Care Home: Willows The

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What the care home does well People`s needs are assessed before they move into the home to ensure that the home are aware of and can meet their needs. This assessment information is used to develop care plans that support the staff to help meet the needs of the individual. We saw that the interactions between the staff and the people living in the home were positive and respectful. People`s relatives and friends are able to visit and to stay and have lunch if they wish to, this assists in the maintaining of these relationships. We saw that people are supported in the meeting of their health needs and that records for this are now up to date to ensure continuity. There are systems in place to support people should they wish to raise a concern and to help them to be protected from harm. The home was clean throughout with people being able to personalise their rooms and make them more homely. There are quality assurance systems in place to seek people`s opinions and help them to be involved in the home and its development. What has improved since the last inspection? Risk assessments are now completed to ensure that risks for people are identified and actions are put in place to prevent people from harm, for example the risk of falls. Forms used to record people`s health needs were found to be up to date, helping to support staff with the correct information in the meeting of people`s health needs. People`s records now reflect that they are able to participate in a range of activities , and the laundry walls are now impermeable to help ensure that the infection control policies are not compromised. There are now records of the training that staff have undertaken, for example medication training. This helps to provide an audit trail when ensuring that the necessary staff are correctly trained to support people. What the care home could do better: Although risk assessments are now in place these had not been fully completed for the use of bed rails and specialist mattresses. Additionally no actions had been taken to ensure that this equipment fully met the needs of the service user and that it was appropriate. These systems need to improve as at the time of the visit the use of bed rails compromised the safety of some of the people who live in the home. The hot water temperatures are not at an acceptable level and actions need to be taken to ensure that people do not receive a bath that is too cold. Photos should be in place in service user files, for example in the case of an emergency if the person becomes missing from the home. Medication practices in the home require improving. Records for the receipt and administration of medicines are not consistent or complete. Details of how to administer medication is not recorded, staff do not always counter sign records and there is limited evidence of how people are offered their medication. Medication must not be allowed to run out of stock to ensure that people receive their medication and their needs are met. Key inspection report Care homes for older people Name: Address: Willows The Bridlington Road Burton Fleming East Yorkshire YO25 3PE     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: Sarah Rodmell     Date: 0 7 0 5 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 32 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 32 Information about the care home Name of care home: Address: Willows The Bridlington Road Burton Fleming East Yorkshire YO25 3PE 01262470217 01262470217 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hexon Limited Name of registered manager (if applicable) Jane Anne Brindley Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP and Dementia - Code DE Date of last inspection Brief description of the care home The Willows is a two-storey building offering personal care and accommodation to 33 older people who may have a dementia. There is a designated area for people with dementia. A two-storey extension has been added to the main building and provides pleasant airy en suite rooms. The home provides communal dining and lounge space and gardens to the rear. There is car parking space to the front of the home. Care Homes for Older People Page 4 of 32 Over 65 0 33 33 0 Brief description of the care home Information about the services available at The Willows is provided to prospective service users and their families in the form of a brochure. The homes statement of purpose is available at the home along with the most recent inspection report. Care Homes for Older People Page 5 of 32 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 the service experience adequate quality outcomes. This inspection report is based on the information received by the Care Quality Commission (CQC) since the last key inspection on 14/09/09, including information gathered during a site visit to the home. The unannounced visit was undertaken over one day by two inspectors. It began at 9.00 am and finished at 5.30 pm. On the day of the visit the inspectors spoke with the people who live in the home, staff the manager and a relative. Inspection of the premises and close examination of a range of documentation including three care plans were also undertaken. The registered manager told us at the time of the visit that the current fees for living in Care Homes for Older People Page 6 of 32 the home are £450 per week. At the end of this visit, feedback was given to the managers on our findings , including any requirements and recommendations that may be in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Although risk assessments are now in place these had not been fully completed for the use of bed rails and specialist mattresses. Additionally no actions had been taken to ensure that this equipment fully met the needs of the service user and that it was appropriate. These systems need to improve as at the time of the visit the use of bed rails compromised the safety of some of the people who live in the home. The hot water temperatures are not at an acceptable level and actions need to be taken to ensure that people do not receive a bath that is too cold. Photos should be in place in service user files, for example in the case of an emergency if the person becomes missing from the home. Medication practices in the home require improving. Records for the receipt and administration of medicines are not consistent or complete. Details of how to administer medication is not recorded, staff do not always counter sign records and Care Homes for Older People Page 8 of 32 there is limited evidence of how people are offered their medication. Medication must not be allowed to run out of stock to ensure that people receive their medication and their needs are met. 