Care Home: Wilton House Nursing Home

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What the care home does well Service users needs are fully assessed before they move into the home. This is important to ensure that Wilton House is able to meet their health and personal care needs. Relatives and friends can visit anytime they want to and people are able to make choices about how to spend their time. Staff are good at ensuring the service users privacy and dignity is maintained. The service is particularly good at providing a high standard of end of life care. The food is good with plenty of choices available. There is a good complaints procedure so that people know their views will be listened too. There are good safeguarding procedures in place so that staff know when to refer incidents to the local authority. This is important to ensure that service users are fully protected. The home is clean, homely and well maintained. Over half of the staff have completed the NVQ level 2 qualification in care. And the manager knows what other training staff need and has a good training programme in place to address this. The manager knows what needs to be done to improve the home and it is clear that he is working hard to improve outcomes for the service users. There are good quality assurance systems in place to help make sure care standards are improved in the home. Service users said: "provides a home environment", "the home always has a good fresh, friendly feel". Relatives said: "the staff are of a high quality and are very attentive and I am very satisfied with the all round care that my mother receives, so is my mum", "friendly always. Kindness whenever I call at the home" and "I am happy with the home". Staff said: "I feel within this house is a very caring home and is very well managed. The residents are always paramount in the care" and "Good individualized care. We feel that it is one big happy family". When asked about what they felt the home does well one member of staff said "palliative care". What has improved since the last inspection? There have been many improvements to this home in the last year. These include putting in place risk assessments for the use of bed rails, which is important to keep people safe. An activities co-ordinator has been appointed and there is an activities programme in place. There have also been many improvements to the environment including re-decoration of communal areas as well as the provision of equipment such as specialist beds. Quality assurance systems have been put in place which include finding out what service users think about the home, as well as a number of internal audits carried out by the manager. Staff and a relative commented about the number of improvements in this home since this manager has been in post. What the care home could do better: The manager knows what needs to improve and has plans to address all of the below issues. We have made recommendatins for the improvements to continue as planned as follows: Care plans would benefit from a bit more information about the service users preferences in relation to personal care. This will help make sure they receive care and support in the way that they prefer. The risk assessment for the use of bed rails need a bit more information in them about why they need to be used. The manager has a new risk assessment which he plans to put in place. Medication should not be handled by staff. This is to prevent cross contamination. And staff who give the medicines should make sure that the service user actually takes them. Although activities have improved it would be good if there were more trips in the local community which service users could enjoy. The development of social care plans would also help to make sure the service users needs in this area are met. The refurbishment and re-decoration programme should continue until complete. Although staffing levels are adequate these need to be kept under review, as planned by the manager, to make sure the health and care needs of the service users continues to be met. It would be good practice to make sure the job applications forms have a full employment history including details of the month and year. This is so the manager can look at any gaps in the employment history of prospective new staff. Key inspection report Care homes for older people Name: Address: Wilton House Nursing Home Wilton Drive Darlington Durham DL3 9RE     The quality rating for this care home is:   two star good 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: Nicola Shaw     Date: 1 3 1 0 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 30 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 30 Information about the care home Name of care home: Address: Wilton House Nursing Home Wilton Drive Darlington Durham DL3 9RE 01325353701 01325353356 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Popular Care Ltd Name of registered manager (if applicable) Mr Paul Anthony Kilburn Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old Age, not falling within any other category, Code OP - maximum number of places 30 Date of last inspection Brief description of the care home Wilton House Care Home with nursing is a detached two story building set in large well maintained gardens on the outskirts of Darlington. The home has 20 single bedrooms, 2 with ensuite facilities and 5 double bedrooms. There are two communal lounges and a separate dining room on the ground floor. There is a passenger lift giving access to the first floor. The home is registered for a total of 30 older people with personal or nursing Care Homes for Older People Page 4 of 30 Over 65 30 0 1 3 1 0 2 0 0 8 Brief description of the care home care needs. Weekly fees are 371 pounds for residential care, 477.30 pounds for nursing care and 455.14 pounds for continuing health care. Care Homes for Older People Page 5 of 30 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: 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. Before the inspection visit: We looked at: Information we have received since the last inspection on 13th October 2008. How the service has dealt with any complaints and concerns since the last visit. Care Homes for Older People Page 6 of 30 Any changes to how the service is run. The providers view of how well they care for people. The visit: An announced visit was made on 13th October 2009. During this visit we: Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had knowledge, skills and training to meet the needs of the people they care for. Checked what improvements had been made since the last visit. We told the manager what we found at the end of the visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 30 There have been many improvements to this home in the last year. These include putting in place risk assessments for the use of bed rails, which is important to keep people safe. An activities co-ordinator has been appointed and there is an activities programme in place. There have also been many improvements to the environment including re-decoration of communal areas as well as the provision of equipment such as specialist beds. Quality assurance systems have been put in place which include finding out what service users think about the home, as well as a number of internal audits carried out by the manager. Staff and a relative commented about the number of improvements in this home since this manager has been in post. 