Care Home: Warley House

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What the care home does well There was a very relaxed and homely atmosphere in the home; people were observed to be very settled and comfortable in their surroundings. The home was generally clean and tidy and domestic staff worked hard to maintain cleanliness. All the people spoken to were happy with their rooms and the cleanliness of the home in general. People`s needs were assessed before they went into the home and detailed plans of care were usually developed. Staff had understanding of individual`s needs and preferences. People said they were satisfied with the overall care provided by the home and the staff. People living in the home said they were offered a good choice of meals and said that they enjoyed the quality of food. Comments included `the meals are very good and `the food is excellent`. Staff were sensitive to peoples needs at meal times and enabled people to make a choice about the food they ate. The home had a complaints procedure in place and complaints were well managed. Sufficient staff were provided to ensure peoples needs could be met. All the required recruitment checks had been obtained prior to staff starting work at the home. This means that a full history had been obtained to ensure that the person was fit to work with vulnerable people. Staff had access to training to assist them to care for people safely. What has improved since the last inspection? Care plans were now more specific in detailing the care requirements of those at risk of developing pressure sores. This means the care provided is more effective in minimising the risk of pressure sores. There were more frequent and varied activities available in the home. The processes for staff to report maintenance issues had been improved. Staffing levels had improved and were in line with current guidance. They had made sure that they obtained written references for staff before they started to work in the home. What the care home could do better: Care plans had improved significantly. However one person had not had a care plan developed for them and the record of evaluation of care plans was limited to date and signature. It would offer a more effective monitoring tool if more detailed evaluation records were maintained. There was generally good practice in the handling of medication but where staff complete hand transcribed prescription instructions on the medication administration records these should be checked for accuracy and signed by a second person to minimise the risk of errors. Whilst activities had improved, care plans should be developed to support the development and provision of more social activities to meet individual needs. There were procedures in place to protect people from abuse and staff had received training in this area. However where one person living in the home was putting others at risk the incidents had not been referred to the safeguarding team and we had not been notified of the incidents as required under the regulations. Internally extensive redecoration and refurbishment of the home had been undertaken. However the exterior of the home and gardens were poorly maintained, this gives a poor first impression of the home and prevents people from having safe access to the garden. Maintenance tasks were not appropriately prioritised. The processes for monitoring the quality of the service had not been maintained since the last inspection. This needs to be re established to ensure that the home continues to develop and improve. Key inspection report Care homes for older people Name: Address: Warley House Warley Road Scunthorpe North Lincolnshire DN16 1PL     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: Kate Emmerson     Date: 2 4 0 5 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 31 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 31 Information about the care home Name of care home: Address: Warley House Warley Road Scunthorpe North Lincolnshire DN16 1PL 01724861507 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): warlhome@globalnet.co.uk Barton Medical Services Limited Name of registered manager (if applicable) Mrs Pamela Sands Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 39 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP and Dementia - Code DE(E) Date of last inspection Brief description of the care home Warley House is a Care Home providing personal care and accommodation for thirtynine older people, twenty of whom may have a diagnosis of dementia. The home is situated in a housing estate in Scunthorpe some distance from the town centre and local amenities, although it is on a local bus route. There is an enclosed garden at the rear of the property and a separate house within the grounds, which has been Care Homes for Older People Page 4 of 31 Over 65 20 39 0 0 Brief description of the care home developed into a laundry. Warley House consists of a two-storey building serviced by a passenger lift and stairs. The home has twenty-one single and nine shared bedrooms, none of which have en-suite facilities. The home has four sitting rooms and a large dining room. There is also a smaller quiet dining room on the upper floor. The home charges between £365.15 and £436.45 per week. There are additional costs for hairdressing, private chiropody treatments, toiletries and newspapersmagazines. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Inspection was unannounced and took place over two days in May 2010. The inspection was conducted over two days as the manager was not available in the home on the first day and the staff on duty did not have access to all the required information. During the visit we spoke to people living in the home, the manager and area manager, and care workers to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, how the home monitored the quality of the service it provided and how the home was managed overall. Care Homes for Older People Page 6 of 31 We checked with people to make sure that their privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them and checked out with staff their understanding of how to maintain peoples privacy, dignity, independence and choice. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. The home had been requested to complete an Annual Quality Assurance Assessment prior to the inspection and this was used to inform the inspection process. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care plans had improved significantly. However one person had not had a care plan developed for them and the record of evaluation of care plans was limited to date and signature. It would offer a more effective monitoring tool if more detailed evaluation records were maintained. There was generally good practice in the handling of medication but where staff Care Homes for Older People Page 8 of 31 complete hand transcribed prescription instructions on the medication administration records these should be checked for accuracy and signed by a second person to minimise the risk of errors. Whilst activities had improved, care plans should be developed to support the development and provision of more social activities to meet individual needs. There were procedures in place to protect people from abuse and staff had received training in this area. However where one person living in the home was putting others at risk the incidents had not been referred to the safeguarding team and we had not been notified of the incidents as required under the regulations. Internally extensive redecoration and refurbishment of the home had been undertaken. However the exterior of the home and gardens were poorly maintained, this gives a poor first impression of the home and prevents people from having safe access to the garden. Maintenance tasks were not appropriately prioritised. The processes for monitoring the quality of the service had not been maintained since the last inspection. This needs to be re established to ensure that the home continues to develop and improve. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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. Peoples needs were assessed prior to them being admitted to the home. Evidence: Four care files were examined in detail. These evidenced that assessments of need and associated risks were usually completed prior to people being admitted to live in the home and that copies of assessments and care plans completed by care management were obtained. Care plans were developed from these assessments to inform staff of the care required to meet peoples needs. There was a basic assessment format on which the manager or senior staff recorded people needs with additional and very detailed risk assessments for areas such as mobility, tissue viability and nutrition. The area manager provided a copy of a new format for recording assessments which had been developed by the company but this had not been provided to the manager prior to the inspection. This format prompts the staff to record peoples need in greater depth and will encourage a more person Care Homes for Older People Page 11 of 31 Evidence: centered approach to assessment and care planning. The home does not accept intermediate care placements so standard six does not apply to this home. Care Homes for Older People Page 12 of 31 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. Peoples personal and health care needs were safely met and provided in a way that protected their privacy and dignity. Evidence: The records of care provided to four people were examined. One person who had been admitted to the home for a short period of respite had not had a care plan developed by the home. However the homes assessment had been completed and the home had obtained the Local Authorities care plan which gave staff some insight into the persons care needs. New care plan formats had been developed and implemented in all other cases. These provided detailed information about the care people required to meet their needs. They included very detailed information about specific care needs such as how to support people who had very challenging behaviour or problems with eating and drinking due to difficulty swallowing. These care plans were supported by detailed risk assessments which detailed the actions required to minimise risk. Care Homes for Older People Page 13 of 31 Evidence: There was a low incidence of pressure sores in the home and the care plans and risk assessments had been improved since the last inspection to support people where they were at risk in this area. People were weighed regularly and nutritional risk assessments were completed and the evidence from these assessments now informed the care. For example where one person had had weight loss recorded a care plan had been developed to support their needs and the records showed evidence of referral to health professionals for support and advice. Monthly evaluations of the care plans were evident and although there was evidence care plans were updated evaluation records consisted of a date and signature only. This does not assist the management or staff to always effectively monitor if the care provided is meeting peoples needs or to identify patterns of behaviour or changes in peoples general or mental health. For example where one person had challenging behaviour very detailed records were maintained of each incident but there was no detailed evaluation to establish any patterns or causative issues which could then be addressed. Daily care records were very detailed and described the care provided and peoples general health and wellbeing. There was evidence that some people had signed in agreement to their care plans. Some people spoken to knew they had care plans, whilst others had little understanding. The manager now involved the persons representative in the agreement of the care plans in these cases. From discussions with people and examination of documentation and observation it was evident that people living in the home were supported in personal care tasks by staff who respected their privacy and dignity. One visitor stated that their relative was always well dressed and they said that the staff ensured their individual preferences with regard to clothing were met. Due to