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 32 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 32 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. We looked at standards 3 & 6. People are assessed prior to them moving into the home to ensure that the staff are aware of and can meet their needs. Evidence: We looked at the files for three of the people who live in the home. Two of the files included the details of the assessment undertaken prior to the person moving into the home. This included the assessment from the Local Authority. The third person did not have a pre- assessment completed by the home, although as they were an emergency admission to the home, the manager had ensured that they received the assessment from the Local Authority on the day of admission. There was no evidence that people had received written confirmation from the manager that the home could meet their needs, prior to them being admitted to the Care Homes for Older People Page 11 of 32 Evidence: home. The manager confirmed to us at the time of the visit that standard 6 is not applicable. Care Homes for Older People Page 12 of 32 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. We looked at standards 7,8,9 & 10. People are supported through a system of care planning to have their identified needs met. However, poor practices with the handling of medication does not ensure that their needs are fully met. Evidence: We looked at the care files for three of the people who live in the home. Each of these people had an assessment of need that had been used to produce a plan of care that detailed their needs and how these were to be met in the home. There were records to show that these were reviewed regularly in the home to ensure that staff had the up to date information for each person. The plans of care covered a variety of areas, for example, mobility, interests and hobbies, daily living needs, and nutritional needs. Only one of the three files included a photograph of the person, which could be used to identify them in an emergency, for example, if they became missing from the home. Care Homes for Older People Page 13 of 32 Evidence: The files also included details of the individual health needs of each person. The areas covered, for example, breathing, rest, tissue viability, mental capacity and safety needs. Each person had a patient passport which is a description of their medical needs, that someone can take into hospital with them and would assist the hospital with the meeting of their needs. The information also included risk assessments relating to health, for example, a falls risk assessment. Other risk assessments also included, the use of the hoist and the use of bed rails. These were reviewed on monthly basis and included the signature of the person to evidence that they knew about the assessment. Although some risk assessment work had been undertaken not all of the bed rails were fitted correctly, particularly when they were used with a specialist mattress. Consequently they were not safely meeting service user needs. This is discussed later in the report. Records included letters from health professionals, for example, the district nurse, GP and optician. Records were kept of visits by these professionals with the details of the reason for their visit and the outcome. This included, for example if any further treatment was required. Daily diary records were seen and these recorded some of the activities of the persons day, this included the activities they had undertaken, the assistance they had required, for example, with personal care and the details of their dietary intake. One persons notes included reference to a medical need and that a named member of staff would telephone to follow this up, no records of this were found in this folder and it is recommended that the home ensure that all records are kept up to date. We found that the temperatures of the hot water for bathing were below the recommended 43 degrees and this could mean that people receive a cool bath. This requires attention to ensure that people can partake in a bath that is comfortable and that does not pose a risk to their health. We looked at the medication systems within the home. Several areas of practice raised concern in the recording of the receipt and administration of medication, these areas should be rectified to ensure that clear records are kept so that staff are fully aware of the medicines to administer, how much to administer and when. This helps to reduce the risk of errors occurring and to ensure that people receive the correct prescribed medication. For example, there are some records for the receipt of medicines into the home, Care Homes for Older People Page 14 of 32 Evidence: however these are not always complete. This means it is not clear when a medicine is received nor how much has been received. We also saw that there were inconsistencies in the records held for people. For example, the instructions for the administration of several peoples medicine was described as, as directed which offers no guidance to the staff team on how this should be administered, which has the potential for errors. Some of the records for administration of these medicines were blank with no evidence that they had been offered or administered to the person. We saw that not everyone had a photograph included in their medication records, this would assist in identifying people and help to reduce the risk of errors. We saw that staff had hand written peoples medicines onto the Medication Administration Record (MAR) sheet, but this was missing a witness signature to confirm that it was correct. One persons prescription on the MAR, had changed, again there was no signature to confirm that this was correct. One person was prescribed a medication that was to be administered at 11am each day, however, we saw that the dispensing of medication was completed by 10.15am, so it