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. Care Homes for Older People Page 9 of 30 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 10 of 30 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 11 of 30 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. Good information is available to help prospective service users make an informed choice about where to live. The admissions process ensures that people are adequately assessed prior to care being offered. This means that service users are offered the right type of care at the home. Evidence: Service users told us in surveys that they were given enough information about Wilton House to help them decide that it was the right place for them, before they moved in. For prospective service users, funded by the local authority, the manager obtains a copy of the needs assessment and care plan from the care manager. This is so that he can decide whether Wilton House is able to meet their needs. In addition to this he Care Homes for Older People Page 12 of 30 Evidence: also completes a comprehensive pre-admission assessment, unless a person is admitted in an emergency. The manager told us that in the last 12 months he has reviewed and up-dated preadmission documentation. Care Homes for Older People Page 13 of 30 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. There is good information in the care plans about the health and personal care needs of the service users. However, more detail about each individuals preferences will ensure that everyone receives care and support in a way that they prefer. Staff care practices preserve the dignity and privacy of the people who live here. And medication administration procedures generally protect the service users. Evidence: A range of standardized risk assessments are in place that lead to the care plans being developed. These cover a number of areas such as mobility and falls prevention, eating, drinking and nutrition, pressure area care and how a person expresses whether or not they are in pain. The care plans we looked at provided good information about the service users health and personal care needs. They provided clear guidance to staff on how to support the service users. However, some would benefit from more information about the service Care Homes for Older People Page 14 of 30 Evidence: users preferred routine. For example: how does a person prefer to have a shave (wet or electric) with more information about what the person can do for themselves. New care plans are quickly put in place in response to the service users changing health care needs. Examples of these include if a person develops an infection and the care pathway for end of life, which is a special care plan that helps to make sure service users receive the care and support they need at the end of their life. There was evidence of the service users health improving since moving into Wilton House. For one person, previously unable to mobilize, their mobility has improved to such an extend that they have been able to walk a couple of steps with the assistance of staff. The care plans and risk assessments are evaluated monthly. And the service users weights are monitored monthly uless clinical need identifies weekly monitoring is required. Some service users have bed rails fitted to their beds. Risk assessments have been completed in relation to the use of these. However, some of these need more information in them. For example; in two we looked at the reason for the service users needing the bed rails was documented as being because they were at risk of climbing out of bed. There was no further information to show why this was a risk to that person and therefore could be seen as unnecessarily taking away their independence. We talked to the manager about this who confirmed he was reviewing the risk assessment process in relation to bed rails. Daily records are maintained, the quality of which, particularly in relation to the care pathway for end of life, were very detailed providing information about the care which had been provided. Relatives confirmed that they are involved in the care plan. Service users have access to all NHS facilities. There are regular visits from GPs and other health professionals, including opticians, chiropody and dental services, community psychiatric nurses and dieticians. We spoke to a visiting health care professional who said that there have been improvements since the new manager has been in post. They said that referrals are being made appropriately to them. Care Homes for Older People Page 15 of 30 Evidence: Three people said in surveys they usually received the care and support they needed, two people commented always. Medication is stored in a locked, secure room. The staff monitor the temperature of the medication room and the medication fridge to make sure that medicines are stored correctly. The nurse in charge orders the medication. Detailed monthly audits of the medication, which includes checking the Medication Administration Records for gaps, checking that there is a photograph of the service user, evidence that the medication has been regularly reviewed by the GP and that the treatment room is tidy, are carried. This is good practice. There is a small stock of controlled drugs. These are stored securely and accurate records are held in relation to these. We watched how the medication was given to service users. In one situation the medication was handled by the nurse in charge and in another we observed the medication to be left by a service user to take. Such practices are not good and were discussed with the manager at the end of the inspection. Staff were respectful in their approach towards the service users and ensured that their privacy was respected. Personal and intimate care tasks were