the needs of the people living in the home none of them were administering their own medications. The home used a Monitored Dosage System for medication and only senior care workers administered medication. There were well developed procedures in place to support the safe handling of medication and the manager completed regualr audits. A medication round was observed and random selections of medication records in Care Homes for Older People Page 14 of 31 Evidence: relation to receipt, administration, storage and stock control were examined and found to be well maintained. Staff observed good infection control techniques during the drug rounds. Controlled drug records were clearly maintained. Where staff completed hand transcribed prescription instructions on the medication administration records the manager was advised that these should be checked for accuracy and signed by a second person to minimise the risk of errors. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were enabled to keep in contact with family and friends. They received a healthy and varied diet according to their assessed needs and choices. There was some improvement in the recreational and social activities provided. Evidence: The home did not employ an activity coordinator and staff were expected to arrange the activities in the home. The manager had purchased some games and cards for use in the home. One staff member stated that carers were doing activities in the mornings although there was none seen on the day of the inspection. Activities records showed an improvement in this area since the last inspection, records indicated a variety of activities had been undertaken including board games, one to one chats, dancing, music, manicures and ball games. One relative said although there had been no activities on the day of inspection there was usually something provided. The care plans did not record in detail peoples social interests or abilities and this would assist staff when planning activities. People spoken to who were able to express an opinion said they felt staff listened to them and said they were able to exercise choice in aspects of their life and daily routines. In discussion staff displayed a good knowledge of individual residents needs Care Homes for Older People Page 16 of 31 Evidence: and likes and dislikes and records contained information about peoples religious observances. Staff were observed to assist people in a kind and patient manner, ensuring that people were given time to understand instructions and allowing them to be as independent as possible. For example it was observed that despite the difficulty in understanding the staff took over thirty minutes of revisiting and gentle persuasion to encourage two of the residents to walk to the dining room for lunch when it would have been easy to bring their lunches to them or use a wheelchair. The staff should be commended for their efforts to work patiently with people to ensure that peoples mobility and independence is maintained. It was confirmed by a visitor that this type of interaction between staff and residents is common place and they stated the staff are brilliant. People spoken to said visitors could come at anytime and could be seen in private. The home provided three meals a day and a light supper. Staff were observed offering people choices of meals sometimes by showing them the choices plated up if this was more appropriate for the person due to limits in their ability to communicate. Meals were well presented and available in different portion sizes and seconds were available. There was a very good atmosphere in the dining room. Staff were observed to sit next to people who needed support to eat their meal and support was provided in a sensitive manner. People spoken to said that the home provides a good standard of meals, which people enjoyed. Comments included the meals are very good and the food is excellent. Care Homes for Older People Page 17 of 31 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. A satisfactory complaints procedure was in place. Procedures were in place to protect people from abuse although in one case they had not made appropriate referrals to the safe guarding team or made notifications to the Commission where people were being put at risk. Evidence: There had been one complaint about the home made to the Commission since the last inspection in August 2009. This related to a missing item of clothing and action to resolve the issue had been taken. Just prior to the last inspection there had been one referral to the safeguarding team with regard to financial abuse. This had been investigated and upheld, action had been taken to meet the recommendations from this investigation. The complaints procedure was displayed in the entrance to the home. Staff spoken to say they had no complaints about the home and felt confident to raise issues of concern. People spoken to who live in the home said they knew who to report concerns or complaints to. They were generally positive about the service they received. When asked about abuse, what it was and what they would do if they saw or suspected any abuse staff stated that they would report it to the management or senior care worker. Examination of a sample of individual staff training records Care Homes for Older People Page 18 of 31 Evidence: showed staff had been provided with training in safeguarding adults in induction and refresher training had also been provided. There were some issues relating to a residents challenging behaviour which put other residents at risk of injury. Whilst the home were being very proactive in working with staff from the Care Trust Plus and health professionals and had a very detailed management plan in place, they had not notified us of the incidents as required under Regulation 37 or advised the safeguarding team of incidents involving other residents. Notifications and referrals were completed by the manager immediately after the inspection. Care Homes for Older People Page 19 of 31 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. People were provided with a clean and tidy home and internally