Care Home: West Point House

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well People considering coming to live at West Point can have access to clear information about the service and agree their terms and conditions of residency. This helps them be aware of their rights and responsibilities whilst living there. There is a relaxed and informal atmosphere in the home and good relationships were evident between staff and people living there, with informal chat and banter. People living there are able to bring in with them some of their own personal items from home and in the bedrooms we saw people had done this. This helped people to make their rooms more personal and familiar with pictures, ornaments and items that held meaning for them. The home has a care planning system that is reviewed on a regular basis. We found that the staff work well as a team and knew the people living there and supported them as well as staff resources allowed. Medication storage is good and records are mostly good. Medicines liable to misuse, called Controlled Drugs, were checked at our visit and were in order. People living there made positive comments about the staff and the care and support they provided. Comments made to us included; "They (staff) are very helpful and polite, they bring me cups of tea, make my bed and take care of my washing. Its all very nice". " I like it here very much, there`s always someone to talk to and the food is very good. Plenty of it too". Relatives also made positive comments about the care people receive from staff at West Point, including: "They look after my Mother very well and I am always informed of any problems". Several people commented on how much they liked the food provided and the choice. The menus we saw were varied and provide a nutritious diet with any special diets catered for. The home received a 5 star rating from the Environmental health department at their last visit. The service has good recruitment systems which help to make sure that the service recruits the right staff to work with vulnerable people. Over 50% of the care staff working in the home have gained level 2 NVQ qualifications in care or above and this is good for staff development to help make sure staff have the right skills for their work. Staff help each other out to work as a team and show a high level of commitment to promoting the welfare of the people living there. We found that the manager has acted quickly to refer any matters affecting people`s safety and welfare to the appropriate agencies for investigation. This helps make sure people are protected. The home has quality assurance systems to identify any areas where they need to improve and the manager understands the importance of making sure staff have the right training. What has improved since the last inspection? Since the last inspection at West Point House the manager has implemented a new complaints procedure to improve this aspect of the service for people. The manager and staff have responded quickly to issues affecting people`s safeguarding and welfare. A more person centred format is used for care planning, involving day and night staff, and the manager continues to try to include people in planning how they want to be supported. The menus in the home have been revised and improved to try to take into account people`s different tastes and preferences. They have also started using new nutritional risk assessments to monitor these needs with people. The manager and staff have worked to reduce the noise levels around the home by reviewing the access system. This was to help create a calmer atmosphere for people living there. There is now a secure key pad access system. Work has been done to improve the exterior of the home to maintain it. There has been work done on the roof to prevent further leaks and damage and the fascias, guttering and down pipes have been replaced. This has improved the appearance of the home and maintains the ongoing upkeep of the home. What the care home could do better: The service uses a person centred format for its care plan but we recommend that these care plans are more thorough and provide staff with clear guidance on managing residents with specific care needs and behaviours so that they are managed safely and effectively. As part of the assessments in place for supporting people we strongly recommend that all aspects of the nutritional assessments being used are always completed in full, including individual preferences. Also that the care plan instructions are followed in practice to weigh people and to monitor and record the food and fluid intake of those identified as at risk nutritionally. Daily and weekly records should be monitored to make sure people are receiving the personal care and support they require as stated in their plans. Overall, we found that the handling of medication was adequate although residents would benefit from improvement in some areas. We strongly recommend that the manager address medication record keeping to ensure accuracy and to minimise errors. Staff should also take care to justify and record why `as required` medicines are being given to show that their use is appropriate and only given when needed. The manager had made improvements in activities provision at the last inspection but this seems to have reduced in frequency and reliability. We recommend that the activities programme is updated and steps taken to oversee it to help make sure advertised activities are carried out as planned in a more structured way so people know what is arranged and for when. We also recommend that the manager restarts the regular outings to help make sure people have the opportunity to go out into the community and see and do things that they enjoy. Although we found the standard of food to be good the manager should consider providing suitable aids and adaptations, such as cutlery and plate guards, to help people retain their independence at mealtimes. We strongly recommend that the manager and service provider reassess the current organisational systems and layout that can restrict people`s freedom of association and movement on the EMI units. They should do this as a high priority and find an alternative system that allows people living there to exercise choice and control over their daily life, association and movement about the home. The management of complaints was effective in the home but the manager should make sure training on safeguarding vulnerable adults is provided for staff who have not done it as soon as he can obtain training places for staff from the service provider. West Point is a comfortable home for people living there but important areas of the environment need improving to promote a good quality of life for people living there. Despite the home manager and accommodation manager identifying offensive odours in 3 bedrooms and all attempts to rectify the problem so far having failed, the flooring in these rooms must now be replaced without delay. This will help to ensure that the home is a free from unpleasant odours and is a clean, hygienic and comfortable place for people to live and work in. We strongly recommend that where a need for improvement has been identified in the physical environment of the home from an accommodation inspection then it should be acted upon swiftly to ensure the health and well being of people living there. Indeed where any quality monitoring systems in use have identified something in the home that needs to be changed or improved, such as training, then to benefit the people living there it should also be done quickly. The provider must make sure there are systems in place to provide prompt