Care Home: Ward House Nursing Home

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What the care home does well The service users are accommodated in a well maintained and homely environment that they say meet their needs. The meals at the home are well managed and meet with the service users` satisfactions. The staff and the service users have developed a good relationship with each other and the service users told us that care is provided in a respectful manner. What has improved since the last inspection? An activity programme has been introduced and some records of activities were available and this was being further developed. People identified as at risks of choking or had difficulty swallowing have been referred to the speech and language therapy team. Assessments have been completed and action plan is in place about how those risks will be managed. The service has in place a medicine cupboard for the storage of controlled medicine as required regulation since the last visit. The process for the recording and looking at complaints/ concerns have been developed and records were available. What the care home could do better: The care plans and assessments should be further developed to ensure that all care needs identified have a clear action plan on how these will be met. Some aspects of medication management are not satisfactory and may put people at risk of not receiving their medication as prescribed. The staffing level on night duty is not adequate in order to ensure they meet the service users` needs and care is provided safely. An immediate requirement was made at the time of the visit for the provider to address this. Key inspection report Care homes for older people Name: Address: Ward House Nursing Home 21 - 23 Alpine Road Ventnor Isle Of Wight PO38 1BT     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: Anita Tengnah     Date: 2 7 0 4 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. 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: Ward House Nursing Home 21 - 23 Alpine Road Ventnor Isle Of Wight PO38 1BT 01983854122 01983854410 matron.whl@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ward House Limited Name of registered manager (if applicable) Miss Catherine Johnson Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 23 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Physical disability (PD) Dementia (DE) old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Ward House is registered with the Care Quality Commission to provide personal and nursing care for up to twenty-three older people. The home has been converted from two older terraced properties to make one home. Accommodation is provided in thirteen single and five twin rooms, some with en-suite facilities. The home provides Care Homes for Older People Page 4 of 30 2 3 0 6 2 0 0 9 23 0 23 Over 65 0 23 0 Brief description of the care home pleasant and comfortable communal space and has an enclosed rear garden with extensive sea views. There is outdoor seating for residents to enjoy the garden and sea views in the warmer months of the year. Limited car parking space is available at the front of the home. The building is accessible and there is a passenger lift for residents to access the upper floors. Details of current fees are available from the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced inspection visit was undertaken over one day on 27 April 2010 as part of our inspection process and lasted six and a half hours. We sent out the Annual Quality Assurance Assessment (AQAA) to the registered person at the service. This is one of the means of collecting data from the service. We also sent out service users and staff surveys to the home to seek their views of the service provision. During the visit we spoke to a number of the service users and the staff. We looked at the environment, the service users records and care plans and some staff records as maintained at the service and we observed care practices. The inspection took into account the homes (AQAA), which arrived when we asked for it and was completed satisfactorily. The AQAA is a self assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We have looked at any other information that Care Homes for Older People Page 6 of 30 we have received since the last inspection. We have received a good response to our surveys from the service users and the staff and their comments will be included in the body of the report as appropriate. 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. There is an assessment process in place that supports people prior to moving into the service. There is no intermediate care faculty available at this home. Evidence: We looked at the process that the home has in place in relation to pre admission assessment as part of this visit. the manager reported that there has been only one new admission since our last visit. The record showed that the service user was assessed prior to admission and detailed information was also received from the previous home where the service user was transferred from. Staff stated that the service user was known to them fairly well as they had been a regular visitor to the service. Care Homes for Older People Page 10 of 30 Evidence: The AQAA states that the service users are provided with information about the home. Potential service users are invited to visit with family, giving them a guided tour of the home and inviting them to stay for a meal. The service continues not to provide intermediate care. 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 care plans and assessments were in place, however further development is needed to ensure that all needs are assessed and action plan put in place to meet those needs as required. Medicines management is not adequate to safely meet the service users needs. The service users are treated with respect when receiving care and support. Evidence: The care records of three service user were looked at as part of this visit. The home has introduced new care plans for the service users and most of these were near completion. The care plans were devised using a nursing model of assessments and care plans were then formulated. One area that has improved since the last visit was that people who were identified at risk of choking/ aspiration had been referred to the Speech and Language Therapist (SALT) team and assessments had been completed. These provided the staff with Care Homes for Older People Page 12 of 30 Evidence: details of the type of fluids and food such as thickeners to be added to fluids and soft/ pureed diets to ensure that people are not put at risk. The care plans for two of the service users contained information about how this risk would be managed and their dietary needs met. The service users records contained risk assessments such as falls and moving and handling and care plans were put in place. Care plans contained details of type of pads that were in use as part