extensive redecoration and refurbishment had been undertaken. The exterior of the home and gardens were poorly maintained, this gives a poor first impression of the home and prevents people from having safe access to the garden. Evidence: A tour of the home was completed with the deputy manager. Major refurbishment of the home had been completed. This had included complete renewal of the majority of the bathrooms and redecoration through out. New furniture had been provided for communal areas and was also being provided for the bedrooms. A new system for reporting maintenance issues had been implemented since the last inspection. The records showed that there was no system to prioritise this work and the manager did not check if work was being completed in a timely manner. For example a fire door that required some adjustment had not been attended to before other more minor tasks had been completed. Although people living in the home had access to the gardens, the gardens were very overgrown and untidy and the garden furniture was in a very poor condition. The exterior of the building was poorly maintained. There had been leaks in the roof in the staff area and in one bedroom. The manager stated that repairs had been carried out Care Homes for Older People Page 20 of 31 Evidence: to the roof and work to repair the interior water damage was to be completed the week after the inspection. Again we had received no notifications with regard to this. (See requirement relating to standard 18) The home was generally very clean and tidy. Some people had furnished their rooms with a range of personal items, to reflect their own individual choice and taste but other rooms were not personalised. Staff in interview confirmed adequate supplies of protective clothing. Equipment provision was also discussed and staff said there were appropriate mobility aides in the home to enable residents needs to be met. Hot water in two of the bathrooms was only 38 degrees centigrade. Records of monthly water temperature checks showed this was the usual temperature. The hot water temperature should be maintained close to and not exceeding 43 degrees to ensure the comfort and safety of people living in the home. The temperature of the hot water provided should be adjusted to be closer to this. Care Homes for Older People Page 21 of 31 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. Sufficient staff were provided to ensure peoples needs could be met. Staff were trained and competent. All the required recruitment checks had been obtained prior to staff starting work at the home. This means that a full history had been obtained to ensure that the person was fit to work with vulnerable people. Evidence: At the last inspection the area manager of the home stated that the Residential Forum Guidance was used to calculate staffing hours. However there was still no evidence of this. The home did not have any formal method of determining dependency of residents in line with the residential forum guidance. This means that the management could offer no evidence as to how they had determined the staffing levels in the home. However on checking the staffing levels against Residential Forum guidelines they were within acceptable limits. Staffing was provided flexibly to provide extra staff at busier times of day. For example to assist people to get up and to cover day care. Staff spoken to say there were generally enough staff on duty to enable peoples needs to be met. The manager stated that she sometimes works as a carer to cover Care Homes for Older People Page 22 of 31 Evidence: some shifts. Whilst this gives her the opportunity to get to know residents needs and how the staff work this should be carefully controlled to ensure that the management of the home does not suffer. Evidence from discussions with residents and visitors during the visit confirmed that they were generally satisfied with the care they received and indicated that there had been an improvement since the last inspection. Comments included there are always plenty of staff, the staff are brilliant and there are always staff to provide the care which has been very successful. Staff were observed to very patient, caring and knowledgeable about peoples care needs. Employment records for two staff members appointed since the last inspection were examined. Records were generally in good order and relevant and the required checks had been obtained before staff started work. It is recommended that a current photo of staff members and interview records are held on all files. The manager stated that they had induction packs which met Skills for Care Common Induction Standards specification. This included a workbook to record evidence that the induction was completed. However an example of this could not be found at the time of the inspection. There was evidence that new staff had completed training in moving and handling and safeguarding. Examination of a sample of staff records evidenced that mandatory training and service specific training was provided and certificates were in place to support recent training courses the staff had accessed. Training consisted of in-house training, distance learning and external facilitators. The staff confirmed that updates in the mandatory training had been provided. Twelve staff had completed the distance learning course on dementia via Grimsby college and a further twelve were due to start. The home had a National Vocational Qualification training programme for staff and exceeded the standard for the number of staff required to have this qualification. Care Homes for Older People Page 23 of 31 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. An experienced registered manager was in place. The manager had concentrated her time on improving some specific areas such as care planning and some of the processes to monitor systems in the home and the quality of the service provided had not been maintained since the last inspection. Records relating to health and safety were not all clearly maintained. Evidence: The manager is an experienced registered nurse and she has completed a National