training and development for all staff where the need for improvements have been clearly identified. This will help make sure that at all times there are suitably trained, competent and experienced staff working in the home to meet the needs of the people living there. Other aspects of the environment need to be given serious consideration as well. The registered persons must make sure they provide sufficient and suitable toilets for people living on the ground floor of the home. This is to make sure that there are sufficient easily accessible and suitable lavatories to meet people`s individual personal and mobility needs.The manager should also make sure that storage areas are provided for aids and equipment, including wheelchairs, so that bathrooms are free from clutter and easily accessible. We recommend that the area of frayed carpet near the entrance to the lounge on Tummer Hill unit be made safe or replaced now before it gets worse, as it presents a risk to people of tripping if they catch their foot or stick/walking frame whilst mobilising. We recommend that the signage on people`s bedrooms should be personalised in a way that holds significance for the person and can be recognised by them as theirs. Changes have been made to the layout of the ground floor and now provides accommodation for more people w Key inspection report Care homes for older people Name: Address: West Point House Solway Drive Walney Island Barrow in Furness Cumbria LA14 3XN     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: Marian Whittam     Date: 0 1 0 2 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 36 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 36 Information about the care home Name of care home: Address: West Point House Solway Drive Walney Island Barrow in Furness Cumbria LA14 3XN 01229472356 01229475750 steve.atwell@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Stephen James Atwell Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To the service users of the following gender: Either. Whose primary care on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE. The maximum number of service users who can be accommodated is 31. Date of last inspection Brief description of the care home West Point House is a residential care home registered to provide personal care and accommodation for up to thirty-one older people some of whom may have dementia. It is owned and run by Cumbria Care, which is a division of Cumbria Contract Services, a Cumbria County Council business unit. West Point is in a residential area of Walney Care Homes for Older People Page 4 of 36 Over 65 0 31 31 0 Brief description of the care home Island, it is near to a bus route to the town of Barrow-in-Furness and within walking distance of local amenities. The property is a two-storey building, with a passenger lift providing access to the first floor. The home has four distinct living units, each with their own lounge, dining area and kitchenette. Two of the units are specifically for people with dementia. The home is in its own grounds with enclosed private garden areas to the rear and ample car parking to the front of the building. The home provides a Statement of purpose and service user guide to prospective residents and the most recent inspection report is made available. At the time of this key inspection the fees charged range from £474.00 to £551.00 per week. Additional charges are made for hairdressing, personal toiletries and peoples newspapers and magazines. Care Homes for Older People Page 5 of 36 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 quality rating for this service is 1 star. This means that the people who use this service experience Adequate quality outcomes. This site visit to West Point House forms part of a key inspection. It took place on 1.2.2010 and two inspectors were in the home for seven hours. The Pharmacist inspector also visited the service as part of this key inspection. Information about the service was gathered in different ways: 1. We (CQC) sent out an Annual Quality assurance Assessment (AQAA) to the home for the registered manager to complete and return to us. The AQAA is a self assessment and a dataset that is completed annually by all providers of registered services. It is one of the ways we gather information from the providers about their service and how they believe they are meeting outcomes for the people living there and using their service. The AQAA also gives us statistical information about the individual service and Care Homes for Older People Page 6 of 36 trends and patterns in social care. 2. We looked at all the information we have about the service, any changes they have made and how the management has dealt with any complaints or safeguarding vulnerable adults. We looked at what the management has told us about things that happened in the service, these are called notifications and are a legal requirement. We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. 3. We spent time during our visit talking to people who live at West Point House and spent time with them at meal times and throughout the day. This helps us to see what happens during their day and ask what they think about the way the home is run for them. We also spent time talking with visitors to the home and to staff who work there on the night and day shift to get their experiences of working there. 4. We looked at any relevant information we had received from other agencies and organisations and any written comments or concerns people have made to us. During the day we spent time talking with people while they were in the lounges, dining rooms and also in private in their rooms. We looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people lived in, how it was being maintained for people and what facilities and choices were available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. Our pharmacist also assessed the handling of medicines through the inspection of relevant documents, storage systems and meeting with the manager and staff. Feedback was given to the registered manager at the end of the visit. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? Since the last inspection at West Point House the manager has implemented a new complaints procedure to improve this aspect of the service for people. The manager Care Homes for Older People Page 8 of 36 and staff have responded quickly to issues affecting peoples safeguarding and welfare. A more person centred format is used for care planning, involving day and night staff, and the manager continues to try to include people in planning how they want to be supported. The menus in the home have been revised and improved to try to take into account peoples different tastes and preferences. They have also started using new nutritional risk assessments to monitor these needs with people. The manager and staff have worked to reduce the noise levels around the home by reviewing the access system. This was to help create a calmer atmosphere for people living there. There is now a secure key pad access system. Work has been done to improve the exterior of the home to maintain it. There has been work done on the roof to prevent further leaks and damage and the fascias, guttering and down pipes have been replaced. This has improved the appearance of the home and maintains the ongoing upkeep of the home. What they could do better: The service uses a person centred format for its care plan but we recommend that these care plans are more thorough and provide staff with clear guidance on managing residents with specific care needs and behaviours so that they are managed safely and effectively. As part