is unclear if this person received their medication at the correct time. We saw that one tablet was prescribed as a quarter of a tablet to be administered, initially it was unclear how staff safely completed this task. However, the manager assured us that there are policies and procedures in place to ensure that this is safe. Another person had been prescribed a short course of medicine for 7 days. We were advised by the manager that the course had been completed but the medicine was still on the persons MAR chart one month later and required updating. Some peoples medication had run out of stock and people had missed several days of their medication, this is not good practice and should not happen. When people are prescribed medication that has specific monitoring records, these records must be kept with the MAR charts. However, this was found not to be the case and does not assist in the safe administration of peoples medicine. We observed the administration of medicine and saw that this was respectful. The staff member ensured that the medication trolley was always locked if she had to Care Homes for Older People Page 15 of 32 Evidence: move away from it, ensuring that the safety of the medicines was not compromised. Staff told us that they respect peoples privacy and that one way that they do this is by knocking on someones bedroom door prior to entering. One of the people who live in the home also told us that staff always knock on their door prior to entering their room. We saw that the interactions between the staff and the people who live in the home was respectful and positive. Care Homes for Older People Page 16 of 32 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. We looked at standards 12,13,14 & 15. People live in a home that offers them some opportunity for the meeting of their social and leisure needs, but were this and the procedures for the meeting of nutritional needs could be improved upon to ensure that these needs are fully met. Evidence: We looked at the records for the different activities that people are able to participate in both in the home and their local community. Peoples records included that they are able to relax and watch the television, play dominoes, listen to an organist and enjoy a sing a long. There is an activities person visits the home and again, people have the choice to participate with this. We received some feedback regarding activities and this included that although staff interactions were always positive, the staff were always busy and so opportunities for interacting with the service users was often limited. Also that there continues to be only limited activities in the home. Staffing is discussed separately in this report. Staff told us about some of the activities that are undertaken in the home and that Care Homes for Older People Page 17 of 32 Evidence: this included; hoopla, a catching game and dominoes. We saw that people participated in a game of bingo on the afternoon of the visit. Additionally there was a DVD available on the past and a book on Scarborough in the 1900s. We saw that relatives and friends of the people living in the home are able to visit as they wish and one person stayed and had lunch with their relative. Peoples access to their local community is mainly when their friends and relatives support them to undertake this and it would be recommended that ways of improving this are considered. When we spoke to the staff they told us about some of the choices that people make each day and how they support people with these. This included that staff felt that they got to know people very well and that they would know peoples likes and dislikes including their favourite colour. One person told us how they maintain their independence , liking to do their own thing and how the staff respect this. Care staff told us that they inform the catering staff of the dietary requirements and wishes of the people who live in the home. We saw that the chef keeps records of peoples personal preferences. When we talked to the catering person they had a good knowledge of the likes and dislikes of the people who live in the home. At the time of the visit one person had complained about the chips that they had been served with their lunch and the chef had quickly replaced these with some more at that time. We received one comment that the food in the home was not as good a standard as it could be. We joined people for lunch. The meal of the day was fish, chips and peas. The fish was pre- frozen and not of a good quality, however, the chips were home made and were of an acceptable standard. We spoke to some of the people having lunch and they found the lunch acceptable although we did receive one comment that the food could be better, and another that the food is a lot better than it was. Overall it is the quality of the food purchased rather than the skills of the chef that seem to require improvement. Care Homes for Older People Page 18 of 32 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. We looked at standards 16 & 18. People are supported through good systems to be able to raise concerns and to be protected from harm. Evidence: One complaint had been received by the service and the records of this included the actions that had been taken to rectify this and if the complainant was happy with the outcome. When we spoke to the staff team they told us how they would handle any complaints in the home, completing a form and liaising with the manager of the service. These also told us that they work quickly to sort out any issues. There is a copy of the Local Authority policy for the protection of vulnerable people held in the home. When we spoke to the staff team they were aware of the actions that they should take should someone raise a concern or allegation of harm in the home. This included referring the details to senior managers. Care Homes for Older People Page 19 of 32 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. We looked at standards 19 & 26. People live in a home were they are able to personalise their rooms and where they are comfortable. However, a lack of good practice in the use of specialist equipment does not ensure that their needs are fully met. Evidence: We completed a tour of the premises. On the ground floor the home comprises of a lounge, kitchen, bathroom, laundry, peoples