Vocational Qualification at level 4. She has completed the process with the Commission to be the registered manager. The manager has concentrated on improving care planning, staff training and care provision since the last inspection and requirements from the last inspection have been met. There were processes for the manager to monitor the quality of the service provided through monthly quality audits of processes. However other than for medication and residents finances these had not been maintained. The manager could Care Homes for Older People Page 24 of 31 Evidence: not evidence that the visits by the provider as required under Regulation 26 had been completed during the area managers absence. The area manager was requested to forward these to the commission. Surveys had been completed by residents and their families just prior to the last inspection and were due again in July 2010. During the inspection people living in the home and visitors expressed expressed their satisfaction with the service provided. Comments included my relative is well looked after and very happy with the home. The Annual Quality Assurance Assessment had been returned to us within the timescales set and the information provided in this document was used to inform the inspection process. The system for holding money on behalf of the residents had been under investigation by the safeguarding team following an allegation of misappropriation of money prior to the current manager taking up post. The investigation had been concluded and was founded. As a result of the investigations new processes had been implemented and the records had been regularly audited by the homes management. A random sample of records and the cash held were checked and these balanced other than one, where cash held was up by 10p. Records were clear and receipts were held for purchases on behalf of people. There were a range of policies and procedures in place for health and safety. Safe working practices were maintained by the provision of training to staff in the form of moving and handling, basic food hygiene, basic first aid, infection control and fire safety. Training records evidenced that the majority of staff had received this training and the manager had ensured that refresher training had been provided. Maintenance certificates were in place, random checks were made and records showed these to be up to date. Accident and incident records were completed but some were not fully completed and lacked detail. The regular quality audits of the accidents to check for completeness and patterns that could be addressed had not been maintained by the manager. Risk assessments were seen regarding moving and handling and daily activities of daily living. Records showed that the fire alarm had been tested on a regular basis, however both the senior staff and the manager completed the fire alarm tests and records were held in different files and did not show the dates of the tests in chronological order. The Care Homes for Older People Page 25 of 31 Evidence: manager was advised to complete just one record for clarity. We requested a fire test to be completed on the first day of the inspection, staff were observed to respond appropriately. Care Homes for Older People Page 26 of 31 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 31 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 Care plans must be completed by the home for all people admitted to the home. To ensure that care needs are met consistently. 15/07/2010 2 18 37 Where there is any event 30/07/2010 which adversely affects the well-being or safety of any person living in the home the manager must notify the Commission without delay. To ensure the home is taking appropriate action to protect people in its care. 3 19 23 The gardens must be kept safe and tidy. To enable people living in the home safe access to the gardens. 31/08/2010 4 19 23 The premises must be kept in a good state of repair externally and internally. 31/08/2010 Care Homes for Older People Page 28 of 31 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 ensure a safe environment for people living in the home. 5 33 26 Reports relating to the 30/07/2010 monthly visits under this regulation by the provider or their representative must be provided to the manager and to the Commission To ensure that the providers are monitoring the conduct and quality of the service. 6 33 24 The processes for 30/07/2010 monitoring the quality of the service must be re established. To ensure the service can continue to develop and improve for the people living in the home. 7 38 17 Accident and incident records must be fully completed. To ensure a complete record is available and accidents and incidents can be monitored. 30/07/2010 Care Homes for Older People Page 29 of 31 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 Evaluation of care plans should provide a more detailed record to enable effective monitoring of any patterns of behavior or changes in peoples general or mental health. Where staff complete hand transcribed prescription instructions on the medication administration records these should be checked for accuracy and signed by a second person to minimise the risk of errors. Care plans should be developed to support the provision of social activities by recording peoples interests in this area. The home should refer any incidents of alleged abuse to the safeguarding team without delay to ensure that an independent investigation can be undertaken as appropriate. The hot water temperature should be maintained close to and not exceeding 43 degrees to ensure the comfort and safety of people living in the home. Records of staff interviews should be held on file to evidence all recruitment procedures. Records of staff induction should be held to evidence the induction training provided. A single record of fire alarm tests should be kept for clarity and to evidence that these are completed at appropriate intervals. 2 9 3 4 12 18 5 25 6 7 8 29 30 38 Care Homes for Older People Page 30 of 31 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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