of managing continence and other information included hoist, glide sheets and number of staff for the moving and handling of the service users. However some of the care plans did not contain all the information needed to ensure that care can be provided consistently and safely. Two of the records showed that the service users have been assessed as at a high risk of falls, but there were no care plans to show how this risk will be managed. Another service users record did not contain a moving and handling assessment and other assessments such as nutritional needs and pressure areas risks. The manager was aware that these need to be developed in order to ensure that a person centred care plans can then be put in place to meet their assessed needs. Staff must ensure that risk assessments and care plans correlate so that care can be provided consistently. One record for a service user showed that they have been assessed as high risk for their nutritional assessment and the care plans indicated low risk. This was brought to the attention of the manager and rectified at the time. One persons record stated that they were independent and another record showed that they required a frame and one carer for mobilising. Continence management care plans should be further developed to include details of support and action needed in order for this to be managed effectively. We observed that the service users had been provided with fluids and the staff had failed to add the thickening agents to these as required. This was brought to the attention of the staff as immediate action was required. Staff must ensure that care practices reflect actions as detailed in care plans in relation to service users fluids that require thickening agents to ensure that they are not put at risk of harm. As part of managing the risks and prevention of pressure ulcers, the records seen showed that the home was using the Waterlow assessment tool and the service users were provided with pressure relieving equipments as assessed. We looked at the record of a service user who was receiving treatment for a pressure ulcer. A wound care plan had been developed and contained details of treatment. Care Homes for Older People Page 13 of 30 Evidence: The wound care showed that they were receiving care to a pressure ulcer and the type of dressing to be used. The plans stated that the wound needed to be reviewed daily, the records we looked at contained a gap of four days when there was no evidence of review/ change of dressing. We also looked at the daily record and this information was not available. This was brought to the attention of the manager at the time. Accurate information must be recorded in care plans following change/ review of wound dressing in order to inform practice and to ensure that the assessed care needs are met. We looked at the medication management that the staff undertook on behalf of the service users.The staff maintained a record of medication administered on the Medication Administration Record (MAR) charts. The manager confirmed that only the registered nurses were responsible for the management of the service users medicines. The home was required at the last visit to put in place a controlled drug cabinet that meets with current Regulations. This requirement has now been met. The MAR contained records of medication as received into the home, however it was lacking in some MAR charts seen. Although staff maintained some records of medicines administered, these were not adequate as the MAR chart records contained a number of gaps and did not demonstrate whether people had received their prescribed medication. The manager has developed a system of auditing the MAR records and has also identified these shortfalls and was looking at addressing these with the staff concerned. The records for the administration of antibiotics showed that there was a large gap in between the dosages administered and the manager has confirmed that the timing will be looked at so that they are administered appropriately. Medicines that are transcribed did not contain two signatures and care plans for as required medicines were not available and needed to be developed to provide consistency. This is to ensure that people receive their medicines when they need them and do not receive medicines when they are not required. This was identified in the last report following a pharmacy inspection that highlighted the need for more information to be provided for staff to support residents with any as required medication. Wound dressings were prescribed for individual service users as required. We observed that there were some prescribed wound dressings that were no longer in use and these have not been disposed of as required. The service also had a large box that contained miscellaneous dressings that need to be reviewed. The manager reported that an inspection visit was due from the primary care trust Pharmacist and Care Homes for Older People Page 14 of 30 Evidence: further guidance would be sought in order to ensure that medicines are managed safely. As part of this visit we sent out comment cards to people and we received a good response. We also spoke to six service users and visitors at the time of the visit. We observed that staff interacted well with the service users and they were treated with respect. Comments were that the staff marvellous and their dignity was always respected when receiving care and support. Some of the comments about what the service does well included: Care from staff. Medical supervision. Cleanliness. Friendly, welcoming and excellent staff. We are happy with Ward House for our relative. Residents are looked after quite well. Mostly staff are competent and friendly. Feed me and they always cook me something I will enjoy. They keep me clean. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity programme is in a development stage and needs to be sustained. The meals at the home are well managed and meet with the satisfaction of people living at the service. Evidence: The home provides a range of activities for the service users and according to people who we spoke to, this is an area that is being developed. Information and evidence of recent activities were available in the lounge and the service users notice board in the entrance hall. A monthly newsletter has been introduced that provided people with information of things that are forthcoming at the service. Some of the activities include games, hand massage, exercise to music, a visiting PAT dog, bingo, music, quiz, videos and films. The manager discussed that the home has introduced framed prints of the local area that will be used as part of reminiscing and encourage/ involve the service users to talk about these places of local interests. The home has employed an activity co ordinator and some records of activities have been developed including one to one time. There was no activities on the day of the visit as the