bedrooms and a conservatory, which is used as the dining room.There is a further lounge, dining room, peoples bedrooms and bathroom facilities on the first floor. There is a small garden to the front of the home. We saw that the home was clean throughout with no offensive odours. People are able to personalise their rooms to their own taste and add items from home to make their rooms more comfortable. Some people in the home are supported with the use of bed rails and specialist mattresses. However, we found that these were not always correctly assessed and installed and some posed a risk to the safety of the people living in the home. Further guidance was sought from the Health and Safety officer from the Local Authority and the home are undertaking work with this person to rectify this. There are no privacy locks on bedroom doors and some of the rooms are Care Homes for Older People Page 20 of 32 Evidence: nearing the time for redecoration. It is recommended that a plan of redecoration is completed. There is a separate laundry area. The walls of this room have been treated to ensure that they are impermeable and do not pose a risk to infection control in the home. We looked at the policies and procedures for fire safety in the home. There is a fire risk assessment and records are kept that the fire systems are regularly maintained. Some use of door wedges was seen in the home. This was discussed with the manager, who is to seek guidance from the Local Fire Authority and ensure that the use of these is recorded in the fire risk assessment and does not pose a risk to the people who live in the home. Records are kept that staff have received fire training and that fire drills take place in the home. Care Homes for Older People Page 21 of 32 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. We looked at standards 27,28,29 & 30. People are supported by adequate numbers of staff, although a lack of good recruitment practices and complete staff training does not ensure that peoples needs are always and fully met. Evidence: When we looked at the duty rotas in the home we saw that there are normally two staff on duty upstairs and two staff on duty downstairs. With an additional staff member from 8 am to 11 am and 5 pm until 7 pm. There are two people who live in the home who need extra support with moving and handling. The staff told us that the additional member of staff assists with this to ensure that this persons needs were met. We received comments that the staff are too busy to regularly spend 1:1 time with the people who live in the home. We noted that the staff team also undertake the laundry tasks in the home, although for the size of the home it would be recommended that this role is separate to that of a carer. This would offer some release to the staff to be able to spend more time with the people who live in the home. We looked at the training records for three for four of the people who work in the Care Homes for Older People Page 22 of 32 Evidence: home. These records reflected that people had undertaken training in Moving and Handling, Fire and Safeguarding Vulnerable People. One person had achieved a National Vocational Qualification (NVQ) level 2 and another person had also undertaken training in the handling of medicines. There was a training matrix on display in the home. The information recorded that the manager had organised training and that staff had completed Fire, Health and Safety, and Moving and handling in 2010. Some staff had completed training in dementia awareness, Infection Control and food Hygiene, although some of these courses were out of date. The manager told us how she has completed a full audit of all the staff team and has plans to provide a variety of training to ensure that all of the staff have up to date training in all area. A staff member told us how they had completed an in house workbook regarding dementia awareness that helped them understand and deal with challenging situations. Staff told us that they had completed an NVQ 3 in care, fire training, moving and handling training and Protection of Vulnerable People training. We looked at the recruitment files for four of the people who work in the home. All of the files contained a variety of documents regarding the recruitment and employment of the person. This included an application form and references. Three of the people had undertaken a Criminal Records Bureau check (CRB), which helps to confirm that they do not hold a criminal conviction that would prevent them from working in this role. The fourth person had not yet received their CRB check but had undertaken an ISA first check which is part of the CRB check and also helps to verify that the person is suitable to work with vulnerable people. One person had declared on their application form that they did have a conviction to declare, however there was not any evidence that this had been verified with the person concerned. The manager has assured us that when a staff member requires a work permit or VISA to work in the UK, they follow all the necessary checks. Additionally they informed us that this has been verified through a routine inspection from the immigration authority. We looked at the supervision records held within the home. these reflected that staff are receiving supervision and support from the manager, although some of these are used as purely training sessions and the areas covered could be improved upon. Care Homes for Older People Page 23 of 32 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. We looked at standards 31,33,35,36& 38. People live in a home that is managed by an experienced manager and where they are able to express their views and overall have their health and safety needs met. However, some practices in the home require improving to ensure that peoples needs continue to be met and that peoples health and safety is not compromised. Evidence: The manager has experience of managing in a care setting and is registered with the Commission. She told us that she has attended training to help to ensure that her skills remain up to date. One person told us that the manager is like a breath of fresh air, and another person told us that they feel the manager has an open door policy and that she will sort things out. The manager showed us the quality assurance system held within the home. This