of the assessments in place for supporting people we strongly recommend that all aspects of the nutritional assessments being used are always completed in full, including individual preferences. Also that the care plan instructions are followed in practice to weigh people and to monitor and record the food and fluid intake of those identified as at risk nutritionally. Daily and weekly records should be monitored to make sure people are receiving the personal care and support they require as stated in their plans. Overall, we found that the handling of medication was adequate although residents would benefit from improvement in some areas. We strongly recommend that the manager address medication record keeping to ensure accuracy and to minimise errors. Staff should also take care to justify and record why as required medicines are being given to show that their use is appropriate and only given when needed. The manager had made improvements in activities provision at the last inspection but this seems to have reduced in frequency and reliability. We recommend that the activities programme is updated and steps taken to oversee it to help make sure advertised activities are carried out as planned in a more structured way so people know what is arranged and for when. We also recommend that the manager restarts the regular outings to help make sure people have the opportunity to go out into the community and see and do things that they enjoy. Although we found the standard of food to be good the manager should consider providing suitable aids and adaptations, such as cutlery and plate guards, to help people retain their independence at mealtimes. We strongly recommend that the manager and service provider reassess the current organisational systems and layout that can restrict peoples freedom of association and movement on the EMI units. They should do this as a high priority and find an alternative system that allows people living there to exercise choice and control over their daily life, association and movement about the home. The management of complaints was effective in the home but the manager should Care Homes for Older People Page 9 of 36 make sure training on safeguarding vulnerable adults is provided for staff who have not done it as soon as he can obtain training places for staff from the service provider. West Point is a comfortable home for people living there but important areas of the environment need improving to promote a good quality of life for people living there. Despite the home manager and accommodation manager identifying offensive odours in 3 bedrooms and all attempts to rectify the problem so far having failed, the flooring in these rooms must now be replaced without delay. This will help to ensure that the home is a free from unpleasant odours and is a clean, hygienic and comfortable place for people to live and work in. We strongly recommend that where a need for improvement has been identified in the physical environment of the home from an accommodation inspection then it should be acted upon swiftly to ensure the health and well being of people living there. Indeed where any quality monitoring systems in use have identified something in the home that needs to be changed or improved, such as training, then to benefit the people living there it should also be done quickly. The provider must make sure there are systems in place to provide prompt training and development for all staff where the need for improvements have been clearly identified. This will help make sure that at all times there are suitably trained, competent and experienced staff working in the home to meet the needs of the people living there. Other aspects of the environment need to be given serious consideration as well. The registered persons must make sure they provide sufficient and suitable toilets for people living on the ground floor of the home. This is to make sure that there are sufficient easily accessible and suitable lavatories to meet peoples individual personal and mobility needs.The manager should also make sure that storage areas are provided for aids and equipment, including wheelchairs, so that bathrooms are free from clutter and easily accessible. We recommend that the area of frayed carpet near the entrance to the lounge on Tummer Hill unit be made safe or replaced now before it gets worse, as it presents a risk to people of tripping if they catch their foot or stick/walking frame whilst mobilising. We recommend that the signage on peoples bedrooms should be personalised in a way that holds significance for the person and can be recognised by them as theirs. Changes have been made to the layout of the ground floor and now provides accommodation for more people with dementia. The Provider must make sure that the home has sufficient staff resources available at all times to support the needs of people living there given the size, layout and purpose of the home. This is to help ensure there are sufficient staff available all the time to support peoples needs, activities and aspirations in an individualised and person centred way. 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. Care Homes for Older People Page 10 of 36 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 11 of 36 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 12 of 36 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 are admission and assessment procedures in place at West Point to help ensure that the care needs of people can be met when they come to live in the home. Evidence: West Point House has a Statement of Purpose and service user guide and these can be made available in large print as well. A copy of the last inspection report is also available for people to look at if they wish. There are also leaflets and useful information and contact numbers displayed in the foyer and the complaints procedure. This helps provide general information about support services and agencies that the people living there and their families may find this of benefit, depending on circumstances. The service offers some respite accommodation and people may be introduced to the service using this. We spoke to a person who was having a respite stay and they were happy with the care and support they were getting. They had previously used the Care Homes for Older People Page 13 of 36 Evidence: home for respite care and told us I cant find any fault, its a nice place. Prospective residents and their families may visit the home and look around if they want to to help them decide if it is right for them. We looked at the pre admission assessments of people living there and four people in detail. This was to see if their individual needs had been fully assessed before they came to live there to help ensure that the home had the staff and facilities to be able to meet their needs when they came in. The records on file indicated that the manager or senior staff do an assessment with people before they come to live there. The information covered relevant areas of assessment to begin developing a plan of care with someone. All the people living at West Point are referred to the home by a social worker and there were also social services care management plans from assessing social workers on file for people. These include their assessments of personal, social and any health care needs and where appropriate information from families and health care professionals involved in their care. The service develops its initial care plans from the information it receives and gathers before and at admission. People have an introductory period followed by a review with the individual, their family, social worker