Care Home: West Farm House

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What the care home does well People are well supported in maintaining their independence and deciding how they spend their day. People have good relationships with staff and Mrs Burnett Price. People have good access to healthcare professionals. People are supported to manage their own medication following a risk assessment. People enjoy the meals which are freshly cooked from locally sourced ingredients. The menus are planned according to what people like to eat. The accommodation is of a high standard and people have individually personalised their bedrooms. The majority of staff have achieved NVQ Level 2 with one staff member having Level 4. What has improved since the last inspection? The statement of purpose and service users guide have been reviewed and revised with details of what the home can provide. The documents now tell people about our role, so that they are better informed about why we visit and want to talk with them. Care planning is improving with more detail of people`s needs and how they are to be met and monitored. Staff have received training in care planning. Assessment of any risks associated with people`s care are more fully documented, including pressure damage, moving and handling and bathing. Mrs Burnett Price is seeking training in pressure sore prevention. New people`s medication is checked with their GP to see what they have been prescribed and should be taking. Any special prescribing instructions are carried out. More training is being offered to staff. All of the radiators in the ensuite facilities have now been guarded. An automatic self closing device had been fitted to a room where smoking is allowed, so that the door closes if the fire alarm sounds. A fire risk assessment is in place. People have their call alarms within easy reach when needed. Mrs Burnett Price is telling us about things that happen in the home. What the care home could do better: The statement of purpose, service users guide and other documents which refer to the previous regulator, need to be updated with details of the Care Quality Commission. The pre-printed care planning format must be reviewed and revised, so that statements about people and their care needs are more person centred. Some of thelanguage should be more positive. Activity provision must be regularly reviewed, particularly with new people. After having consulted with people and others about their views on the quality of services provided, the home must report on what they are doing to improve the quality of services. Staff views should also be included in the review. Inspecting for better lives Key inspection report Care homes for older people Name: Address: West Farm House Collingbourne Ducis Marlborough Wiltshire SN8 3DZ     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: Sally Walker     Date: 0 7 0 5 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: West Farm House West Farm House Collingbourne Ducis Marlborough Wiltshire SN8 3DZ 01264850224 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) : Noe-mailfacility Mrs Helen Burnett- Price care home 10 Number of places (if applicable): Under 65 Over 65 10 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 West Farm House provides personal care and accommodation to up to ten older people. The home is situated in a quiet village location. Village amenities, including a convenience store, are within walking distance of the home. West Farm House is a two storey, period property, with some adaptations that have been made to meet the needs of older people. There is a large well-kept garden with a lawn and seating areas. The communal areas of the home consist of a sitting room and a dining room, with a sun lounge extension. Individual accommodation is on the ground and first floors. A passenger lift is available. All bedrooms have an en-suite facility. Mrs Burnett-Price is the registered provider and manager. During the day there are a minimum of two staff working with Mrs Burnett-Price. Mrs Burnett-Price provides sleeping-in cover. The current fee levels can be obtained directly from the home. Care Homes for Older People Page 4 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 peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This unannounced Key inspection took place on 7th May 2009 between 9.35am and 4.35pm. Mrs Burnett Price, provider and registered manager was present during the inspection. At the last key inspection of 17th April 2008 we were concerned that there were a number of outstanding requirements which had not been addressed. We made a short unannounced inspection, known as a Random inspection on 21st August 2008. This was to look at progress they were making with their improvement plan. We noted at the Random inspection that seven of the eleven requirements had been addressed and three were in good progress. Care Homes for Older People Page 5 of 28 We looked at the statement of purpose, service users guide, care plans, risk assessments, training records, activities, menus and medication. We made a tour of the building and spoke to people who use the service and to staff. We asked the home to fill out their AQAA (Annual Quality Assurance Assessment). It was filled out in full and returned on time. Some of the information we received can be found in the body of this report. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose, service users guide and other documents which refer to the previous regulator, need to be updated with details of the Care Quality Commission. The pre-printed care planning format must be reviewed and revised, so that statements about people and their care needs are more person centred. Some of the Care Homes for Older People Page 7 of 28 language should be more positive. Activity provision must be regularly reviewed, particularly with new people. After having consulted with people and others about their views on the quality of services provided, the home must report on what they are doing to improve the quality of services. Staff views should also be included in the review. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes Statement of Purpose had been reviewed and revised in the last year so that people who are considering using the service have more information about what the home provides. People have assessments so that the home can decide whether their needs can be met. Evidence: The statement of purpose had been updated at the Random inspection of 21st August 2008. Mrs Burnett Price told us that this would now be further updated to include the details of the Care Quality Commission. Since the Random inspection the homes contract had been amended to include current legislation. As a matter of good practice, there were also details about our role, how we carry out inspections and access to peoples records. In the AQAA Mrs Burnett price told us that people had been provided with updated copies of the statement of Care Homes for Older People Page 10 of 28 Evidence: purpose, service users guide and contracts. She went on to say that copies of inspection reports are made available to people and their relatives. No new people had come to live at West Farm House since the Key last inspection. A number of local people were regularly using the respite service. Their needs are assessed regularly to see if their needs can still be met. People who were considering using the service are invited to visit to see the accommodation and discuss what the home has to offer them. Mrs Burnett Price told us that new people were offered a months trial period to see if the home was suitable. One of the people we spoke with told us that their family had looked at six different homes before choosing West Farm House. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning is improving with more detail about how peoples needs are met and monitored. People have good access to healthcare professionals. Safe systems are in place for administering peoples medication. People can administer their own medication following a risk assessment. Staff respect peoples right to privacy and dignity. Evidence: At the Random inspection we found that peoples care plans were more detailed with better information about how their needs were to be met. We saw that one person had a care plan in place on the day they were admitted. At this inspection we saw that training in care planning had taken place. A new care planning system had been introduced in November 2008 using a format provided by the trainer. There was still some work to do to make the format more person centred. However, we said that the format was a good starting point for developing person centred care plans with people who use the service. This is because it details all aspects of a Care Homes for Older People Page 12 of 28 Evidence: persons care and support needs including, medical appointments activities, behaviour management, pressure area care and assessment, encouraging independence and personal support. We said that the more positive statements should be retained, for example: I like staff to, my favourite, my interests are and I enjoy going to. The format a tick list of information or yes or no answers. We advised that the format should be amended so that more personal details can be included. Some of the language in the document was outdated. We advised that more positive statements should be included. We gave an example: visual impairment rather than blind. We said that the words problem and wandering in the format could give a negative view of peoples care needs. We said that details of staff intervention should be recorded rather than the number of staff involved in each area of the plan. We advised that the statements about depression and anger should have accompanying statements about how the person is supported with managing those needs. We saw the implementation of this format had a positive outcome in the amount of detail that was now recorded. The care plans are beginning to give a better picture of how the care and support is being delivered and monitored. We saw good information about peoples sleeping patterns and whether they needed any assistance during the night. All the people who use the service had signed their care plan. There was a care plan in place for one person who was due to use the respite service later in the month. The daily reports showed good information about how people had spent their day, visits and trips out with family, medical appointments and staff interventions. We saw that peoples care plans had been reviewed monthly. Risk assessments were included in peoples care plans. We saw that staff were required to be present when people were bathing. We saw that the new format contained a form for assessing peoples risk of developing pressure damage. Mrs Burnett price told us that no one had pressure sores as they were all mobile. She told us that the district nurses had provided treatment in the past for one person who had been receiving end of life care. The home also had pressure reducing mattresses should anyone need them. Staff had not received training in tissue viability, which means that they may not be able to monitor people and recognise the early indicators of peoples risk of developing pressure sores. Mrs Burnett Price told us that she would arrange the training through the Tissue Viability Specialist Nurse. People have good access to relevant healthcare professionals. People