Care Home: Wilbraham House Residential Home

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What the care home does well There is usually a relaxed atmosphere in the home. During the time of this inspection the home was very "busy". Staff were supporting people to rise, have breakfast and to support them in their daily needs, additionally a training course was held in the home for staff and many staff normally off duty were therefore present. During this time several visitors arrived they were greeted well and staff found time to talk and update them about their relatives progress. Staff spoken with were committed and keen to ensure the chosen lifestyles of people are met. People arrived for breakfast throughout the morning and clearly making decisions about rising times and other choices. We saw examples of good engagement between staff and people using the service. An example was a recently admitted person with dementia care needs who wished to go home. Her repeated requests were dealt with respectfully and in a professional way giving her positive support, encouragement and reassurance. Visitors spoken with said that they were happy with the care provided at Wilbraham House and one found the support given to him and his partner vital to their wellbeing. People are assessed by the homes staff prior to moving in and are invited to visit and make a judgment about the suitability of the home for them. This is not always possible in relation to emergency admissions. Multi-agency assessments are also obtained to inform care plans. The statement of purpose and service users guide are readily available to all and contain copies of the homes complaints procedure. The intention is to provide a "Home for Life" and there have been instances where people have been supported well by the service, with help from the District Nursing Service with a high standard of care to the end of their life. What has improved since the last inspection? Recruitment procedures have been improved since the last inspection. A more robust system has been introduced to ensure all required references, checks and documents are available prior to people commencing employment in the home. This has improved the protection of people using the service. The final part of the planned improvements to upgrade and improve the standards of the environment has been completed. The kitchen area has been completely refitted and upgraded to provide a standard of fittings and equipment to professional catering standards. Hot water outlets identified as exceeding a safe limit for people using the service on the last inspection, were sampled and are now within safe temperature limits. This has reduced the potential risk of scalding to people. Some progress has been made in linking with community groups and activities and bringing people into the home from the community. The garden area has been improved and made safe for people to enjoy during the summer months. What the care home could do better: The care provided for a person with diabetic needs has been highlighted as inadequate. Nutritional assessments had not been properly established with a care plan to ensure frequent and adequate snacks. Following incidents where medical input was needed and a safeguarding alert made, nutritional plans have been put into place but we found that the daily record of food intake was not being completed as proof of adequate diet. This must be done. Daily insulin has been administered by care staff under guidance from the District Nursing Service. In the last report we recommended that evidence of training and competence for individual staff members should be obtained. This has not happened. The District Nursing Service have now taken back the responsibility for daily insulin injections. Some ares of medication administration need improvement. More details are required in relation to medication returned to the pharmacy. Without this an audit of the system is not possible. When handwritten entries are needed on MAR sheets another member of staff should check and sign the MAR sheet to ensure the correct medication is recorded. Care plans should record the creams required and there should be clear instructions about how, where and when the creams are used. Care staff can sign to confirm they have been applied. It is important that prescribed medication is given at the times directed on the MAR sheet. Instructions on the MAR sheet to administer tablets 30 minutes before food were not followed, the medication was given after breakfast. A list of special diets and peoples known preferences, likes and dislikes should be available in the kitchen area for the information of all catering staff. Reviews of moving and handling and other risk assessments have not been carried out on a regular basis, some had not been reviewed for up to a year. It is important to weigh people regularly to monitor any changes. Weight loss can be an indicator about the persons health and wellbeing. The homes objective of weighing people monthly (more regularly if there are concerns about weight loss) should be carried out without exception. All cleaning materials must be securely stored where people using the service do not have access to them. This will reduce potential risks to people. Key inspection report Care homes for older people Name: Address: Wilbraham House Residential Home The Old Vicarage Church Street Audley Stoke On Trent Staffordshire ST7 8HL     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: Peter Dawson     Date: 1 2 1 2 2 0 0 9 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 29 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) 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. 