carried out in the privacy of the service users own bedrooms. Staff referred to the service users by their preferred name and it was clear there was a good rapport between the staff and service users. Service users commented in a survey carried out by the manager the staff are kind and attentive, not patronizing and staff look after residents well, giving respect to all residents. Care Homes for Older People Page 16 of 30 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 range and variety of activities available has improved but could be better to ensure service users have opportunities to lead a fulfilling lifestyle. Service users are able to maintain family and other contacts if they want to. This ensures that they do not become socially isolated. Service users are able to exercise control and choice over their lives, as far as is possible, which enables them to remain independent. Service users receive a varied menu, which promotes their general health and wellbeing. Evidence: Since we last inspected an activities co-ordinator has been employed. The range of activities available to service users is available in the entrance foyer. These include group dominoes, 1:1 talks and games which encourage movement and exercise. There are no social care plans in place although the activities co-ordinator said that she has asked relatives about the service users life history. The activities available do not include trips out, however, the manager has assisted a number of service users to Care Homes for Older People Page 17 of 30 Evidence: obtain taxi vouchers so that they can use the local community more. One service user commented that there is the odd coach trip. Daily newspapers are delivered to the home and there is also a mobile library service that one service user was observed to take advantage of. Service users said there is not alot of activities and another person said people are very diverse and I get lonely, no-one to talk to. During our visit relatives were observed to freely come and go. The manager said there are absolutely no restrictions on visiting. Relatives are encouraged to stay with their family member if they are reaching the end of their life, which includes over night. One relative had written to the home and said I cannot thank you enough for letting mam stay with dad in the last weeks of his life. Another relative said I visit every afternoon and I am always made to feel very welcome here. I always get a cup of tea. Last Saturday the home had a party for my relative and the whole family were invited. Service users said its not institutional. One service user has their own mobile phone which they said the staff helped them with. The telephone number of someone important to them was beside them so that they could independently contact them if they wanted to. There are a range of areas where service users can choose to sit and spend their time. One relative had commented in the homes survey when asked about daily life residents are given the choice of doing anything. We spent time with people whilst lunch was served. Tables were nicely presented with table cloths and flowers. Those service users who needed support were offered this by staff, in a sensitive discrete manner. There is a choice of main meal and since we last inspected a new menu has been developed. Relatives said the the staff usually come around just before lunch and offer people a choice. The cook is provided with information about each service users nutritional needs. For example: if they require fortified drinks, their food likes and dislikes and how they need their food prepared. Service users said: the food alright and Care Homes for Older People Page 18 of 30 Evidence: there is a good variety and standard of food. Care Homes for Older People Page 19 of 30 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. The home has a good complaints procedure so people know that their views will be listened to and acted upon. And staff training helps to ensure that the service users are protected from abuse. Evidence: The home has a complaints procedure. All service users said in surveys that they knew how to make a complaint and staff said that they knew what to do if someone made a complaint to them. There have been two complaints made to the manager in the last year. We looked at the complaints record, which showed that these had been thoroughly investigated by the manager and included details of the nature of the complaint, whether any further action was needed and the date the complaint was resolved. There has been one safeguarding referral made in the last year, which has been managed and dealt with appropriately. Staff we spoke to said that they would have no hesitation in reporting bad practice. Some staff have been provided with training regarding safeguarding adults and the manager told us that more safeguarding training is planned through the local authority for both senior and care staff. Care Homes for Older People Page 20 of 30 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. Service users benefit from a clean, homely place to live. Evidence: Since we last inspected there have been a number of improvements to the environment. These include the re-decoration of the kitchen, together with the provision of new grill, re-decoration of communal areas, provision of additional commodes, clinical waste bins, soap and paper towels and the provision of six new profiling beds. The manager told us that plans for the next twelve months include the continued investment in redecoration and re-carpeting. Service users said in surveys provides a home environment and the home always has a good, fresh, friendly feel. Three service users commented in surveys that the home was usually clean and fresh and two commented always. The manager has implemented an infection control audit which includes checking that bathrooms and toilets have been cleaned after use as well as checking that clinical waste is stored appropriately. Training for staff in infection control is planned for this year. Care Homes for Older People Page 21 of 30 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. Staffing levels are adequate but could be improved to ensure person centred care is provided. Staff training is satisfactory and is improving in order to meet the diverse needs of the service users. Staff recruitment procedures fully protect the service users. Evidence: On duty when we visited was the manager, administrator, registered general nurse, 3 care staff, cook and kitchen assistant, domestic and housekeeper and a handyman. There were 21 people living in the home. Three