and the home staff to help make sure they are satisfied with the care and support they are receiving and that the service is meeting their individual needs. We saw that residents personal files contained copies of terms and condition of residence and the homes contracts with the purchasing agencies. The terms and conditions outlined peoples rights and responsibilities and had been signed by people living there or their representatives if they were unable. The service does not provide intermediate care. Care Homes for Older People Page 14 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at West Point have individual plans of care and individual assessments but some care plans lack sufficient detail to guide and support staff in helping people to manage their personal and health care needs. Evidence: The service has individual care plans for people living there based on initial needs assessments and risk assessments. The plans set out peoples individually assessed health, personal and social care needs and had generally been reviewed. The care plans follow a person focused format, written in the first person and had an informative section called all about me and this gave information on what people wanted and how they preferred to be cared for. Life histories can give staff detailed information and an insight into the person and their lives, beliefs and significant events. Such information can be of great value in giving staff the individuals perspective, expectations and what kind of life style they want and about the person rather than a resident. The home has a link worker system to underpin individualised support but there was evidence that this was not being fully effective in its objectives due to staff related issues. These issues are addressed elsewhere in the report. Some Care Homes for Older People Page 15 of 36 Evidence: people had chosen not to take part in the life history work being done and their wishes were being respected. We could see from care plans that people were getting access to and receiving the services they were assessed as needing, such as physiotherapy, behavioural support and support from the community mental health team. Referrals to doctors and other health care and specialised services are in care plans and records are kept of what is to be done. Responses to our surveys to GPs indicated that usually peoples health care needs are properly monitored, reviewed and met by the service. They also said that the service always seeks advice and acts upon it to meet peoples health care needs and improve their well being. We received comments from people living there in our surveys and we asked people about their care and the support they received from staff. People made many positive comments about the staff and their care, including, Staff are very caring and helpful. They make sure my needs are met, regarding personal care, laundry, health and safety to a high standard. They keep everyone clean and tidy and safe. From what we saw of positive staff interaction during the day, our survey responses and what people told us about living there the indication was that people felt generally well cared for and supported by staff. We looked at four peoples care plans in detail and found their plans covered information for staff on moving and handling needs, skin condition, mobility, personal care, and continence. Appropriate equipment to prevent pressure sores is in use. We found that nutritional screening and monitoring of weights required in the care plan was not being consistently done. We found in all four care plans we examined in detail that not all aspects of the assessment were being done or put into action. For example one had a nutritional assessment completed identifying the need to weigh on weekly basis but records did not reflect this. Also a dietary assessment including a persons likes and dislikes was not completed which was important for them due to weight loss and their dementia. Daily care notes referred in general terms to what has been eaten and drunk but there was no detailed monitoring where a high risk had been identified by assessment. The homes weighing machine was broken on the day of the visit and the manager told us this was already being addressed. Due to changes in the layout of the ground floor units and staff available we observed Care Homes for Older People Page 16 of 36 Evidence: that people on Longreins unit were all expected to use the large lounge on Dova How unit. This meant their bedrooms on Longreins were not easily accessible and some distance and this could affect peoples choice on privacy and for medical and health examinations and treatment. This matter is addressed elsewhere in regard to the overall environment. The pharmacist inspector examined the handling of medication by looking at relevant documents, storage and meeting with the manager Steve Atwell, and other staff. We looked at records for receipt and administration of medication for a period of five weeks. Overall they were satisfactory, showing the treatment received by residents and reasons why medication was omitted. However records of disposal of medication were incomplete so that some medicines could not be accounted for. We counted a sample of medicines and compared these with records to check if they tallied and to show they were administered in the prescribed dosage. Whilst the majority of these samples were in order, some contained discrepancies such as an extra tablet or two showing that there were occasional errors in either records or administration. We looked at a sample of care plans for managing residents with specific health care needs and those with when required medication such as sedatives. Some care plans lacked information and did not always fully map out the management plan for the resident. For example, we looked at a care plan and the protocol for administration of a when required sedative for agitation. This did not give clear guidance on the management of the resident prior to the administration of the sedative, nor the monitoring arrangements to ensure efficacy and safety of treatment. We checked records that were made when these sedatives were administered and on occasions they failed to explain why they were given or were contradictory. Staff must take care to justify why these medicines are given to show that their use is always appropriate. Medicines liable to misuse, called Controlled Drugs, were checked and were in order. The manager was planning to introduce a system of checks, or audits, of medication and assessments of competencies of staff by supervising medication rounds. This will help to ensure that staff use safe medicines administration practices and also the identification of concerns that can be dealt with promptly to keep residents safe. Care Homes for Older People Page 17 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at West Point have a choice of nutritious meals but a lack of resources and structure in the provision of activities means people may not have a range of choices to help them enjoy full and stimulating lifestyles. Evidence: We judged the outcome of these standards through observations made during the visit, from survey responses, care plan and activities records and by talking to people on the day. We spent time with people on the different units during the day to see what was going on and how people were being supported to take part in activities and follow their interests. We joined people in the dining room on the ground floor Dova How unit for lunch and observed the lunch time meals on the other units. We found that the food we saw being served to people at mealtimes was