Care Home: Westgate House Nursing Home

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What the care home does well The home has a relaxing atmosphere and the people who were able to were observed walking up and down the spacious corridors. The people and their families are encouraged to visit the home. One family member said that personal recommendation was given to them to visit the home. They visited and `liked the openness and living area on the other side, where the people are able to walk freely without restraint`. Another family member spoken to said that `their relative is kept clean` and they did not `smell any thing` offensive. They said that the `carers are very nice`. They know the GP visited the home regularly and this was said to be very good. We were told that the `staff tell us every thing` when their relative is `poorly`. One relative told us that `the staff and the nurses are friendly towards` their family member and they seemed happy at the home. The staff enjoy working at the home and it was said `I like working with the residents` The staff say that they work very hard to meet the needs of the people `to make sure that all the people are looked after well`. They are getting the relevant training to help them meet the people`s needs. They were observed talking and listening to the people and encouraging the people to eat in a nice manner. They say they work well as a team, and get good support from the proprietor and the nurses. What has improved since the last inspection? The care plans were being updated in to a new format and being reviewed on a monthly basis. A hoist had been replaced and the home had increased the number of pressure mattresses and bought two profiling beds. A new fire place feature was put in the dining room to make it homely. Another section of the flooring in the corridors downstairs was tiled. What the care home could do better: An occupational therapist assessment needs to be undertaken to find out if the chairs and settees in the lounge and dining area are appropriate and meeting the people`s needs. Replace the carpet in some areas of the corridor and in some bedrooms. This is so the people live in a pleasant environment. Provide staff one to one supervision that is recorded on a regular basis to monitor how they are meeting the needs of the people Provide meaningful activities for all the people living in the home to meet their needs. Provide a contract that has all the information stated in the standard. This is so the people know their rights and responsibilities. Provide signs that are user friendly on toilets, bathrooms and other areas of the home. to meet the needs of the people with dementia. Repair or replace the broken bath seat, wobbly toilet seat, and head boards. This is so the people are not put at a risk when using this.Replace the old commodes. This is so the people`s dignity is maintained. Provide a quality assurance system that takes account of all the peoples views, relatives, staff and other professionals to find out how the home is meeting the people`s needs. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Westgate House Nursing Home Eastcote Road Gayton Northampton Northamptonshire NN7 3HQ     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: Ansuya Chudasama     Date: 1 2 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 29 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 29 Information about the care home Name of care home: Address: Westgate House Nursing Home Eastcote Road Gayton Northampton Northamptonshire NN7 3HQ (01604)859355 01604858074 westgatehouse@aol.com 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) : Mrs Patricia Byrom,Mr James Byrom care home 41 Number of places (if applicable): Under 65 Over 65 41 0 41 dementia mental disorder, excluding learning disability or dementia terminally ill Additional conditions: 41 41 0 Bedrooms numbered A50 and C6 may only be used to accommodate Service Users who are fully ambulant. No one falling within the category DE(E) may be admitted into the home where there are 40 Service Users of this category already accommodated within the home. No one falling within the category DEmay be admitted into the home where there are 41 Service Users of this category already accommodated within the home. No one falling within the category MD (E) may be admitted into the home where there are 40 Service Users of this category already accommodated within the home. No one falling within the category MD may be admitted into the home where there are 41 Service Users of this category already accommodated within the home No one falling within the category TI may be admitted into the home where there are 40 Service Users of this category already accommodated within the home. Care Homes for Older People Page 4 of 29 The age range for the Service Users in the category MD is 40 years and above Date of last inspection Brief description of the care home Westgate House is a large nursing home situated in the outskirts of the village of Gayton near to Northampton. The home provides nursing and personal care for up to forty-one people within the categories of Dementia, Mental Disorder and Terminal Illness. There are registered nurses on duty 24 hours aday. The home has a lift to the first floor. The ground floor is very spacious and has a large dining room, a TV room and a quiet room. At the time of this inspection, the fees ranged from £592 to £745:00 per week. The fees include, accomodation, full board. laundering of personal items, hairdressing, chiropody, inco-pads, alcohol beverages, newspapers, recreational therapy, clothing and toiletries. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Care quality Commission (CQC) policy and methodologies which require review of key standards for the provision of a care home for older people that takes account of the peoples views and information received about the service since the last inspection. Evidence used and judgments made within the main body of the report include information from this visit. We looked at the Annual Quality Assurance Assessment (AQAA) that was sent to us by the home. The AQAA is a self-assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Older People Page 6 of 29 The report refers to we this is because the report is written on behalf of the Quality Care commission. This key unannounced inspection was carried out on the 8th and 9th of May 09. The registered providers of the home helped out with the inspection process. During this inspection we tracked the care of two people who use this service. This involved reading their care records and also talking to them wherever possible to obtain their views on the service. We also spoke to some of the other people who live in the home and relatives who visited the home. Documentation relating to staff recruitment, training, supervision, medication administration, complaints and health and safety were also examined. We had the opportunity to talk to some of the staff who were on duty and a tour of the home was also conducted. What the care home does well: What has improved since the last inspection? What they could do better: An occupational therapist assessment needs to be undertaken to find out if the chairs and settees in the lounge and dining area are appropriate and meeting the peoples needs. Replace the carpet in some areas of the corridor and in some bedrooms. This is so the people live in a pleasant environment. Provide staff one to one supervision that is recorded on a regular basis to monitor how they are meeting the needs of the people Provide meaningful activities for all the people living in the home to meet their needs. Provide a contract that has all the information stated in the standard. This is so the people know their rights and responsibilities. Provide signs that are user friendly on toilets, bathrooms and other areas of the home. to meet the needs of the people with dementia. Repair or replace the broken bath seat, wobbly toilet seat, and head boards. This is so the people are not put at a risk when using this. Care Homes for Older People Page 8 of 29 Replace the old commodes. This is so the peoples dignity is maintained. Provide a quality assurance system that takes account of all the peoples views, relatives, staff and other professionals to find out how the home is meeting the peoples needs. 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 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 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 people admitted to the home are assessed prior to their admission to ensure that their needs will be met by the home. Evidence: The service user guide had been reviewed and had pictures of the home. However all the information stated in standard 1 of the National Minimum Standard for Care Homes for Older people needed to be included in the guide to give more information about the home. Relatives spoken to had visited the home prior to their relative coming to stay at the home. One relative spoken to said that the home was recommended by a nurse. They visited the place and liked it. Another family member said that personal recommendation was given to them. They visited and iked the openness and living area on the other side, where the people are able to walk freely without restraint. It Care Homes for Older People Page 11 of 29 Evidence: was also said that they were given information about the home when they visited the place. The peoples files looked at showed that there were admission details of the person being admitted to the home and information from the funding authority. We spoke to one relative who told us that they did not have a contract, which tells them of their responsibilities and rights whilst staying in the home. We were given a copy of the conditions of admission but this needed further information as stated in standard 5 of the National Minimum Standards for Care Homes for Older People. Care Homes for Older People Page 12 of 29 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. The peoples health care needs are being met by the home. Evidence: We were informed that female patients in the home were attended by female staff when giving personal care. This was to maintain their dignity. The registered providers of the home told us that they practice the Liverpool care pathway for people who are terminal and needs palliative care. This was confirmed by talking to one of the nurses on duty. We were also told and evidence showed that the home worked very closely with the GP who visited once a week and held a surgery at the home. Because of the location of the home, arrangement had been made with the GP to keep antibiotics on the premises. This was so treatment for infections can be started straight away. This method was approved by the Care Quality Commission (CQC) and the Primary Care Trust (PCT) pharmacist. The home had started reviewing all the care planning documents. They had adopted Care Homes for Older People Page 13 of 29 Evidence: the Care Doc system to do the new care plans on. We looked at two peoples care plans in detail. One was in the style of the new care doc system and another one was in the old style. The New format had information on personal care, health care and risk assessments. This was good but more information was needed as discussed with the provider in explaining the process of how staff meet the peoples need. An example was being told about a persons challenging behaviours and information needed to be recorded to show how staff managed this persons behaviour. staff spoken to told us how they managed this behaviour. We were told that the home was still getting used to working with this new format. The other care plan looked at was still in the old format style. The information in the care plan needed expanding so all staff would know how the persons care needs were being met. We were told by the nurses that they had expanded the information