Care Home: Waverley Nursing Home

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What the care home does well The Waverley has always had a caring team of carers that have worked in the home for a number of years. The care staff provide a good continuity making sure that the people living in the home have a team of "familiar faces" who they can deal with. There is an activities organiser who makes sure that a number of "days out" occur at regular basis. The people who live in the home enjoy these days out. The people living in the home are supported to undertake activities of their own choices such as leaving the home independently. As a small care home there is a welcoming atmosphere. All the people who live in the home spoken with were pleased with the care that they receive in the home comments such as "it`s a lovely place to live staff are very good", "I have been living here for about four years, it`s my home now and I`m happy here". . All the care staff spoken with were enthusiastic and wanting to supply a good service to the people that they support. They demonstrated a genuinely warm and caring attitude in keeping with their roles as care staff. Staff told us that they thought that "morale" had significantly improved over recent months. What has improved since the last inspection? The manager and the staff team have worked very hard to increase the quality of the service. The Waverley had a number of concerns raised in the last 12 months regarding their ability to support complex nursing care and manage medications safely. At this visit we noticed that medications were managed in a safer manner. Records of medications needed and given were clearer and staff had instructions for the application of creams as an example. All staff who gave out medications had been checked that they were competent to do so. The manager started checks on medications on a regular basis and addressed any issues immediately with the nursing staff. Information to people wishing to move in the home is now readily available. This has been updated and in the future will be available in a different formats including other languages. The manager does all assessments (to find out people`s needs), both before and when they move into the home. The ways to do this have been reviewed and the assessments viewed provide good information about people`s needs. This helped staff decide if The Waverley could meet their needs. Information to care staff such as care plans have all been re-written and update. All now include a section titled "all about me", this provides clear details to staff as to how to meet people`s individual needs, choices and preferences. Staff told us that they thought that this was a significant improvement from previous plans. New staff have been recruited to the home and other staff have left. The manager told us that this has increased the quality of the service. Staff told us that they had betterteam work since the changes in staff. What the care home could do better: There remains some area in need of further development. All but one of the previous requirements have been meet. The manager needs to update the fire risk assessment and make sure that all equipment checks and staff training is carried out correctly. Although significantly improved the service still needs to make sure that all medications are recorded correctly. Care plans have increased in quality but daily records that detail what support staff have given that day are not detailed and do not describe the support given by the staff. The menus in the home need to be reviewed both the people who live in the home and the staff said that they needed to "improve". Menus do not describe special diets as an example. The opinion of the food provided varied with some people "enjoying" the food and others finding it "repetitive and boring". The building remains in need of refurbishment and redecoration and does not present a welcoming and comfortable place for people to live. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Waverley Nursing Home 14/16 Waverley Road Liverpool Merseyside L17 8UA     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Garrity     Date: 2 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Waverley Nursing Home 14/16 Waverley Road Liverpool Merseyside L17 8UA 02085315737 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : phillippa.hoxha@btconnect.com Daughters of Mary Mother of Mercy care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following categories 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. The maximum number of service users who can be accommodated is: 20. Date of last inspection Brief description of the care home The Waverley provides nursing care and personal care for a maximum of twenty people who required support for age related conditions. The home is a converted building on four floors, there are two lounges one on the lower ground floor and one on the ground floor. There is a passenger lift to support people living in the home to access all the floors. Bedrooms are located on the ground floor, first and second floors. There are gardens at the rear that are accessible from the main building and parking to the front and the side. The Home is located in a residential part of Liverpool near to the shopping areas of Lark Lane and Sefton Park area. There are frequent buses to this area and a train Care Homes for Older People Page 4 of 28 0 9 1 0 2 0 0 8 Brief description of the care home station within 15 minutes walk. Fees are charged in the home in accordance with those paid by Liverpool Social Services, which starts at 420 pounds. Private clients fees are based on their individual assessment and the support that they need. There are several areas not covered in the fees such as hairdressing and newspapers. The Waverley has a copy of the latest report from us on display in their main entrance to the home. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was carried out over a period of one day. We (the commission) arrived at the home at 10:30 and left at 18:20, at total of 7 hours 50 minutes. We spoke with 5 people living in the home, 6 staff members, three relatives and the manager. We completed the inspection by a visit to The Waverley and a look at the building. Written records in the home were looked at and these included, care plans, assessments, staff files, staff training, staffing rotas, cleaning records, GP visit records, information to people living in the home and daily records. Information supplied from the home such as a completed questionnaire, reporting of incidents and correspondence was also reviewed as part of this inspection. The service also sent us a copy of their Annual Quality Assurance Assessment (AQAA), this is a self assessment Care Homes for Older People Page 6 of 28 that indicates to us what improvement the service has made and any plans for the future. Additionally we looked at information received from social services and the primary care trust in the Liverpool area. We sent surveys to the people living in the home and the staff. The manager confirmed that these had been completed and returned to us. However none were received by us. Feedback was given to the manager during and at the end of the inspection. The arrangements for equality and diversity were looked at during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support people living in the home to make informed decisions in line with their individual choices. What the care home does well: What has improved since the last inspection? The manager and the staff team have worked very hard to increase the quality of the service. The Waverley had a number of concerns raised in the last 12 months regarding their ability to support complex nursing care and manage medications safely. At this visit we noticed that medications were managed in a safer manner. Records of medications needed and given were clearer and staff had instructions for the application of creams as an example. All staff who gave out medications had been checked that they were competent to do so. The manager started checks on medications on a regular basis and addressed any issues immediately with the nursing staff. Information to people wishing to move in the home is now readily available. This has been updated and in the future will be available in a different formats including other languages. The manager does all assessments (to find out peoples needs), both before and when they move into the home. The ways to do this have been reviewed and the assessments viewed provide good information about peoples needs. This helped staff decide if The Waverley could meet their needs. Information to care staff such as care plans have all been re-written and update. All now include a section titled all about me, this provides clear details to staff as to how to meet peoples individual needs, choices and preferences. Staff told us that they thought that this was a significant improvement from previous plans. New staff have been recruited to the home and other staff have left. The manager told us that this has increased the quality of the service. Staff told us that they had better Care Homes for Older People Page 8 of 28 team work since the changes in staff. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available to both the people wanting to move in the home and staff that supports them to decide if The Waverley can meet peoples individual needs. Evidence: We looked at the assessments of a recently admitted individual and assessments of people living in the home. Assessments need to be done in order for the staff in the home to be sure that can meet person wishing to move in the homes individual needs. Assessments viewed had all been reviewed and updated regularly as individual needs changed. The AQAA for the home told us that the homes assessments were too basic and have been re-written. The manager had updated both the pre-admission assessment (done before the person moves in) and the assessment on admission. Both these now offered the member of staff doing the assessment a better change of clearly identifying peoples individual needs including behavioural and psychological needs which previously had been missed. Of the assessments viewed they had been Care Homes for Older People Page 11 of 28 Evidence: completed well and included relevant information about the persons needs. We discussed including an assessment of individual social needs such as likes and dislikes for food and daily activities. The manager told us that this was likely to be added to both the pre-assessment and the admission assessment. There is now information that informs people of what services the home provides and how it intends to support those who live in the home. This provides clear information that explains the home to individuals it will be supports them to decide if the home is for them. The information known as a statement of purpose (what services Waverley will provide) and the service users guide (how they will provide the services) was available in the main foyer of the home and in bedrooms of the people living in the home. The manager told us that they are looking at ways to provide this information in different forms such as Braille and tape. The majority of the individuals have lived in the home for several years and told us that they thought its a lovely place to live staff are very good, I have been living here for about four years, its my home now and Im happy here. We spoke to a relative who told us that they were shown around the home when they first came to look the reason that they choose the home was because the staff were very friendly, they welcomed us when we first looked around and I knew my (parent) would be happy here. The person living in the home that they had come to visits told us my family came to look around for me. They made a good choice I want for nothing. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their individual healthcare needs met. Staff have clear instructions available that keep them informed as to how to meet peoples individual needs. Evidence: People living in the home told us that I like living here, the staff really care about you, they know how to look after me properly and its a very nice place to live. Staff are very lovely nothing is too much for them. We looked at how people were supported in getting their medications. This showed that all people living in the home received their medications in a safe manner that maintained their health. There were some minor documentation areas that do not maintain good practice. This included making sure that medications not used the previous month were accounted for and recorded as being available for the person receiving medications to use. Carrying forward medications that are left over makes sure that the manager can always check that medications have been given properly. Care Homes for Older People Page 13 of 28 Evidence: We noted that medications were significantly improved and information on external preparations and when required was now clear and informed staff of how to deal with these medications correctly. The AQAA for the care home told us that each person, has a person centred plan that described their individual needs. We looked at four care plans and noticed that each person had their own plan of care. Each person also had a document called all about me this explained the support that the person needed in clear and simple terms. We sampled four care records and noticed that in most cases clear instructions were available to staff as to how to meet each persons individual needs. All the plans had been reviewed and in some cases signed by the person living in the home or their relative. Staff told us that they thought that the care plans were of more value and that they now had proper instructions as to how to support people living in the home. We looked at how the staff members monitor the effect of the support that they gave. Each person living in the home has a record kept of care or support they received that day (a daily record). The quality of these records was not sufficient to detail the care that had been given that day. The daily records were not specific, individual or explained what had happened to the person that day. A daily record that accurately shows what support has been give that day supports the staff to monitor individual care. When we looked at how the service accessed external professionals such as doctors or dietitians we found that in all cases the staff had recognised changes in peoples needs and contacted the relevant expert. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Waverley supports people to live a lifestyle of their choosing. Evidence: A menu is available that does detail two choices of meal, the menus were available in the kitchen and were not distributed to the people who live in the home for them to see. Several individuals needed a special diet and in general even though not on the menu staff try to make sure that they receive these diets. There was no identification on the menu that showed a choice for a diabetic diet as an example. On the day of the visit the lunch time meal was sausage rolls and tinned spaghetti. This was not the same as what was written on the menu that day. Opinions of the food varied with one person describing the lunch that day as horrid I left half of it and another as I liked the lunch. In general people living in the home had varying opinions of the quality of the food. Staff spoken with also said that there was room for improvement. The activities co-ordinator keeps records of the activities that individuals have done. The manager has implemented a support plan called all about me, this goes someway to describing peoples daily routines and the things that they would like to do. The AQAA for the service told us that that each person now has n activities log Care Homes for Older People Page 15 of 28 Evidence: that is completed. Records were availaible that showed us what activities people had taken part in. Trips out do frequently occur, but are limited by staff and the mobility of the individual. Several of the people living in the home are able to organise their own activities with some support. As an example one person likes to go out for most of the day and another likes to colour in colouring books. Both these personal choices were supported by the staff working in the Waverley. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home believe that any concerns that they have will be taken seriously and dealt with. Evidence: We looked at how people living in the home are supported to raise their concerns. There is information in the service users guide that tells people how they can make their concerns known. The AQAA for the home told us that our complaints procedure is provided to every person living in the home. People living in the home told us that they were confident that their concerns would be dealt with. When we spoke to people living in the home who told us I dont have any complaints, I would talk to the staff if I was worried about anything and my family would talk to the manager and I am sure it would be rectified. Training records show that staff have received training in dealing with concerns regarding the protection of adults. The service has had adult protection concerns raised in the last twelve months and are awaiting for these to be fully resolved with social services. As a result of those concerns regarding nursing care and management of medications the manager has made a number of improvements that were noted as this visit. These recent events have help increase staff knowledge of reporting and dealing with serious concerns. Staff are now aware of when to make sure that social services are aware of issues. Policies and procedures in this area have been reviewed Care Homes for Older People Page 17 of 28 Evidence: by the manager. There remains some inaccuracies in the policy that we discussed with the manager. The manager informed us that she will further update the policy and procedure to make sure that it meets best practice and social service guidance. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The maintenance of the building is not sufficient to make it a welcoming and comfortable place for people to live in. Evidence: The building is on four floors, there are two lounges one on the ground floor another in the basement area next to the managers office. This room has recently been rearranged and the clutter removed. There is also plans to remove the office space in this area and to create a new office. This will return the room to the exclusive use of the people who live in the home. There are no dining facilities, people who live in the home eat at tables in front of their chairs or in their bedrooms. The manager intends that the basement room will be turned into a welcoming dining space that will encourage people living in the home to enjoy their mealtimes. A number of areas of the home were looked at most were in need of redecoration or refurbishment this included, two bathrooms, the main corridors, seven bedrooms, both lounges and the furniture in the main lounge on the ground floor. There is no maintenance plan that details what needs maintaining and when. There is a list of things to be redecorated but not structure as to when and how this will be done. The maintenance of the building has been noted to continually deteriorate at all the visits over the last three years. There are no regular audits that determine the areas that Care Homes for Older People Page 19 of 28 Evidence: need redecorating. The lack of maintenance has also reduced people who live in the homes choices as the shower is no longer functioning. If the home became full they would not have enough bathing facilities to meet the needs of people living in the home. People living in the home did not have the facility of a shower and their only choice was a bath or a wash. Several of the bedrooms viewed had been personalised and included individuals own items such as ornaments. Several other bedrooms viewed were bare and had no items of a personal nature. People who live in the home will feel more at home with familiar items around them. The home was not clean and tidy on the day of the site visit, corridors were in need of cleaning as they are now badly stained. The Waverley does not have a cleaner everyday of the week and on the days that their no cleaner care staff do cleaning as part of their duties. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training and recruitment of staff has improved in order to provide a better qulaity of service to the people living in the home. Evidence: Three staffing files were looked at in all including newly recruited staff. The files contained information that showed staff had been properly checked before they started working in The Waverley. One file was identified at a previous visit as needing proof that a work permit was correct. The manager has spoken to the owner regarding this matter. As yet neither has contacted the relevant government body to confirm that the permit is accurate. We discussed this with the manager who told us that this would be done within the next few weeks. Records regarding staff training were looked at. This showed significant improvement staff have had training in a number of areas. There was still gaps in general training and not everyone had up to date training particularly fire training. Some staff had received training in specialised areas such as the mental capacity act this knowledge had not been passed on to other staff as yet. The manager told us that she plans to hold a number of up date training sessions in the home to make sure that all staff are up to date. Care Homes for Older People Page 21 of 28 Evidence: The Waverley has had concerns raised since the last site visit regarding the ability of the service to provide suitable nursing care. Significant improvements have been noticed at this visit. Some new staff have been recruited and other staff have ceased to work in the home. The care staff told us that this has significantly improved morale and they now feel that they can ask questions that wont be dismissed and we will be told information that helps us do a better job. We spoke to people living in the home and staff about the staffing levels. All said that this to had improved. The manager was now able to dedicate her time to improving the service. Staff were spending less time on ancillary duties such as laundry as a laundry person had begun working in the home. We observed staff during the day an noticed that they supported people in an unhurried and kind-hearted manner. After lunch several of the staff were in the main lounge and a lot of laughing and joking was taking place that was inclusive of the people living in the home and sensitive to their needs. People living in the home told us the staff are a good giggle, they are just lovely and so easy to get along with, I love the girls here they are so kind and staff work hard but always have enough time for you if you need them. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of the service provided by The Waverley has improved over the last few months. People living in the home are provide with a service that better maintains their safety and their health and welfare needs. Evidence: The AQAA for the home told us that various areas are now audited on a regular basis e.g. medications, documentation, kitchen audits, bi-annual satisfaction surveys and care plan reviews. When we looked at the home we noticed a significant improvement in the quality of all these areas. Additionally staff and resident meetings are now held on a regular basis with minutes available to keep people informed of changes happening in the home. The manager is doing regular supervision on staff to make sure that they are developing the correct skills that they need. One member of staff told us that they Care Homes for Older People Page 23 of 28 Evidence: found this very useful as the person doing their supervision and they worked on days. The staff member to us, its great to have contact with someone I dont usually work closely with. Im learning lots about other people working in the home and the (residents). The manager showed us evidence of staff receiving supervision as a minimum of every three months. The manager has reviewed all the policies and procedures. Several have been amended to include good practice guidance. Once these are completed the manager. Without good guidance staff will be unable to make sure that they can maintain a good quality service. A clear system is in place for the management of individual funds pocket money. A breakdown of what each individual is entitled to is not available. We spoke to manager and the administrator about this who told us that they receive funds from the head office but are not aware of what people are entitled to confirm if the amount received is correct. Receipts were available for spending. There are no policies and procedures around the management of peoples funds. The manager has made sure that all risk assessments in the home for individuals have been updated. Main assessments such as fire safety have not been updated. Checks on fire alarms have not been done weekly, emergency lighting and nurse call systems are have not been checked monthly. These need to be done in order to maintain the safety of the people living in the home and staff. Care Homes for Older People Page 24 of 28 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) (2) (a) It is essential that residents 27/04/2008 (b) (c) (d) health and welfare needs are recognised and staff have clear written instructions that supports them to be aware of and meet the residents health and welfare needs appropriately. This includes up to date care plans that provide staff with clear instructions on how to meet resident?s needs. Care plans for the residents need to be reviewed and monitored in order to determine that they fully respect the support that is to be provided by staff. Outstanding from 16/02/08 2 38 13 (4) (a) Environmental risk 27/04/2008 assessments such as equipment and potential fires need to be updated. This will need to include when and how specific equipment are to be tested, maintained and used. Outstanding from 31/10/07 Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Carried forward medications need to be recorded in order to make sure that medicines can be audited correctly. Where doses are variable such as given one or two tablets this needs recording to make sure that medications can be checked as given accurately. Stickers that detail medicines need to be avoided and handwritten entries signed and checked by two members of staff are safer. Menus need to be reviewed in order to make sure that all people have their food choices, preferences and needs met. A maintenace plan that has definate timescales for completion needs to be developed and shared with the people living in the home. Staff training needs to be further looked at and training that meets the assessed needs of people as well as mandatory training needs to be availiable for all staff working in the home. The manager needs to resubmit her application to us for registered manager. A policy and procedure on dealing with individuals finances needs to be developed. There needs to be an awareness within the service of how much people are entitled to Page 26 of 28 2 3 13 19 4 30 5 6 31 35 Care Homes for Older People receive and evidence that they are getting the correct amount. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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