told us that Mrs Burnett Price would take them to appointments with their GPs or their GP would see Care Homes for Older People Page 13 of 28 Evidence: them at the home. One person told us they saw the district nurse now and again. One person attends a local memory clinic. The care plans had a section which recorded results of any healthcare appointments and medical interventions. Body maps were available to record any marks or wounds. These records did not record size, location, colour and dates for any wounds for monitoring purposes. Mrs Burnett Price told us that no one had any pressure sores. In a survey form one of the GPs told us Excellent residential home. Another GP told us Providing a really friendly home from home which doesnt feel institutionalised whilst managing to observe health and safety etc. One of the people we spoke with told us that they could have a bath three times a week which they enjoyed. They said that staff were present. At the Random inspection we found that all medication received from people who use the service or their relatives was being checked with their GP to ensure it was what they were currently prescribed. No one else had come to live at the home since we last visited. However the home was checking the medication of those people who regularly used the respite service. At the Random inspection we found that people were encouraged to administer their own medication. The home had carried out risk assessments and continued to monitor their safety in managing their own medication. Two people told us that staff kept and administered their medication. Another person told us that they administered their own medication which they kept in their bedroom. We saw that staff worked in a professional manner, respecting peoples rights of dignity and privacy. 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. People follow their own routines and many told us they were happy to follow their own pursuits. Activities had been tried but people currently using the service did not want organised activities. People maintain regular contact with families and friends and visitors are welcomed. People enjoy the meals and contribute to menu planning. Evidence: At the Random inspection we noted that some different activities had been tried but people were happy to follow their own pursuits. During this inspection we asked everyone about activities and how they liked to spend their day. They all told us they liked to read their daily papers, do crosswords and watch television. Two people told us about their walks in the area and various shopping trips. One person told us about a lady from Age Concern who regularly took them out. Mostly people preferred to go out with their family. Everyone used the mobile library which stopped outside the home on the day we visited. Mrs Burnett Price told us that two people went for walks on their own and another person was accompanied by staff when they went for a walk. In the AQAA Mrs Burnett Price told us that newspapers, magazines, videos and DVD are provided. She told us she would continue to promote activities, particularly with new people who came to live at the home. Care Homes for Older People Page 15 of 28 Evidence: One of the people we spoke with told us Its lovely Im very happy here. They told us that their visitors were welcomed to visit any time. Another person told us that someone who lived nearby and was a friend of Mrs Burnett Price regularly took them out with their family. They told us they had settled in well and described the home as a first class hotel. Mrs Burnett Price told us that she had provided exercise classes but the people who currently use the service were not interested. She showed us the plants and patio sets she had purchased so that some people could get involved in planting and other gardening activities. In the AQAA Mrs Burnett Price told us that she planned to organise more shopping trips and exercises. In survey forms all of the people who responded said they did not want organised activities. One of the people we spoke with told us that they went to the dining room for lunch and had all their other meals on a tray in their bedroom. They told us Its up to us if we go to meals. All of the people we spoke with did not know what was being provided for lunch. One person told us they could find out but were happy to wait and see what was offered. They said they enjoyed the meals and described them as home cooked. Another person told us The food is very good and if I dont like something they will give me something else that I like. The lunch was Spanish omelette with stir fried cabbage and broccoli in a cheese sauce. The meal was well presented. We tried the Spanish omelette which was tasty. The pudding was plum crumble and custard. People who were having their lunch told us that they were enjoying the meal. One person said Its lovely and tasty. The staff are involved in cooking the meals. There is a four week menu based on what people like to eat. The menu may change according to what is in season and the staff keep a record of what is actually served. We saw that the menus provide a range of traditional meals with some dishes from different countries. In the AQAA Mrs Burnett Price told us that she planned to provide more soups and salads following comments from people who use the service. More varied meals are planned. She went on to say that all produce is locally sourced and the meals are cooked from fresh ingredients. In survey forms two people told us that they usually liked the meals provided. 