to explain how peoples needs were being met in the new format. Discussion with them showed that they had very good understanding of the needs of the people that they cared for. The other care staff spoken to also had good understanding of the peoples care needs. We were told that the staff got involved in reviewing the peoples care plans. We observed staff interaction and noticed that they talked to people in a respectful manner and were careful to preserve their dignity. One family member spoken to said that their relative is kept clean and they did not smell any thing offensive. They said that the carers were very nice. They knew that the GP visited the home on Thursdays and this was said to be very good. We were told that the staff tell us every thing when their relative is poorly. They also attended the PCT reviews. Another relative told us that their family member had settled in the home well. It was said that before they came to the home, they were on lots of medication. The medication was reassessed and it was said that this had been greatly reduced and they were very please with this. We observed that some of the peoples hair was not combed and did not look pleasant. We were told that some staff did not do this. However this would be sorted. Evidence in the care records showed that people are offered support for their physical and emotional health needs. There were records of general practitioner, and hospital appointments, and people have access to the opticians, dentists, tissue viability nurse, and other health care professionals. One care file we inspected had a Care Management Plan and the information was Care Homes for Older People Page 14 of 29 Evidence: completed by families. This information is called the end of life plan and information read said the family says no resuscitation or CPR and for 999 it said unsure. We were told by the provider that this form was devised by the GP. We had a discussion with the provider with regard to getting legal advice to find out if this document was legally acceptable. We were told that this was being looked at by them. Some staff in the home had received the Mental Capacity Act and deprivation of liberty training. We were told that two nurses or sometimes a nurse and a care staff at the home gave out medication. We observed staff giving out medication and this was done by talking to the people. The home had controlled drugs and these were kept in the controlled drugs cupboard. The records and medication checked was satisfactory. Some care staff spoken to have done the training on dying and death. We were told that the nurses on duty would support care staff to carry out this task. Care Homes for Older People Page 15 of 29 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. The home is aware of the need to plan the routines and activities in a way which meets the needs of all the people. Evidence: We were told that some people with mental health needs attended mind group sessions twice a week. These people also went to the post office to take out money from their account. This was good practice to maintain their independence. We were also told that an occupational therapist visited the home three or four times a week and did activities. However on the day of the inspection there was no activity person doing any activities. We observed one staff giving out a duck, and a tambourine and other objects to people sitting at the dining table. The people were observed just staring at these objects. One member of staff was observed helping one person to do an activity by sitting with them. Some times staff did activities as and when they had time to do this. The information in the Annual quality Assurance Assessment (AQAA) stated that the home is aware that they need to ensure staff to engage more readily with the more cognitive impaired people. Care Homes for Older People Page 16 of 29 Evidence: We were told that one person came to the home once a week from 2pm to 4 pm to do activities such as music and movement. Another person called Mick and his music attends on a monthly basis to do dance and music. We were told that the people enjoyed these activities. We were given a copy of the activities list. This did not have the date or the time each activity for the week was to happen. So there fore the people and their family would not know when these activities were going to take place. We asked one relative about activities and it was said that they knew some activities took place but did not know when these were. We observed the people living in the home having their lunch. This was eaten in a relaxed atmosphere with staff talking to the people and encouraging them to eat in a kind manner. A variety of comments were received about the food that was offered to the people. One person told us that the food is nice. One visitor told us that their relative had food that was liquidised and they seemed to enjoy the food. Most of the people in the home maintain contact with their families or friends. The relatives of the people were encouraged to visit the home and some people visited the home often. It was said that they were made to feel welcomed by staff. The home does not have a residents meeting due to their mental state. However the home should consider having relatives/advocate meetings to get their views on how they see the home is meeting their relatives needs. Care Homes for Older People Page 17 of 29 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. Management have an open door policy so the people and their relatives are able to voice their concerns to ensure the peoples needs are met. Evidence: The home informed us that they have not had any complaints since the last inspection. We were told that they had an open door policy and they listened to any concerns raised and addressed them. We spoke to relatives who informed us that if they had any concerns, they would speak to management. The complaints procedure is displayed in the entrance hall of the home. The staff spoken to informed us that they had completed the safe guarding of vulnerable adults procedure training. They knew what to do if they suspected any of the people were being abused. It was said that they would tell management. They also understood the peoples behaviours to know if they were unhappy or not feeling well. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a relaxing atmosphere and the programme of redecoration is on going to meet the needs of the people. Evidence: A tour of the home showed that the place was generally clean and homely. The lounge had a homely feel to it but the settees both in this room and in the dining area needed an occupational therapist assessment. This was because we observed some people struggling to get off these chairs. We were told that two familys had bought high chairs with sides to meet their relatives needs. The plastic garden chairs used in the dining room also needed assessing because observation showed that these were not always suitable for some people and we noticed that after sitting on these chairs for a short period, it felt sticky and sweaty. Some people enjoyed spending a lot of their time sitting in the dining room area. We were told that a hoist had been replaced and they had increased the number of pressure mattresses and bought two profiling beds. One of the bath seat was broken and one toilet seat was wobbly and old in one of the bathrooms. The bathroom doors for the main area were noisy when closing the door. This was because the doors had not been done properly. We were told that the wet room was being done up, with Care Homes for Older People Page 19 of 29 Evidence: new tiling being put in. The home was also getting a new sling hoist. It was said another section of the corridor which was worn out was tiled and this was on going. The AQAA says that the final section of the corridor is to be completed after they receive the date from the builder. This was still not known at the time of this inspection. The carpet upstairs in the old part and in some of the bedrooms was old and dirty and not very pleasant for people living in the home. We were told that when a room becomes vacant, this room is then decorated for a new admission. Some of the peoples head boards on the beds were wobbly and we were told that this will be fixed. Some of the old worn out commodes were cleared away on the second day of inspection but there were still a few left and we were told that these will be replaced when new ones arrive. We observed and were informed that some of the places in the dining room needed to be better cleaned. This was also stated in one of the questionnaires read. The bedrooms seen were individualised to the peoples need. Those spoken to informed us that they like their rooms. Most of the bathrooms and toilets did not have a sign to say what they are. So there fore the people will not be able to know how to find the toilet. The garden was secure and pleasant for the people to sit outside in the summer months. The home had a miniature putting green and a croquet lawn and this is used when the weather is warm. Care Homes for Older People Page 20 of 29 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. The home ensures that all staff receives relevant training that is targeted and focused on improving outcomes for the people. Evidence: The staff informed us that they received good induction and spend three days with the trainer who is an experienced ex nursing sister. They also receive in house training on mandatory and specialist training such as Moving and Handling, fire safety, dementia, food hygiene, safe guarding of vulnerable adults procedures, palliative care, diabetes, and wound care. One person spoken to said that they were also getting dementia training by distance learning. The home has over 50 per cent of staff with NVQ level 2 or above training. A training matrix for the staff is needed so we can see all the training the staff have undertaken and training that is planned for the future. The staff spoken to told us that that they get good training and if they have any problems I talk to one of the providers of the home. It was also said that she is very supportive to us and the nurses were also very helpful. Another person said that they would go to the nurses for advice on any medical concerns that they had about the people. Care Homes for Older People Page 21 of 29 Evidence: Recruitment files were looked at in detail. Evidence showed that the home was obtaining all the relevant information required to safe guard the people in the home. The home did not keep copies of the peoples birth certificate and passport. We were told that these were seen at the time of completing the criminal record bureau (CRB) checks for new staff. We were told by staff that there were enough staff on duty to meet the high needs of the people. It was also said that they had a low turnover of staff and many of the staff had worked at the home for many years. The duty working rota looked at showed that the home sometimes had 3 or 4 nurses working in the mornings and two in the afternoon. This was good and the peoples health was always being monitored well. The staff told us that on some Wednesday afternoons they have refresher training on health and safety, manual handling, food hygiene, and fire safety by watching videos and having discussions. The staff say that they are happy working here and it was said that there is good atmosphere. It was said that they looked after the peoples needs well. We were told that the home has staff meetings to discuss what was happening in the home and discuss peoples needs. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interest of the people so their needs can be met. Evidence: The home is managed by the registered providers. They have many years experience of running a home. The staff tell us that the registered provider is supportive and listens to us. The nurses were also said to be very supportive in giving advice and information on health issues. The trainer for the home was said to be providing good training. We were told that four staff in the home had completed their Registered Managers Award (RMA). The registered provider stated that they had an open door policy and staff and relatives were welcomed to talk to her any time. We were told by one relative that they would speak to the manager or staff if they had any concerns. The provider told us that four questionnaires had been completed by a member of staff with four people. It was also said that she puts questionnaires near the visitors book Care Homes for Older People Page 23 of 29 Evidence: and had 5 that were completed. The information recorded was positive about the home and there were areas that needed looking at. The provider told us that she talks to the relatives and the people when they visit to get their views about the home. But this information is not recorded. We had a discussion with the provider and explained that in order to get the views of all the people and from their relatives, it was important that the questionnaires were sent to them to complete. This was because not all the families/friends visited the home on a regular basis so their views were not being obtained. It was also good to get the views of the staff and other professionals involved with the people. The information received from the questionnaires needed to be analysed and displayed where the people and their relatives could view this to find out how the home was meeting the peoples needs. Discussion with staff showed that they were not all receiving supervision on a one to one basis, which was recorded, dated and signed by both parties. This is to show that the staff are being monitored to find out how they were working and meeting the peoples needs. We were told that the staff were asked how they were getting on at the home by senior staff. The accident and incident records show that these were being recorded appropriately in the book. The home experienced people slapping and scratching each other and having unexplained bruises. We were told by the proprietor because of the client group they had, the people were going to have falls and bruises and they could not stop this from happening. We were told that management reviewed this and a decision is made to find out if a safeguarding referral needs to be made to social services. We were told that a few peoples money is looked after by the home. This money is kept at the home and the registered provider only deals with this. We were told that this was to ensure that the money was kept safe by one person dealing with this. The finances of one person were looked at. This person received a cheque on a monthly basis from the people who look after the persons money. They are supported by staff to get money from the bank. The money is kept safe in the office and is checked in and signed by the registered provider and another member of staff to ensure all is correct. We were told if a person is in debit, the home lends them the money until they get their own money and then they pay back the home. When the registered providers are on holiday, they leave a float of money for staff to give to the people when needed. The money used by the people is then taken out of the peoples money, which is kept by the home. Clear records of all transaction are kept of the peoples money. The fire alarm system was being tested on a weekly basis. The emergency lighting was done on a monthly basis. We were told that fire drill practice was also happening so the staff know what to do on duty if there was a fire. The staff were also receiving fire training. We were told that the Fire Officer was happy with the fire procedures at the home. The Environmental Health Officer had visited and had given four stars which is Care Homes for Older People Page 24 of 29 Evidence: said to be good. The infection control audit had been carried out by the PCT in May 2008 and this was said to be exemplary. Care Homes for Older People Page 25 of 29 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 26 of 29 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 19 23 An Occupation therapist assessment must be undertaken for chairs and settee in the dining room and in the lounge. This is to find out if these chairs are suitable to meet the needs of the people living in the home. 30/07/2009 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 5 Provide a contract that has all the information stated in the standard. This is so the people know their rights and responsibilites. Meaningful activities must be provided for all the people living in the home. This is so they are socially stimulated to meet their needs Repair the broken bath seat, wobbly toilet seat and head boards in peoples rooms. This is so the people are not put at a risk when using these facilities. Replace the carpets in some areas of the home and in some of the peoples bedrooms. This is so they live in a plesant Page 27 of 29 2 12 3 19 4 19 Care Homes for Older People enviroment. 5 6 19 19 Replace the old commodes with new ones. This is so their dignity is maintained. Provide indicators to orientate people to their enviroment. This is so the people are able to identify where these are situated. Ensure that the dinning room is kept clean.T his is so that the people live in a plesant enviroment. Provide a quality assurance system that takes account of all the people and their relative and staff and other professionals involved with the people to find out their views in how the home is meeting its aims and objectives in meeting the needs of the people in the home. Provide staff one to one supervision which is recorded and dated. This is to monitor how the staff are meeting the needs of the people. 7 8 26 33 9 36 Care Homes for Older People Page 28 of 29 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. 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