staff member was away on leave. Care Homes for Older People Page 16 of 30 Evidence: Comments we have received included Ward House is striving to improve activities. This must continue. Other comment was that the home needed Better quality TV/ Video. Activities for bedridden service users. The home has an open visiting policy and a record of visitors as maintained at the service supported this. The service users are able to maintain contact with family and friends and visitors are welcome at any time. The relatives we spoke to said that they visited a few times a week with no time restriction. The service users told us that they enjoyed the easter party and relatives are involved in birthdays celebrations at the home. Another service user told us that they went out with their relatives and the manager said that another service user was supported by their relative and staff to go to the local public house as they wish. There is a monthly service and communion is also available. The staff also support the service users and provide an in house library service where books, DVDs and talking books are available. We observed the lunchtime meal on the day of the service. People we spoke to expressed a high degree of satisfaction with the meals provided. They told us that there is a choice of meals and the chef/ kitchen staff are always obliging and they are offered alternative meals as preferred. A service user commented on what the service does well was : Feed me and they always cook me something I will enjoy. The lunchtime meal was well presented and pureed meals were served separately. Meals looked appetising, well balanced and nourishing. The chef attended the dining room and meals were served from a hot trolley. It was evident that the staff were aware of the service users likes and dislikes including a service user who added wine to his soup. Staff were available to offer support with meals in a sensitive manner and meals were not rushed. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a satisfactory complaints process in place to ensure that any concerns are recorded and responded to appropriately. Training in safeguarding adults was available to the staff. Development of processes to include action plans following safeguarding investigations need to be put in place. Evidence: The home has a complaint procedure and a log of complaints/ concerns that have been raised with the service was available. The records showed there is process that staff followed in resolving any issues raised. The manager discussed that some of the concerns were not resolved as investigation were ongoing. The registered person is aware of its responsibility to report to the professional body any staffs misconduct as required. Information we have showed that there have been some concerns that had been referred to the safeguarding team and investigated as per safeguarding protocols. The registered person was kept informed of the investigation. The manager reported that the safeguarding team has closed their investigation following a visit in January 2010 and recommendations were made. There was no record of what action the home has put in place following the investigation in order to address these. The home must ensure that clear records of action plans are put in place in order to inform practice and protect the service users. Care Homes for Older People Page 18 of 30 Evidence: The provider has since responded to say that feedback regarding the safeguarding investigation was provided to them in February 2010 and they were excluded from the safeguarding meetings. The manager reported that five staff have completed training in safeguarding and more training is planned in May 2010 for ten other staff. The recruitment process was not always robust to ensure that people are not put at risk. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are provided with a warm, homely and clean environment that they say meet their needs. There is a satisfactory infection control process in place that the staff adhered to . Evidence: We looked at some parts of the home as part of this visit and this included a number of the service users bedrooms, lounge, dining area, kitchen and communal bathrooms. This showed that the service users lived in a safe and well maintained environment and had access to comfortable indoor and outdoor facilities. Residents have the specialist equipment they require to maximise their independence and the home was clean, warm and pleasant. Furnishing was of satisfactory standard and appropriate to the service users needs. These included specialist chairs that allowed the service users to get out of bed and join others in the lounge or stay in their rooms as per their preferred wishes. People we spoke to said that the home is always clean and fresh and that the staff work very hard to ensure that there is no odours. The bedrooms we saw during the visit indicated that the bedrooms were highly Care Homes for Older People Page 20 of 30 Evidence: personalised and it was evident that people are supported to bring with them items of their choice to make their bedrooms as homely as possible. The staff stated that the relatives are also involved in supporting the service users and bring pictures, flowers in. The AQAA states that the home has a very homely feel to it and they continue to decorate the home making it light and airy.They have a very stringent housekeeping team who maintain the clean and odourless home. There is an efficient laundry service for the residents clothing. They have a clear and concise infection control policy which all staff adhere to. The home has an infection control policy and procedure in place. There is an internal laundry in place that is situated away from the main area of the home. Staff practices observed at the time of the visit showed that they were aware and followed the infection control procedures. Protective garments were available to the staff and different type of aprons were used at meal times. Equipment such as wheelchairs were kept in satisfactory condition. Some of the service users we observed were provided with individual slings for use with the hoists. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a satisfactory staffing during the day duty hours to meet the current needs of the service users. However there is inadequate staff on night duty. Training programme is in development stage and needs to be sustained to ensure that staff are supported in their work. Evidence: The staff roster as maintained at the service showed that there was one trained nurse and four carers to provide care during the day duty hours. This also showed that night duty has one trained staff and one carer. The home has other staff such a housekeeping team and a chef, kitchen assistants, maintenance person, laundry assistant and activity coordinator who supported the care staff during the day. The home was accommodating 20 service users at the time of the visit and the staff reported that eighteen of the service users would require two carers in order to provide the care and support they required and meet their needs safely. We left an immediate requirement form due to the level of our concern to require that immediate actions are taken to ensure that the home has adequate staff to meet the assessed needs of the service users. We wrote to the provider following our visit to provide us with information/ action that he has taken to address this concern. We are Care Homes for Older People Page 22 of 30 Evidence: waiting for a response from the provider at the time of this report going out as draft. The registered person has since confirmed that an extra carer has been allocated on night duty. The people we surveyed and those we spoke to said that the staff were very kind and they were treated well. The staff were complimentary about the support that they received and said that they felt that they worked well as a team. Interaction observed showed that the staff and the service users had developed good relationship with each other. Staff reported that following assessments, more people were supported to get out of bed and although this was hard work, this had a positive impact for the service users. Comments from the staff were that an extra staff member in the morning would be beneficial as this was their busy time. The AQAA states that there is a training programme, recruitment process and two monthly supervision for all care staff. The induction process included the common induction standards and yearly staff appraisals. We looked at the recruitment records for three staff who had been recruited since the last inspection. We found that the staff completed an application form and references were sought as part of the recruitment process. Two of the staff records showed that checks such as criminal record bureau (CRB) and POVA first were completed as part of the recruitment. One staff member had commenced work prior to the full clearance checks and POVA first checks were received. The registered person is aware that all necessary checks must be completed prior to staff commencing work in order that people are not put at risk of harm. The manager stated that this person had been working under supervision, however there was no evidence/ supervision record available to support this. The home has put in place an induction programme for carers and for the domestic staff that has been adapted as per the common induction standard. The manager reported that some of the staff had completed this induction but we did not see any completed induction records during our visit as they were not available. A training programme has been developed in the last few months since the appointment of the new manager. It was evident that some training has taken place to support the staff in their work and further training has been planned. Some of the training that the staff have completed included safeguarding, first aid, fire evacuation Care Homes for Older People Page 23 of 30 Evidence: training, moving and handling and health and safety. Care Homes for Older People Page 24 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. There is a satisfactory management structure in place to support people receiving care. There is a an internal audit system in place to monitor care provision and delivery. The health and safety of the service users are promoted, however further development is needed to ensure safe and consistent care. Evidence: The home has recruited a manager who has responsibility for the day-to- day management of the service. The manager is a registered nurse and an application for her to be registered with the commission was in progress at the time of this visit. Staff and the service users we spoke to commented that they have seen some changes since the manager has been appointed. They told us that they were confident in approaching the manager if they had any concerns. Care Homes for Older People Page 25 of 30 Evidence: The AQAA states that there is an internal audit process in place and this included yearly surveys of the service users views. The responsible individual carried out monthly visits to the service as required. Detailed records of the visits were maintained at the service and shared with the manager. The manager confirmed that the service did not manage any of the service users personal allowance. Invoices were raised for items such as chiropody, hairdressing and these are sent out to the people responsible for the bills as appropriate. The home sends us reports as required by regulations. Information from the AQAA shows that there is an ongoing refurbishment programme in place to ensure that the home is maintained in good order and to provide a safe environment for the service users. The AQAA database shows that fire safety equipments, gas appliances, fire alarms, emergency lighting have all been recently serviced. The service provided the service users with pressure relieving mattresses to manage pressure ulcers and associated risks. There was no guidance for staff regarding the setting of these mattresses and checks that are needed to ensure these are managed safely at all times. The manager confirmed that these will be looked into and action plan put in place. The health and safety of the service users are promoted through staff training. Further developments are needed in areas such as fall risk assessments, moving and handling assessments, medication management and care plans must be developed to support how the risks will be managed. This is to ensure that risks identified are managed appropriately at all times and care is provided in a consistent and safe manner. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must ensure that detailed care plans and assessments are put in place to demonstrate how these needs will be met. To ensure that care is provided safely and needs are assessed and care plans support the delivery of care. 15/06/2010 2 9 13 The registered person must 15/06/2010 ensure that arrangements are in place for the recording, safe administration, receipt and disposal of medicines received into the care home. To ensure that people receive their medicines safely 3 27 18 The registered person must 15/06/2010 ensure that there are suitably qualified, competent staff and in such numbers as are appropriate to meet the Page 28 of 30 Care Homes for Older People 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 needs and for the health and welfare of the service users. To ensure that people receive their care safely and their needs are met at all times. 4 29 19 The registered person must ensure that all necessary checks are completed prior to staff commencing work. To ensure that people are not put at risk of harm. 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 15/06/2010 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. 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