nutritious and from what we could see and what people told us was well presented and hot when served. It came in a hot trolley from the kitchen and was served in the dining room. One person we talked to told us The food is good and that there was always a choice and survey responses were also generally complimentary about the food. We saw there was a choice of two hot meals which had been chosen the previous day and a choice of two puddings. Alternatives were provided when one person did not want Care Homes for Older People Page 18 of 36 Evidence: their chosen meal. The home did cater for therapeutic diets such as for people with diabetes and the home had achieved 5 stars from the environmental health departments inspection. All the people on the dementia unit ate their meals in the dining room with the three staff available to serve meals and drinks and support people who required it. Some people struggled to eat their meals with the traditional cutlery being used so the manager should consider providing suitable aids and adaptations to help people retain their independence at mealtimes. The activities timetable displayed in the foyer of the home was out of date and from what people living there told us, their surveys and what we observed they were not being following. We did not see any current activities programmes on the units for people living there or staff to consult. It was evident there was little structure to the provision of stimulating activities for people to take part in that reflected their interests or in the local community and they were presently more ad hoc and decided on the day. We asked people about what there was to do during the day, one person told us there was Not much going on at present and another told us Theres not a lot to do, no entertainers, we did do bingo but not now. Another person said Mostly I watch the telly, or chat, sit in my room if I want and read the paper. When asked people told us there was No entertainers, no exercise sessions and no bingo. People did however confirm that the local vicar comes in and people could see him or their own ministers and priests if they wanted to so they could follow their faith and receive pastoral support. Some people told us they used to have nice trips out but had not recently. Some people who are more physically able were able to go out themselves or with relatives but for those less able or on the EMI unit there was no evidence of a current programme of activities or individual ones suited to different abilities being consistently provided. The manager told us that activities were to be discussed at the residents meeting. Attempts had been made to continue a monthly trip out but these had been canceled in recent months due to an outbreak of a virus in the home and then because of the bad weather conditions. Previously people had been out locally to see Christmas lights and the nature reserve on the island and the nearby stables. We recommended to the manager that these trips or regular social events need to be restarted now the problems had passed to make sure people had the opportunity to go out into the community and see and do things that they enjoyed. We also recommended that the activities programme was updated and steps taken to oversee it so a range of activities were carried out as planned for groups and individuals in a more structured way and advertised in advance. Care Homes for Older People Page 19 of 36 Evidence: The number of people with dementia living at West Point has increased to 14 across two units, Longreins and Dova How. One large lounge is now used for both units during the day where everyone is encouraged to go once they have completed personal care and had their breakfast. There is also a small smoking area off the foyer. It was not really an option for people to stay in the a smaller Longreins unit due to a minimal amount of staff available for support and needed to supervise the lounge. We saw that three staff were supporting the 14 people. It was early afternoon before the three staff were available to offer activities to people in the large lounge. We saw that the first activity took place after 2pm with staff organising some musical bingo and singing in the large lounge on Dova How. However if a person did not want to join in the singing and bingo they would not have anywhere quiet to do. They would not be able to easily use their bedroom or the Longreins lounge as staff needed to be in the main lounge. Staff feedback through surveys returned, our observations and our discussions with staff confirmed that the new EMI arrangements are causing problems with recreation and freedom of association. Because of the reorganisation of the layout of the ground floor and the staff numbers available for the people there they could not move easily around the ground floor onto the smaller Longrein unit as the connecting doors were locked. this arrangement did not allow people to move freely, go to their rooms and spend time where they wanted rather than be in the large lounge or dining room. This did not suggest an individualised approach to peoples social and recreational preferences and expectations and it was not maximising peoples capacity to exercise personal choice and autonomy. Some people may want to be in a group, others may want more privacy and independence from other people living there. This issue has already been raised in the home with the registered manager and the operations manager. Although the matter is receiving some attention we strongly recommended that the manager reassessed the current systems that restrict choice as a high priority. This is to find an alternative system that allows people living there to exercise choice and control over their daily life and movement about the home and not one that restricts their liberty. Care Homes for Older People Page 20 of 36 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 at West Point are protected by the complaints and safeguarding procedures which were understood by staff. Evidence: The home has a complaints procedure and a system for logging and responding to any complaints made. The procedure is on display on the foyer of the home and in the homes Statement of Purpose and service user guide. Records indicated that the home has received one complaint in the last year and it had been looked into and resolved to the satisfaction of the complainant. There were also compliments made about the service from six people and cards and letters expressing appreciation of the service provided. Those people living at West Point who responded to our surveys indicated that they did not know how to make a formal complaint. However surveys indicated all felt they had someone to talk to informally if they were unhappy. People we spoke to did however tell us that they knew who to talk to if they were unhappy about something and that they would speak directly rather than make a written complaint. People told us that they did see the manager most days if they wanted to talk about anything they were unhappy with or raise a complaint directly. There are policies and procedures in place to protect vulnerable people from abuse and whistle blowing procedures for staff to report any bad practice. There are also policies and procedures on gifts to staff and handling peoples monies to safeguard their interests. Staff we spoke with knew about safeguarding procedures and what to Care Homes for Older People Page 21 of 36 Evidence: do if they suspected abuse or bad practice. We observed that staff had raised issues with the management where they believed peoples best interests were not being served. This indicated that staff were