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: Wilbraham House Residential Home The Old Vicarage Church Street Audley Stoke On Trent Staffordshire ST7 8HL 01782720729 01782720729 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Wilbraham Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 33. The registered person may provide personal care and accommodation (without nursing) for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 33 Physical Disability over 65 (PD)(E) 6 Physical Disability over 55 (PD) 2 Dementia over 65 (DE) (E) 6 Date of last inspection Brief description of the care home Wilbraham House is a privately owned residential care home, registered to care for up to 33 elderly residents with a variety of dependency needs. It has been under the present owenership since October 2001. Care Homes for Older People Page 4 of 29 Over 65 6 33 6 0 0 0 2 3 0 1 2 0 0 9 Brief description of the care home The extension to the home was finally completed in 2006 - providing 6 additional bedrooms, each equipped with an en suite, as well as a separate adapted bathroom and shower. Many improvements to the environment were needed. A programme of improvement over the past three years has taken place and is almost complete. Other areas such as staff training and care practice have also improved. Wilbraham House is well located in the village of Audley, opposite the Church and convenient for a wide range of local amenities including shops, pubs, post office, community centre and health centre. The garden area has recently been developed to provide more user friendly and safe areas for people to enjoy in the summer months. Weekly charges at Wilbraham House are avaialable directly from the service. 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: 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: This service was last inspected on 23rd January 2009 when a key inspection was carried out. The quality rating of the service remained 1 Star at that inspection. This key unannounced inspection was carried out on one day by one inspector from 08:30 - 19:00. An AQAA (Annual Quality Assurance Assessment) was completed and returned to us prior to the inspection by the Registered Manager. The AQAA is a legally required selfassessment document containing information about what the service think they do well, what progress they have made over the past year, what they think they could do better and their plans for improving the service over the next 12 months. Some information from the AQAA is included in this report. Care Homes for Older People Page 6 of 29 Most people using the service were seen and many spoken with together and separately. It was helpful to discuss life at Wilbraham House with a small group in one of the lounge areas, as well as having discussions with individuals in private. We spoke with staff on duty throughout the day and with 3 visitors. The Registered Manager had resigned just prior to the inspection. We carried out the inspection with the Deputy Manager and Manager from another home in the Group who was providing support and advice to the home. The three providers were present in the later stages of the inspection and we were able to feedback and discuss our findings with them. We inspected the environment, including the communal areas and we were able to see a sample of bedrooms. Records relating to the inspection process were inspected including care plans, risk assessment, medication records, staffing records and other relevant documents. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Recruitment procedures have been improved since the last inspection. A more robust system has been introduced to ensure all required references, checks and documents are available prior to people commencing employment in the home. This has improved the protection of people using the service. The final part of the planned improvements to upgrade and improve the standards of the environment has been completed. The kitchen area has been completely refitted and upgraded to provide a standard of fittings and equipment to professional catering standards. Hot water outlets identified as exceeding a safe limit for people using the service on the last inspection, were sampled and are now within safe temperature limits. This has reduced the potential risk of scalding to people. Some progress has been made in linking with community groups and activities and bringing people into the home from the community. The garden area has been improved and made safe for people to enjoy during the summer months. Care Homes for Older People Page 8 of 29 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. Pre admission information and assessments ensure peoples needs are assessed and can be met by the service. Evidence: There is a Statement of Purpose and Service Users Guide. All people using the service have a copy of this and a copy is available in the home for visitors. The Service Users Guide is in pictorial form to assist easy reading. People are assessed prior to amission by the homes Manager and a multi-agency assessment is completed by a Social Worker. In the records seen on this visit a recent admission was arranged as an emergency, it was not possible to assess the persons needs prior to admission to Wilbraham House. A dated assessment was provided by the Social Worker and care plan established based upon assessment following admission and the Social Workers Assessment. Care Homes for Older People Page 11 of 29 Evidence: It is the home preferred option that where possible people considering admission should spend time in the home to assess the suitability of the service for them. This also allows a more in-depth assessment, beneficial to the person and the home. Wilbraham House does not provide intermediate care. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in care planning and aspects of medication administration would ensure peoples health care needs are met and they have the medication to ensure their health and wellbeing. Evidence: A requirement was made at the time of the last inspection in relation to shortfalls in recording of medication and two recommendations were made relating to health professionals seeing people in private and to ensue that only staff trained and authorised as competent by the District Nurse should administer insulin. A recent safeguarding referral was made by the ambulance service relating to concerns about a person on insulin whose blood sugar levels had dropped to a dangerous level. There were concerns about the person not having sufficient /appropriate food at required intervals to sustain adequate levels. There was no care plan in place to ensure actions were taken to sustain adequate blood sugar levels. This person has a history of fluctuating blood sugar levels. Care Homes for Older People Page 13 of 29 Evidence: The AQAA recorded An allegation made regarding neglect of a service user was referred to social services, but due to our excellent documentation and records, as well as the care plan, social services were satisfied with all our documentation and recording, risk assessments as well as care plan - This statement is incorrect. Two social workers visited the home as a result of the this safeguarding referral and found records inadequate. there was no care plan outlining the actions needed to maintain good diabetic care. Since that investigation the home have introduced a plan of care for this purpose and update risk assessments. Daily food intake charts were also introduced for this person, although we found on this inspection that they had not been completed correctly, on some days there were no recordings after breakfast or lunchtime. The home have continued to provide twice daily insulin injections but no authorisations obtained from the nursing service as previously recommended. We spoke with the District Nursing Manager following this inspection to discuss concerns about the diabetic and insulin management for this person. The Nursing Service felt they should take over responsibility for daily insulin and monitoring of blood sugar levels for this person. The District Nursing Manager we spoke to about the above incidents had been unaware of them. She did say that she felt that relationships between the service and the home were good, that staff were helpful and responded to positively to advice given The care plan for this person was poor and inadequate prior to the incident stated above. Since that time the care plan and risk assessments have been revised, updated and extended. We looked at the care plan for another person recently admitted to the home in an emergency. Time did not allow for a pre admission assessment but a plan of care introduced from observations and some dated information from Social Care and Health. We saw that people were weighed on a monthly basis or more often if there were concerns about weight loss. We found that a person had been weighed only 3 months out of the last 6 months and over a period of 2 months had lost 9lbs. This highlights the importance of regular monthly monitoring of weight. We inspected the medication system in the home. The medication is now stored in a more secure area of the home. Some shortfalls were identified in the system. We found that there was not a record on the MAR (Medication Administration Record) Care Homes for Older People Page 14 of 29 Evidence: sheet of a person allergic to penicillin - this will be notified to the Pharmacist. We found that a person seen by the police and emergency doctor a week previously had been prescribed sedative medication following an attack upon staff. This had been out of stock for two days prior to the inspection. The Deputy Manager made an urgent call to the surgery and a prescription was obtained. There were several handwritten entries on MAR sheets due to change of medication or recent admissions - it is important that all handwritten additions to MAR sheets are countersigned by another member of staff to ensure accuracy and safety. There was a stock of medication for return to the pharmacy, one date was given and medication listed but the names of the people it had been prescribed for were not listed. We saw 96 tablets in the medication trolley prescribed for a person no longer at the home. It was impossible to know if they were included in a larger number of the same tablets ready for return to the pharmacy. Medication returns must identify the person it was prescribed for so that an audit of the system can be carried out. We saw that medication prescribed for a person must be given 30 minutes prior to eating (breakfast), this had been given after breakfast. The same person has insulin to be given prior to food - the two could be given together before eating. Prescribed creams were listed on MAR sheets (not signed) and located in bedrooms for convenience. We found 3 creams in a persons bedroom to be applied to different parts of the body at different times. It is important that a care plan outlines prescribed creams and states when, where and how they are to be applied. This record can be kept in bedrooms for ease of use. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home attempts to meet the social and daily life choices of people using the service. Evidence: The AQQA states improvements in activities provided for people: We have more involvement with the local church (across the road) people can go to their coffee mornings, participating in events - harvest festival, boxes for overseas aid - The church youth group have become involved with the home helping to reconstruct a picture rubbing of Lord Audley. The Vicar visits monthly and conducts a service. People visit the community centre where they meet others, have coffee and make purchases. We have brought reminiscence material into the home to promote discussion. We have improved relationships in the community. Service users going into the community and the community coming into the home. People using the service confirmed some of the above. Some felt that there could be more to do in the home. All said that they were not pressurised to engage in activities. Some said activities were about right. There were no activities taking place during the inspection day, although it seemed a particularly busy day for staff. Care Homes for Older People Page 16 of 29 Evidence: Activities are recorded for each person, although we did not see the records on this visit. There is a choice of 4 lounge areas where people can sit together or separately, watch TV, listen to music or sit in a quiet area. We saw examples of chosen lifestyles being accommodated. People arrived for breakfast throughout the morning, confirming their rising times were known and respected. Some accessed their bedroom throughout the day as they wished. One person said she rises early and likes to spend the morning in the lounge and go to her bedroom after lunch to watch TV and relax. We spoke with visitors to the home. Very positive comments were made about the home, care and staff. Someone said Without these people we wouldnt have survived - this was stated by a person visiting his partner and related to health and dementia care needs that had been addressed with respite care and support for each of them. Other comments included It is not a posh place but there is good food, staff speak properly and respectfully to us and are on the go at all the time. At the time of the last inspection many people reported improvements in the quality and variety of food. They were very satisfied. On this visit the home could not demonstrate that the regular required food was being made available for a person with diabetic needs. There was also confusion about a person arriving for breakfast, catering staff saying they would prepare toast a carer saying the person preferred bread and jam. It was later established this person was on a soft food diet. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safeguarding referrals have highlighted areas for improvement in the home. Evidence: There is a clear and concise complaints procedure in place. All people have a copy in their bedrooms together with the Service Users Guide. There is also a copy in the home for visitors. The home state that they have not received any complaints since the last inspection and none have been received by us. There have been two recent referrals to Social Care and Health under Safeguarding procedures. One was made by the ambulance service and referred to earlier in this report. This related to concerns by the ambulance service that the persons blood sugar levels were dangerously low and they were concerned that an inadequate diet was placing the lady at risk. Investigation found that there were inadequate plans and pratices in place to address the fluctuating blood sugar and diabetic care needs of the person. This has since been addressed. The other Safeguarding referral was made by the home when a male made inappropriate approaches to females in the home. The same person presented challenging and threatening behaviour towards staff members. We found that a plan had been put into place to monitor the persons movements at all times, but there Care Homes for Older People Page 18 of 29 Evidence: were examples of opportunities to approach other females and medication prescribed to deal with his behaviours was out of stock. The home could have dealt with this in a more positive, robust way. Records showed that the majority of staff had received training in Safeguarding procedures and the Manager had also attended the Trainers Course in Safeguarding. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the environment have provided a comfortable, homely place for people to live in. Evidence: There have been improvements to the environment over the past 3 years. The providers have followed an action plan to refurbish and upgrade many areas of the home. The final planned refurbishment was the kitchen area and since the last report this has been completed. The kitchen has been completely refitted from domestic to commercial standards with stainless steel fittings throughout. This was overseen by the Environmental Health Officer who is satisfied with the outcome. The overall presentation of the home has improved considerably over the past 3 years and there has been an ongoing redecoration programme. We made a recommendation in the last report to ensure that all hot water outlets in bathroom, toilet and bedroom areas did not exceed the safe limit of 43C. Random testing of outlets on this visit confirmed that hot water temperatures were safe for people to use. A sample of bedrooms seen were well furnished, comfortable and personalised to reflect peoples individuality. People we spoke with were pleased with the presentation Care Homes for Older People Page 20 of 29 Evidence: of their bedrooms and had made choices about furniture, furnishings and colours. The AQAA stated: External security has increased with extra lighting and new fencing. The rear garden has been improved with a sensory area where people are able to sit in the summer. The garden is used and people have grown peppers and tomatoes. Standards of hygiene and cleanliness throughout