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. Systems are in place for people to make complaints about the service. Staff are trained in safeguarding vulnerable people and know how to raise any concerns using the local reporting process. Evidence: One of the people who we asked about raising concerns or complaints told us I would talk to staff. Another person told us they would speak to Mrs Burnett Price, She will deal with it. I dont have any complaints. Another person told us I would tell Helen [Mrs Burnett Price], so far I havent had to. The homes complaints procedure is given to people and their families when they move in. The complaints log showed no complaints recorded since 1999. Mrs Burnett Price confirmed that she had received no complaints since this time. We asked staff about reporting any allegations or observations of abuse. They were familiar with the local reporting procedure. All staff had received training in safeguarding vulnerable people. A copy of the booklet entitled No Secrets in Swindon and Wiltshire was available to staff. There have been no safeguarding issues reported. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a warm, comfortable, safe environment that is well maintained and cleaned to a high standard. Evidence: The building is over three hundred years old in parts. All of the accommodation is single bedrooms, some having ensuite toilet and wash basin. The accommodation is over two floors, accessed via a passenger lift and stairs. One of the people we spoke with told us that they were very comfortable in their bedroom. They said they could lock their bedroom door if they wanted to but did not need to. We saw that people had their call alarms within easy reach. At the Random inspection we saw that all the ensuite radiators had been guarded to reduce the risk of scalding if people fell against them. In the AQAA Mrs Burnett Price told us that thermostatic controls had been installed to the hot water supply in the bathroom. People have been assessed as needing staff support when bathing. The room in which smoking is permitted had been fitted with an automatic self closing device. The device will activate and close the door if the fire alarms are sounded. We did not see any bedroom doors being wedged open inappropriately. Risk assessments were in place if people smoked. Care Homes for Older People Page 18 of 28 Evidence: Mrs Burnett Price told us that she was considering how to address the tears in the plastic floor covering in the kitchen preparation room. This room has access to the gardens and a bedroom which was currently not in use. Due to the age of the property, there are flagstones underneath the floor covering. Tears had occurred in the floor covering and had been repaired with adhesive tape. We advised that when the adjoining bedroom was due to be occupied, the flooring must be given attention. In the AQAA Mrs Burnett Price told us that she planned to replace carpets which were worn. The central heating boiler had been replaced in the last year. The home has a large enclosed garden to the back with a patio area and garden furniture. In the AQAA Mrs Burnett Price told us that she planned to develop and maintain the garden to a higher standard. We saw that the home was cleaned to a high standard and no unpleasant odours were noted at any time during the inspection. One person we spoke with told us that their laundry always came back nicely ironed. We looked at the laundry area which is housed in a room outside. It was well ordered and arrangements were in place for dealing with any soiled or infected laundry. All staff had been trained in infection control. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who are available throughout the twenty four hour period. Staff are benefiting from more training. Most of the staff have NVQ Level 2. Staff work well with people who use the service and good relationships have been established. Evidence: At the last Key inspection staffing had been provided during the night. At the Random inspection we saw that the rota did not necessarily always show who had actually worked the shifts. From the rota it looked like Mrs Burnett Price was working all of the shifts and carrying out the sleeping in duty without any breaks. Mrs Burnett Price told us that she did have regular breaks. The current rota showed that Mrs Burnett Price was carrying out the sleeping in duties. One of the staff told us that they would sleep at the home when Mrs Burnett Price was on leave. There was a list of contractors and contact numbers in the event of an emergency. When we arrived at the home Mrs Burnett Price was on duty together with another member of staff who was serving breakfast. Another member of staff came in later to prepare and cook the lunch. All staff had been trained in food hygiene. No new staff had been appointed since the last inspection. Mrs Burnett Price told us Care Homes for Older People Page 20 of 28 Evidence: that she would be appointing more staff as the number of people increased. At the Random inspection we saw that updated mandatory training had been sought. At this inspection we saw that this training was well under way and included fire safety, care planning and keyworking and food hygiene. Training in dementia care was also in progress with all staff undertaking this. Mrs Burnett Price told us that she had the contact details for Skills for Care to request more training. Mrs Burnett Price had produced a training matrix so that she could monitor training needs. In the AQAA Mrs Burnett price told us that more than 50 per cent of staff had attained NVQ Level 2 and she intends that all staff will eventually have the qualification. One staff had achieved NVQ Level 4. We saw staff working in a friendly, professional and positive way with people who use the service. It was clear that they had established good relationships with people. One of the people we spoke with told us that the staff were very friendly and helpful. They said that staff always knocked on their bedroom doors before being invited in. They told us there were staff on duty at night as well as during the day. Another person described the staff as wonderful. They are friendly, efficient and always have time for a laugh. Another person told us that the staff were Marvelous, very very kind. Mrs Burnett Price is also very kind. We always have a good laugh together. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mrs Burnett Price has made significant efforts over the last year to improve the service and address requirements we made during recent inspections. She provides good continuity in the day to day running of the home. Record keeping is improving. The home is run in the best interests of people who use the service. People manage their own finances. Systems are in place to ensure the health and safety of people and staff. Evidence: Mrs Burnett Price has run the home for over sixteen years. She has the NVQ Level 4 in management and care. She has maintained and made improvements to the service over the last year. At the Random inspection we saw that the fire risk assessment advised by the Fire and Rescue Authority had been completed and was dated July 2008. Mrs Burnett Price told us that an automatic self closing device would be fitted to any bedroom doors which needed to be held open. At this inspection we saw one of these devices in place on a Care Homes for Older People Page 22 of 28 Evidence: door to a room where smoking is permitted. The door also had a notice about smoking in the room. Since the Random inspection we have been notified of events that the home needed to tell us about by regulation. We saw that some documents and paperwork still need to be dated for monitoring purposes. Mrs Burnett Price told us that she was gradually updating all the paperwork on the computer. In the AQAA Mrs Burnett Price told us that she had reviewed all of the homes policies and procedures in March 2009. She told us that she had only recently learnt how to use the computer and had sought help with business organisation. She said she planned to develop a website for the home. At the Random inspection we saw that risk assessments had been completed on all tasks that staff may be involved in. Risk assessments dated July 2008 had been completed on the premises both inside and out. The assessments included cross infection, disposal of soiled waste, food preparation, prevention of back injury, bathing and moving and handling. Hot water temperatures were being recorded. Staff had signed to say they had read the risk assessments. We looked at the accident records. There were few entries with the last in January 2009. There was no particular pattern to when accidents happened. The home does not deal with anyones finances. People who use the service, families or solicitors manages their finances. The care plans identify who is responsible for each persons finances. There is no formal quality review. In the AQAA Mrs Burnett Price told us that surveys are sent to people, their friends and families and healthcare professionals. She also told us Staff and management are in close contact throughout the day and comments are listened to, discussed and acted upon. Being a small unit we are in close contact with service users friends and families, community nurses, doctors and other visiting health professionals. Any comments and views are noted and we are able to incorporate ideas and suggestions in what we do. Mrs Burnett Price gave examples of what changes had been made as a result of listening to people. Some people had had their rooms rearranged and items had been found for their rooms. The menus had been changed. People had the option of having meals in the garden. Shopping trips had been arranged. There was no formal quality assurance report and staff views were not included. We advised that in order to fully meet this standard, the home must report on how the home is improving the quality of care as a result of these consultations. We also advised that staff views should be included in the review. Care Homes for Older People Page 23 of 28 Evidence: Updated fire safety training was planned. Environmental risk assessments were in place. Mrs Burnett Price told us that any maintenance issues were dealt with by contractors. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 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 1 7 15 The pre-printed care 31/07/2009 planning format must be reviewed and revised so that statements about people and their care needs are more person centred. Some of the language should be more positive. Descriptions of peoples needs should be more positive. 2 12 16 Activity provision must be regularly reviewed particularly with people who are new to the service. So they are consulted about what they like to do. 31/07/2009 3 33 24 Following the quality assessment consultation, the home must produce a report on the measures being taken to improve the quality and delivery of services. 31/07/2009 Care Homes for Older People Page 26 of 28 As evidence that the quality of care is fully monitored and findings acted upon. 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 1 The statement of purpose and service users guide and other documents which refer to the previous regulator need to be updated with details of the Care Quality Commission. Body maps and care plans should record size location, colour and dates of any wounds or marks for monitoring purposes. Staff views on the home should be included in the quality assurance audit. 2 7 3 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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