aware of the issues around peoples individual rights and motivated to act to make sure they were promoted. It also indicates a culture where staff feel they can take issues forward on peoples behalf. The service uses the local authority multi agency guidance on safeguarding and records showed most staff had received mandatory training on safeguarding in the home and also cover this topic in their NVQ courses. The manager has identified that a small number of staff need this training and should make sure it is provided as soon as they can obtain training places for staff. The service has made 4 safeguarding adults referrals to social services under Safeguarding procedures to protect the interests of people who use the service. These were reported by the manager and investigated by the appropriate agencies to promote peoples safety and interests. The home does not manage any residents finances but holds small amounts of spending money on their behalf. Residents are supported to maintain control over their own finances where possible or with the help and support of family and representatives. All the homes financial processes are audited annually by the Local Authority. We checked the financial records where the home hold personal monies for people. These were securely stored and clear records maintained of all transactions. These were recorded and signed for by two people with receipts retained and cross referenced to the relevant record. This system safeguards both the person and the staff supporting them. We spot checked three peoples finances and found these to be in order. Care Homes for Older People Page 22 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. West Point House is a comfortable and relaxed home. However the lack of prompt action to resolve problems with malodours and toilet access means the environment is failing to meet some peoples individual needs and promote a good quality of life. Evidence: Overall West Point House is decorated and maintained to a satisfactory standard. The furnishings and decoration are generally in a satisfactory condition. Over the last 12 months work has been done to maintain the exterior of the building replacing facias, gutters and downpipes. This general maintenance has also improved the appearance of the building. There is a passenger lift so people can move between the two floors and hand rails in corridors help people with mobility problems. Moving and handling equipment is provided and this has been serviced to ensure it was in good working order. We made a tour of the premises and checked bathrooms, toilets, the laundry and communal areas. There are suitable bathrooms with assisted bathing aids, showers and toilets on each floor. All the toilets were clean and had been fitted with red toilet seats which are easier for people with visual impairments to see. We saw that in some bathrooms there was equipment being stored, including wheelchairs and mobility aids. We recommended to the manager that they should make sure that storage areas are provided for such aids and equipment so that bathrooms are free from clutter and Care Homes for Older People Page 23 of 36 Evidence: easily accessible. During our visit we examined a number of bedrooms. We saw that many people had chosen to bring in their own personal things, photographs and items of importance to them to make their rooms more personal and homely. Bedrooms were warm and generally suitably furnished for peoples comfort. There was new signage being used on doors which can be helpful to people in identifying different rooms such as toilets and bedrooms. However all the bedroom door signs were the same which may cause confusion, especially for people with dementia. We recommended they should be personalised in a way that holds significance for the person and can be recognised as theirs. In three of the bedrooms we saw there was a very strong and offensive smell of urine and also highly visible stains on the carpet. Maintenance records in the home showed the issue of malodours had already been highlighted in these rooms in the annual accommodation survey conducted by the organisations accommodation manager. The issues were rated at level 1 and 2 meaning they required attention but the matter has not been addressed effectively and has been allowed to continue by the Provider. We discussed the odours and the lack of prompt action with the manager. The manager had already tried to improve the situation by using a number of different cleaning machines and cleaning agents without success. As a result people living in the home, their visitors and staff were still expected to live and work with this unacceptable situation, with a strong smell of urine in the affected rooms on a daily basis. This also undermines peoples daily quality of life and it cannot continue. The Providers must now replace the flooring in these rooms without delay. Given that all the other cleaning attempts to rectify the problems have failed and that it has already been clearly identified and recorded as requiring action in the annual premises survey it is very clear it needs to be done. This will then help to ensure that the home is free from unpleasant odours and is a clean, hygienic and comfortable place for people to live and work in. We also found the carpet in an upstairs hallway on Tummer Hill unit was frayed near the entrance to the lounge. We recommended this be attended to now before it gets worse, as it presents a potential risk to people of tripping if the catch their foot or stick/walking frame whilst mobilising. The laundry is on the ground floor and we found it to be clean and tidy with easily washable surfaces. The washing machines were suitable for heavy use and at appropriate temperatures to thoroughly clean linen and reduce the risk of infection. Care staff on duty attend to laundry as part of their duties. The home has policies and Care Homes for Older People Page 24 of 36 Evidence: procedures in place for infection control. Training records available to us indicated that most staff have had this training. The manager has highlighted that some staff need this training but must wait to see what training places will be made available to the home by the provider. We saw that there were gloves and aprons provided for staff and these were seen being used by staff providing personal care. Changes have been made to the layout of the ground floor to allow for an increase in the number of people with dementia who live in the home. This included both Longreins and Dova How units. A large communal lounge is now on the Dova How unit and also a large dining room, where everyone from both units have their meals. We could see that it was not really a safe option for people to stay in Longreins due to a minimal amount of staff to supervise the unit. Longreins lounge was empty during our visit and people were not using their bedrooms as they would be alone and locked in if they did. Staff feedback through surveys returned and our discussions with them helped confirm our observations that this new layout of the home has created some environmental problems. There is only one toilet close by the lounge and dining room where up to 14 people are spending their time during the day. Consequently people do not have easy access to a toilet if more than one person may want to use the toilet. There is another toilet on Dova How but at a further distance from the lounge and dining areas and this can cause difficulties and anxieties for people with dementia, reduced mobility and continence problems. There are toilets on Longreins but this is even further away. Because of the long distances between rooms and also to the next nearest toilets staff are also often left isolated with a group of people. We could see that there were not enough suitable and easily accessible lavatories close to the lounge and dining areas in use to meet the different needs of people living there on the ground floor. Hence the new ground floor layout of the home was not suitable for its purpose and did not meet the specific assessed needs of the people living there. This issue has already been raised in the home with the registered manager and the operations manager. The situation is still being reviewed. Although the matter is receiving some attention no actions to improve the situation has been made and this must be done promptly as some individuals needs were evidently not being met. It was evident that this change to the environment had not been thought through with individual personal needs and choices in mind. We advised the manager this must be addressed as a matter of importance and we would be monitoring progress on achieving this to meet the expectations and needs of people living there. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at West Point are protected by a thorough recruitment process. However staff training and staffing levels do not always reflect the importance of person centred support and could affect the care of people living there. Evidence: The rotas in the home are planned in advance with a view to continuity but we saw that changes often occured due to problems with staff sickness and shortages that needs to be covered internally or using relief staff. We could see that this was undermining the effectiveness of the link worker system the manager was trying to use. Additionally the supervisory team of had a high proportion of relief supervisors and this is a problem for the manager trying to develop a strong supervisory team. Looking at rotas, surveys responses we received, observing staffing during the day and speaking to people living and working in the home it was clear that staff are running at capacity. The manager and supervisors spend a lot of time trying to make sure there is adequate staff cover to meet peoples personal care needs within the resources available to them and this is not a good use of their time. The rotas also indicate that there are periods when there may not be sufficient staff numbers on a unit due to staff starting and finishing work at different times and due to their deployment. It is hard to make sure information is communicated effectively to everyone if staff are not together for a staff handover at the same time. This is a Care Homes for Older People Page 26 of 36 Evidence: situation the manager has inherited and has developed over time with staff shift patterns not being based on achieving good outcomes for people using the service but more on staffs working preferences. We saw three staff were supporting the people on Longreins and Dova How units, which during the morning. This meant 1 person was in the lounge at all times, 1 carer on the units and the other in the dining room supporting people with their breakfast. The number of people with dementia has increased but staffing levels on those units affected has not and in real terms may be seen as reduced. The new arrangements are already proving difficult to manage with only one toilet close by and because of the long distances between rooms and staff are often left isolated. This level of staffing and staff use could result in people having their choices limited in daily life, not always getting prompt assistance to meet their needs and preferences and also affect their safety and welfare if there are not enough people to properly supervise or carry out aspects of care needing 2 carers or one to one support. From observation and speaking with residents and staff it was clear that staff work hard to make sure peoples needs are met and support each other and that the manager and supervisors make best use of the staff resources available to them to try and maintain outcomes that are acceptable to residents. The service does however need to look at the ratio of staff to people living there according to their individual needs, preferred routines, individual choice and levels of dependency rather than what staff can be made available to them. This would also uphold the person centered approach to care the manager and staff have been working on in the care plans and provide consistent staff levels focused on delivering improved outcomes for people living there. It would help make sure that individualised care they are trying to achieve can be put into real practice focusing on people living there as individuals not focusing as much on the tasks to be done and what staff are available at different times of the day. The manager is meeting with staff to discuss working times but this situation has been going on for some time and must be dealt with now. We looked at staff personnel and training records and spoke with staff about their training and recruitment experiences. Records show NVQ Level 2 training is being supported and over sixty seven percent of staff have done this vocational training. Records and staff surveys indicated that the service followed robust and effective recruitment procedures to safeguard people living there and made all the required security checks. Our discussions with the manager indicated to us that he recognised the importance of training staff and the benefits of a skilled trained work force. He has identified that there are some gaps in staff training through doing an analysis of both mandatory and supplementary training needs. The manager has clearly identified who Care Homes for Older People Page 27 of 36 Evidence: needs what training updating or providing to make sure people at the home have well trained and informed staff. However the manager must then nominate staff to go on the courses and wait for places to be offered, as they are available. So has little control over obtaining training promptly where a gap has been highlighted. The provider must make sure there are systems in place to provide training where the need for improvements have been clearly identified. A number of staff need to do moving and handling refresher courses and significant numbers need health and safety, infection control and food hygiene training or updates. These are very important areas of practice that can have a direct impact on peoples health and well being if staff are not competent and up to date in their principles. The training gaps analysis is a valuable piece of work and must be implemented to ensure that all the staff caring for people at West Point have at least all their mandatory training up to date. This is to help ensure that all staff are consistently trained and skilled to deliver the best level of care and safe practice to people living there. Care Homes for Older People Page 28 of 36 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. West Point has quality monitoring systems in place to promote peoples welfare and safety but a lack of prompt action to follow up the findings of some of the quality assurance checks hinders the ongoing improvement of the service. Evidence: The home has a registered manager,Steven Atwell who is suitably qualified for the post. People living at West Point told us they saw the manager to talk to most days and one said He always asks if everything is OK. One person told us that the manager was a nice fella, and they felt they could talk to him. The home has regular staff and residents meetings so that their views and ideas may be aired and people kept up to date with what is happening in the home. The providers and manager