service users said in surveys there are usually enough staff available if they needed them and one person said there are always enough staff. Relatives said about staffing levels most of the time there are staff around. They do their best but sometimes they are rushed off their feet. If they take one or two emergencies or someone is poorly they are short staffed. Staff said sometimes we are pushed on the morning, for example, today the tea trolley didnt get around until 11.30AM instead of 10.30AM and the staffing situation has been good recently, but there have been times when there havent been enough staff to cater for the service Care Homes for Older People Page 22 of 30 Evidence: users needs. However, there have been the correct number of staff on duty. During our visit staff had no time to sit and chat with service users as their time was spent attending to the service users physical health care needs. Staff we spoke to said that sometimes they had more time during the afternoon to sit and chat with service users. The manager told us that this service specialises in end of life care. We asked the manager about staffing levels, should a person be reaching end of life, and requiring 1:1 support, or what happens in an emergency. He told us that in such situations additional staff are provided. The manager has reviewed staffing levels during the early morning and is exploring the possibility of providing an additional member of staff from 6.AM in order to meet the needs of the service users. There has been a low turnover of staff, which is good for continuity of care. Seven out of 12 care staff have completed the NVQ level 2 or above qualifications in care. Other specialist training has included venepuncture, male catheterisation, tracheostomy management, palliative care, verification of death and continence management. The manager told us that he has invested heavily in training and he plans to further invest in training in the next twelve months to address the shortfalls he has identified. All new staff complete an induction training programme. All of the service users spoke positively about the staff and there was clearly a good rapport between the service users and staff. Service users said: everybody is very kind the staff do their job Relatives said: staff are lovely and the staff are of a high quality and are very attentive. Staff files showed that good recruitment procedures are followed. This includes obtaining two written references and an Enhanced Criminal Records Bureau check to ensure that the prospective staff member is suitable. Prospective employees are requested to complete an application form and provide details of their employment Care Homes for Older People Page 23 of 30 Evidence: history. On occasion this information had not been completed fully with details of the month of employment missing. Care Homes for Older People Page 24 of 30 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. Good management systems ensure the health, safety and welfare of service users. There is a good quality assurance system. This is based on the views of service users, where they are able to communicate their wishes, so that they know their rights and views will be listened to. Evidence: It was evident that the new manager, in the time that he has been at Wilton House, has worked hard to improve the service for service users. He provided us with information, before we visited, about what has improved in the home in the last year and it is clear he knows what needs to be done to improve things further. Service users said: I find Paul (the manager)very pleasant, hes got a sense of humour Care Homes for Older People Page 25 of 30 Evidence: Relatives said: The manager has identified areas for improvement and is working on them keeping families informed at relatives meetings held on a regular basis. Staff said: its alot better since Paul has been in charge and I think that our manager deserves alot of credit for turning the home around in his time there. Our reputation in the local community has greatly improved in the last year due to the improvements Paul has implemented. Service user satisfaction questionnaires are used to obtain feedback about the service. There is also a comprehensive internal audit system. This involves a monthly audit, carried out by the manager, of medication, pressure sores, infection control and environmental issues. The outcome of the audits and questionnaire are used to develop an annual development plan, which identifies standards which need to improve. We looked at how the home manages the service users personal allowance. Good records of this are maintained and receipts are obtained for any money deposited or withdrawn. The manager checks that the records are correct. The home carries out internal maintenance checks and has contractors to service equipment. Staff are provided with training in health and safety issues such as first aid, fire safety and moving and handling. Records are maintained of all accidents. The manager also monitors the occurrence of accidents and incidents in order to identify if there are any themes or trends. All staff receive regular supervisions. And there are regular team meetings and staff handovers, which is important for effective communication. Care Homes for Older People Page 26 of 30 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 27 of 30 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans would benefit from more information about the service users preferences in relation to personal care. This is so that care and support is provided in the way that they prefer. The review of the bed rail risk assessments should continue as planned. To prevent cross contamination medication should not be handled by the person administering it to service users. The person responsible for administering medication should ensure that it has been taken by the service user for whom it is prescribed. The activities programme should continue to develop to include more trips out in the local community. Social care plans should also be developed to help make sure each service users social needs are met. The refurbishment and redecoration programme should continue as planned. Staffing levels should to be kept under review and additional staff provided, as planned, to meet the needs of service users. Page 28 of 30 2 3 8 9 4 12 5 6 19 27 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 7 29 Full details of employment history should be obtained, including the month of employment. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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