the home were good. We did notice that a storage cupboard with a notice to be kept locked at all times was open and contained cleaning materials/liquids. We we told that the lock was defective and that it was replaced later in the inspection day. Care Homes for Older People Page 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improved recruitment procedures and the ongoing staff training programme ensures support and protection for people using the service. Evidence: Staffing levels remain the same. There are 4 Care Staff on duty in the morning and 3 in the afternoon - Plus a Manager. There are 2 waking night carers. An additional carer works on the early shift from 6.30 am prior to night staff completing their shift at 8 am. This ensures there are no pressures to get people up early to comply with shift changes. There are adequate numbers of ancilliary staff to support the care team. We were not satisfied with recruitment procedures on the last inspection and made a requirement to improve them. There was no record of interviews or reference from a previous employer. Someone had a previous conviction and there was no signed declaration about previous convictions. We inspected 2 staff files on this visit and found that all required references, checks and documentation had been completed and was in place. A new system of recruitment documentation has been purchased by the providers and introduced. Care Homes for Older People Page 22 of 29 Evidence: Staff training documentation showed that required statutory training has been completed. NVQ training is available to all staff who are encouraged to complete this important training. We feel that it is important for staff to receive training in meeting the needs of people with diabetic needs. This applies to only one person at this time but training from a Diabetic Nurse Specialist would be helpful for all staff who have a contribution to make in this important area. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The appointment of a Registered Manager is needed to address shortfalls in areas of health care, medication protection and recording. This will provide safety and protection for people using the service. Evidence: The Registered Manager who has been working at the home for the past 3 years has recently resigned. During her time at Wilbraham House the home moved from 0 Star to a 1 Star service. There have been improvements to the environment, care planning and practice. The home remained 1 Star at the time of the last inspection due to shortfalls in Health and Personal Care. Unfortunately, on this visit further shortfalls in those areas, highlighted particularly in Safeguarding referrals, are needed. The AQAA states, in relation to how things have improved over the past year: We have move forward with Health and Personal Care and improved how we deliver medication. The directors of the home are more involved with operations to assist in developments detailed so far, which is positive as the service users can meet with Care Homes for Older People Page 24 of 29 Evidence: them as well as the staff. Unfortunately shortfalls mentioned earlier in this report relating to health care and medication mean that progress has not been made in these areas. We found that record keeping was poor and required improvement. Some key information was missing and some records were inadequate. The providers have always visited the home weekly and been available by telephone at any time. Because of concerns they have recently become more involved in the daily running of the home. Due to the resignation of the Registered Manager the home is currently operating with the Deputy Manager and Assistant Deputy Manager running the home with input from the Registered Manager from another home in the group. The providers have daily input and are monitoring progress. They were all present during this inspection and aware of the concerns expressed in this report. We are satisfied with the interim management arrangements until another Registered Manager is appointed. 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 7 12 Care plans must be in place to ensure the health care needs of people are adequately addressed. This will ensure that peoples health and well being is promoted. 31/12/2009 2 18 13 The home must take steps 31/12/2009 to ensure that people are not placed at risk of harm or abuse This will ensure people are protected at all times. 3 37 17 Details of any plan relating to a persons specialist health care and nutrition must be kept. This will ensure people have the inputs they need to ensure their health and well being. 31/12/2009 Care Homes for Older People Page 27 of 29 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 8 People using the service should be weighed regularly. This will ensure any weight loss is identified early and action take to promote good health. It is recommended that handwritten entries on MAR sheets are countersigned by another staff member and medication returned to the pharmacy is recorded in more detail. This will provide a safer system of medication for people that can be audited. It is important to ensure that medication is adminsitered as prescribed. This will ensure people have the medication they need, at the time they need it to promote good health. The home must ensure that prescribed medication is always available. This will ensure the health and wellbeing of people using the service. We recommend training for all staff in diabetic care. This will ensure people have the necessary inputs to meet their individual needs and ensure their wellbeing. 2 9 3 9 4 9 5 30 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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