involves questionnaires to people who live in the home and their relatives, with the Care Homes for Older People Page 24 of 32 Evidence: information from these compiled into a report. This was on display in the main entrance of the home were visitors and people who live in the home would all be able to view this. Records were seen that people who live in the home and staff meetings take place within the home. The service user meetings included a variety of topics, for example, the food and menus and activities. Staff meetings have been developed into specific meetings for each staff group. Visits required by the registered provider are taking place; these help to monitor the practices within the home. However, it is recommended that these take place on a monthly basis. We saw the system for the handling of peoples monies and saw that records are kept of all receipt and expenditures. We looked at the supervision records held within the home. These reflected that staff are receiving supervision and support from the manager, although some of these are used as purely training sessions and the areas covered could be improved upon. We looked at some of the health and safety records held in the home and saw that records are kept for the maintenance of the moving and handling equipment, electrical wiring and portable appliance testing (PAT). However, the risk assessments for and the use of bed rails does not ensure that peoples safety needs are fully met and must be addressed. Additionally some of the radiators in the home are not guarded and this must be addressed through a risk assessment basis and actions taken to ensure that they do not pose a risk to the safety of the people who live in the home. Care Homes for Older People Page 25 of 32 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 32 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 3 14 Written confirmation that the home can meet the needs of the individual must be provided prior to the person moving into the home. This helps people to make informed choices about their home. 06/07/2010 2 8 13 The temperature of the 11/06/2010 water for bathing in must be kept at a comfortable level . This helps to ensure that this is a relaxing experience and does not compromise the health of the individual. 3 9 13 Medication records must be accurately completed and maintained in a timely manner for those medicines received, administered and leaving the home. 11/06/2010 Care Homes for Older People Page 27 of 32 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 This will help to show that medicines are being used correctly as directed. 4 9 13 Records for the 11/06/2010 administration of medicine must be clear, giving full guidance to staff on how and when the medication is to be administered. This will help to ensure that people receive their medication correctly and their needs are met. 5 9 13 Medication must be administered at the correct prescribed time. This will help to ensure that peoples health needs are met. 6 9 12 Medication must not be allowed to run out of stock. This will help to ensure that people receive their prescribed medication and their health needs are met. 7 19 13 The use of any door restrictors must meet with current legislation and be recorded in the fire risk assessment. 11/06/2010 11/06/2010 11/06/2010 Care Homes for Older People Page 28 of 32 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 This will help to reduce the risk of injury to the service users should a fire occur in the home. 8 29 19 Staff should only be 11/06/2010 employed in the home when it has been verified and clearly recorded that they do not hold a criminal conviction that would prevent them from working with vulnerable people. This will help to ensure that service users are protected from unsuitable staff working in the home. 9 30 18 All staff should be trained with all mandatory training, and this training must be kept up to date. This will help to ensure that staff have the necessary skills to meet peoples needs. 10 38 13 Radiator guards should be installed through a risk assessment basis. This helps to ensure that people are protected from the risk of burns. 11 38 13 Risk assessments and practices for the use of bed rails and specialist 18/06/2010 09/07/2010 06/08/2010 Care Homes for Older People Page 29 of 32 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 equipment in the home must meet current legal guidelines. To help to ensure that the personal and safety needs of the individual are met. 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 2 3 4 7 8 9 9 Up to date photographs of each service user should be kept in their file in the case of an emergency. Records of medical checks must be kept up to date. Records should be kept for when people decline their prescribed medicines. Hand written entries on MAR sheets, should be countersigned and witnessed to confirm that they are correct. Options to increase the opportunity and to participate in more community based activities should be assessed and implemented. Privacy locks should be installed to ensure that people may use these if they wish to do so. A plan of redecoration of the home should be completed and followed to ensure that the home is maintained to a good standard. Consideration should be given to employ a person to undertake the laundry tasks in the home, with the potential to release the care staff to spend more 1:1 time with the service users. Evidence must be kept that the management of the home have ensured that people do not hold a criminal conviction that may prevent them from working with vulnerable people. Page 30 of 32 5 13 6 7 19 19 8 27 9 29 Care Homes for Older People 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 10 11 12 13 30 33 36 38 All staff should undertake trainnig in dementia awareness. Monitoring visits by the senior management of the home should take place on a monthly basis. Staff supervisions should be developed to ensure that they cover the aims and objectives of the home. A system to monitor that bed rails remain in good working order and remain suitable for the individual should be implemented and kept up to date. Care Homes for Older People Page 31 of 32 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. © 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. 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