either medication has administered or an appropriate code entered to record the reason for non administration. This is to promote the health and welfare of each person. 9 9 13 The records of the receipt, 01/07/2010 administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. This is to promote the health and welfare of each person. 10 37 37 The management must 01/07/2010 ensure notifications are submitted to the Care Quality Commission of any incident that has affected the health, safety or wellbeing of the people at the care home, without delay. This includes serious accidents, pressure ulcers and medication errors. This is to safeguard the Care Homes for Older People Page 15 of 19 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action health, well being and safety of people living at the home. 11 38 13 Individual risk assessments 01/07/2010 must be reviewed and revised where necessary to include all risks associated with the person and show all control measures, have been considered. This is to safeguard the health, well being and safety of each person living at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Records of health and social care professionals visits should be on a separate sheet and include the reason for the visit and outcome, so care can be monitored and followed up effectively. This is a previous unmet Good Practice Recommendation. Daily records must clearly indicate follow up of concerns and peoples health, social and psychological welfare. This is a previous unmet Good Practice Recommendation. Advice from the diabetic specialist nursing service should be sought for any person with diabetes, living at the home, with records of screening, support and advice offered and that a record be maintained of staff training in relation to diabetes. The correct pressure setting for pressure relieving mattresses should be recorded in each persons care records with regular documented checks. Moving and handling risk assessments should reviewed and expanded to include instructions for the level of assistance and named equipment required for all transfers. Page 16 of 19 2 7 3 8 4 8 5 8 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 8 To ensure that people with poor nutritional intake and / or weight loss are monitored using a recognised screening tool as frequently as required by their risk assessment and care plan. Staff should be given training in respect of tissue viability and health conditions to enhance their knowledge and understanding of peoples needs and ensure they are met effectively. This is a previous unmet Good Practice Recommendation. An up to date medication reference guide such as the British National Formulary (BNF) should be available to staff. Internal and external medicine should be stored separately to avoid contamination. The management should seek clarification with the prescriber or pharmacist of as directed dosages on the MAR charts, as this does not give sufficient guidance staff as to how to administer medication. The medication policy for refusal of medication should be expanded to include a time limit, after which advice should be sought from the persons doctor. Carried forward stocks of medication should be recorded on each persons MAR sheet and random audits of medication stocks should be carried out, with recorded remedial action for any discrepancies. There should be an up to date specimen staff signature list for the administration of medication and that staff should sign and date the homes medication policy to demonstrate their awareness and compliance. Staffing should be kept under review to ensure that at all times suitably qualified, competent and experienced persons are on duty in sufficient numbers to meet the needs and promote the health and welfare of each person using the service. The registered managers hours should be recorded on the staff rota to demonstrate there is adequate managerial time to provide leadership, support and monitoring to make sure each persons needs are met effectively and their health and welfare is safeguarded. Page 17 of 19 7 8 8 9 9 10 9 9 11 9 12 9 13 9 14 27 15 31 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 16 33 Serious consideration should be given to implementing more effective communication systems such as regular staff, resident and relatives meetings with minutes made available for people unable to attend. The quality assurance systems should be developed further with the development of audits, meetings etc, to improve the process of feedback and continuous development. This is a previous unmet Good Practice Recommendation. Record keeping should demonstrate compliance with the Data Protection Act and give sufficient information about care provided for each person. Regular documented accident analysis should be implemented to ensure that accident records are fully completed, with the unit clearly identified and risk assessments are reviewed and revised in accordance with any changed needs. 17 33 18 37 19 38 Care Homes for Older People Page 18 of 19 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 19 of 19 - 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. 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