of West Point monitors the services performance using satisfaction surveys, which are due to go out. There is an overall organisational development plan that the service is part of with its own annual objectives to achieve. Care Homes for Older People Page 29 of 36 Evidence: There are quality assurance systems in place and annual quality checks, including on the accommodation and premises, quality and financial audits and audits of policies and procedures. The manager has done a very good training gap analysis to highlight areas he has identified as needing resources to improve and help ensure the service can meet its care objectives. However resources still need to be provided for this so staff training can be brought up to date and to improve the accommodation as identified at their own audit. Otherwise, despite having quality assurance and quality monitoring systems, that the manager is participating in, he will not have what is needed to ensure improvements are done quickly. This undermines the point of having quality monitoring systems if improvements required do not take place quickly to improve daily life and care for the people living there. Staff comments to us and in surveys and speaking with staff and residents indicated that care staff tried to work together as a care team and help each other. Our observations during the morning the rotas and staff feedback also indicated that staff did have to work alone at times and that at busy times of the day staff were too stretched especially in the mornings. We met with several staff during the day and talked to them individually as they went about their duties. Some staff had come in to meet with the manager for an update, which is good practice and helps to maintain a good continuity of care. Staff said, they get well supported, and they receive regular formal supervision. They confirmed that management and supervisory staff are approachable. Records confirmed staff had been given formal supervision on a one to one basis. Financial records are kept and the service has systems in place to protect peoples money. Transactions are receipted and the service does not act on anyones behalf financially. The home has adequate insurance cover in place. Records indicated that the home has systems and practices to promote the safety of people living there and staff had received fire training. However some staff require training updates on mandatory training in moving and handling, infection control, food hygiene and health and safety. The manager has identified this using his own training analysis. Records show that the testing and servicing of equipment including emergency equipment is being done as required and that staff have been given fire training. Care Homes for Older People Page 30 of 36 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 31 of 36 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 21 23 The registered persons must 15/03/2010 make sure they provide sufficient and suitable toilets for people living on the ground floor of the home. This is to make sure that there are sufficient easily accessible and suitable lavatories to meet peoples individual personal and mobility needs. 2 26 16 The registered manager and 15/03/2010 Providers must make sure the carpets in the bedrooms affected by the offensive odours are replaced without delay. This will help to ensure that the home is a free from unpleasant odours and is a clean, hygienic and comfortable place for people to live and work in. It will also improve the quality of life of the people using the Care Homes for Older People Page 32 of 36 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 affected bedrooms. 3 27 18 The Provider must make sure that the home has sufficient staff resources available at all times to support the needs of people living there given the size, layout and purpose of the home. This is to help ensure there are sufficient staff available all the time to support peoples needs, activities and aspirations in an individualised and person centred way. 4 30 18 The provider must make 03/05/2010 sure there are systems in place to provide training and development for staff where the need for improvements have been clearly identified in the training needs analysis. This will help make sure that at all times there are suitably trained, competent and experienced staff working in the home to meet the needs of the people living there. 02/04/2010 Care Homes for Older People Page 33 of 36 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 It is recommended that care plans are more thorough and provide staff with clear guidance on managing residents with specific care needs so that they are managed safely and effectively. Daily and weekly records should be monitored to make sure people are receiving the personal care and support they require. It is strongly recommended that all aspects of nutritional assessments are always completed in full, including individual preferences, and that care plan instructions are followed in practice to weigh people and to monitor the food and fluid intake of those at risk. Staff should take care to justifyand record why as required medicines are given to show that their use is appropriate and only given when needed. It is strongly recommended that the manager address medication record keeping to ensure accuracy and to minimise errors. We recommend that the activities programme is updated and steps taken to oversee it to help make sure advertised activities are carried out as planned in a more structured way. We recommend that the manager restarts the outings to help make sure people have the opportunity to go out into the community and see and do things that they enjoy. We strongly recommend that the manager and service provider reassess the current organisational systems and layout that can restrict peoples freedom of association and movement on the EMI units as a high priority and finds an alternative system that allows people living there to exercise choice and control over over their daily life, association and movement about the home. The manager should consider providing suitable aids and adaptations to help people retain their independence at mealtimes. The manager should make sure training on safeguarding vulnerable adults is provided for staff who have not done this as soon as he can obtain training places for staff from the service provider. 2 7 3 8 4 9 5 9 6 12 7 13 8 14 9 15 10 18 Care Homes for Older People Page 34 of 36 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 11 19 We strongly recommend that where a need has been identified for improvement in the physical environment of the home from an accommodation inspection then it should be acted upon swiftly to ensure the health and well being of people living there. The manager should make sure that storage areas are provided for aids and equipment, including wheelchairs, so that bathrooms are free from clutter and easily accessible. We recommend that the signage on peoples bedrooms should be personalised in a way that holds signifigance for the person and can be recognised by them as theirs. We recommend that the area of frayed carpet near the entrance to the lounge on Tummer Hill unit be made safe or replaced now before it gets worse, as it presents a risk to people of tripping if the catch their foot or stick/walking frame whilst mobilising. Where quality monitoring systems have identified something in the home that needs to be changed or improved to benefit the people living there it should be done quickly. 12 22 13 24 14 24 15 33 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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