Care Home: Wilton Lodge

What the care home does well There is a detailed and informative Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. The people who use the service receive a nutritious and balanced diet with a varied choice of food in line with the residents` preferences. Quality assurance systems are in place, which enables the service to monitor and improve their service. There is an open house policy which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents` finances. Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The homes processes and staff training should protect residents in the event of an allegation of abuse. What has improved since the last inspection? The requirements that were set at the the last key inspection have been either met or are a work in progress. The Statement of Purpose and Service Users Guide now reflect the limitation on the facilities for the less mobile people. Expert advice has been sought in respect of the wheelchairs in use by the home and appropriate action taken to protect the people from harm. All staff have received moving and handling training. Some work has been done in improving the quality of the care plans and related documentation. What the care home could do better: As discussed fully during the unannounced site visit to the home, the care plans viewed were not all of a good standard. Whilst two of the care plans had been reformatted and updated, two care plans were confusing and had not been updated accurately to reflect the residents specific needs. As this was seen to be a work in progress a requirement has not been made at this time. There were some areas of environmental risk to residents safety and well being identified during the site visit. Whilst these were rectified immediately, it is a concern that these had not been identified by staff working in the home and on the regulation 26 visits and dealt with. The lounge door was propped open with a chair and at times a resident was seated in it. This contradicts the homes` fire plan and policies. Three lounge chairs had split covers with exposed stuffing, which is a choking hazard as well as a source of cross infection. The overall environment of the home is restrictive for older people with mobility deterioration and the mobility needs of the people who live in the home need to be continually monitored and their individual risk assessments updated regularly. Key inspection report Care homes for older people Name: Address: Wilton Lodge 55 Wilton Road Bexhill-on-sea East Sussex TN40 1HX     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: Deborah Calveley     Date: 2 3 0 4 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 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) © 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 30 Information about the care home Name of care home: Address: Wilton Lodge 55 Wilton Road Bexhill-on-sea East Sussex TN40 1HX 01424216250 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): wilton@angelhealthcare.co.uk www.angelhealthcare.co.uk Angel Healthcare Ltd Name of registered manager (if applicable) Mr Christopher David Robbins Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Wilton Lodge is a Victorian terraced property set close to the seafront and town centre in Bexhill-on-Sea. There are bus routes and a mainline railway station within a short distance. The home, one of four care homes owned by Angel Healthcare Limited is registered to provide residential and social care for twelve older people with dementia type illnesses. Accommodation is provided on three floors. Stair lifts are fitted, providing assisted access to rooms on the first and second floors. There is a staff sleep-in room on the fourth floor that doubles as the managers office. At the rear of the premises is a small, private courtyard for use by residents. The layout of the Care Homes for Older People Page 4 of 30 Over 65 0 12 2 7 0 4 2 0 0 9 Brief description of the care home home is not suitable for service users who have a physical mobility restriction. Potential service users find out about the service via word of mouth, Angel Healthcare website, brochure, contacting the home direct, through care managers and placing authorities. 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: 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Wilton Lodge will be referred to as residents. This was a key inspection that included an unannounced site visit to the home and follow up contact with residents representatives and visiting health and social care professionals. This unannounced inspection was carried out over 4 hours on the 23 April 2010. There were four residents living in the home on the day of which all four were met and spoken with. The purpose of the inspection was to ensure that the requirements set at the last key inspection had been met within the given timescales and inspect all other key standards. During the site visit, a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Two members of care staff were spoken with Care Homes for Older People Page 6 of 30 in addition to discussion with the appointed manager and the director of Angel Health Care. Telephone contact was made with visiting professionals following the visit and one relative was spoken with also following the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received completed in full prior to this key inspection and received within the given timescale. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: As discussed fully during the unannounced site visit to the home, the care plans viewed were not all of a good standard. Whilst two of the care plans had been reformatted and updated, two care plans were confusing and had not been updated accurately to reflect the residents specific needs. As this was seen to be a work in progress a requirement has not been made at this time. There were some areas of environmental risk to residents safety and well being identified during the site visit. Whilst these were rectified immediately, it is a concern that these had not been identified by staff working in the home and on the regulation 26 visits and dealt with. The lounge door was propped open with a chair and at times a Care Homes for Older People Page 8 of 30 resident was seated in it. This contradicts the homes fire plan and policies. Three lounge chairs had split covers with exposed stuffing, which is a choking hazard as well as a source of cross infection. The overall environment of the home is restrictive for older people with mobility deterioration and the mobility needs of the people who live in the home need to be continually monitored and their individual risk assessments updated regularly. 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 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 10 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. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. Evidence: There is an informative Statement of Purpose and Service Users Guide in place which contain clear information about the home the facilities and the services it provides. These documents give prospective residents and their families the information they need to make an informed choice about where to live. The environmental statement has been amended to state that the home has steps internally and externally that would inhibit people with mobility problems. The written contract is clear and was seen to be written in plain English. There is a copy of the terms and conditions of residency included in the Service Users guide Care Homes for Older People Page 11 of 30 Evidence: The home has not had any admissions or placements to home since the last key inspection. Therefore the pre admission assessment could not be fully inspected at this time. The format of the pre-admission document was seen to be relevant, but as stated above could not be assessed as to its content. The appointed manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and ensures that carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged. The manager confirmed that residents are invited to a trial period to ensure suitability of the home. This is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Intermediate or rehabilitative care is not provided at Wilton Lodge. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plan documentation continues to be improved and when completed will identify the needs of the residents with clear guidance for staff to follow. All care is delivered in a way that protects residents privacy and dignity and promotes their independence. Evidence: The care documentation pertaining to the four people who live in the home were reviewed as part of the inspection process. These residents were also met and spoken with. Two care plans have recently been rewritten with a new format and clearly identified the individual residents needs with the expected outcome and steps for care staff to follow to ensure these needs are met in a consistent manner. As fully discussed there are areas that need developing and the appointed manager confirmed that this is a work in progress. On the whole the care documentation of these two residents demonstrated that the health, social and welfare needs were reviewed and evaluated. However the other two care plans were not of a good standard and contained Care Homes for Older People Page 13 of 30 Evidence: conflicting information about the care needs. It is acknowledged that the appointed manager has only been in post for a couple weeks but the incorrect information could impact negatively on the health and safety of the these two people. It was confirmed that the shortfalls would be addressed immediately. Two residents have been identified as having challenging behaviour and the care plan needs to be updated to reflect this with a consistent plan of appropriate action in place for staff to follow. Whilst the care plans evidenced regular review, there was no evidence of involvement with the resident or their representative and this needs to be established. As discussed at the site visit, the review should be undertaken in a competent manner and be accurate and specific to the individual being reviewed. There was evidence of risk assessments for health needs in the care planning format used by the home, and whilst completed not all were followed through with an appropriate plan of action when identified as required. This was discussed in full Staff spoken with confirmed that they received a full report on each resident daily and read the care documentation that is kept in a cupboard in the dining area.They felt that their views were taken into account when planning residents care. The shortfalls in the care documentation were fully discussed and will be adressed immediately and therefore requirements have not been made at this time, but will be assessed at the next key inspection. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. Medication Administration Charts (MAR) were found to be in the main competently completed. A recommendation of good practice is that the residents medication is documented clearly with clear explanation of the reason for prescription, side effects and contra indications. This will inform the staff who provide the care. The identity photographs of the residents need to be updated and renewed regularly. Staff were seen to be respectful and considerate to all residents and visitors whilst attending to their needs. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. The interaction between staff and the people who use the service was seen to be positive and residents were comfortable with the staff. Care Homes for Older People Page 14 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. Social activities and meals continue to be creative and provide daily variation and interest for people living in the home. Residents are able to make a range of choices about their lives as well as maintaining links with friends and relatives. Evidence: There is a range of activities offered to the people who use the service on a daily basis. Activities are based on the capabilities of the people living in the home at this time. Residents religious wishes are taken into for residents to receive Holy Communion benefit from more information in respect wishes and then evidence regular review consideration and arrangements are made if they choose to. The care plans would of the residents social needs, interests and to ensure that their needs are being met. Residents are facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the people who use the service. There are two communal areas in the home that are available to residents and their Care Homes for Older People Page 15 of 30 Evidence: visitors for meetings as well as their bedrooms. Many of the residents have individualised their bedroom with items from home and it was confirmed that they are encouraged to make it homely. It was observed during the site visit that the routines at the home are flexible, breakfast was taken by residents when they were ready and at various times. The home has an advocacy policy in place and the information regarding this is available to all who use the service. The meals provided for residents were seen to be nutritious and attractively presented, including the pureed meal. The menu evidenced a well-balanced nutritious diet which rotates 4 weekly. The midday meal is cooked at the nearby sister home 3 days a week and then transported and served by the home staff. Whilst the menu does not offer an alternative, records demonstrated alternatives are offered and these are listed for each resident. Mealtimes can be varied upon request and residents guests are also welcome to have meals at the home. Medical therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. The staff keep a record of residents food consumption, fluids taken and output details. The home staff use a nutritional assessment tool to identify any residents with special dietary needs including monthly weights. However as previously mentioned an action plan needs to be in place for those whom have been identified as at nutritional risk or who have special dietary needs. Care Homes for Older People Page 16 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. Practice in the home ensures that complaints are responded to with residents and their representatives being confident that they are listened to and demonstrated that robust procedures are followed. Practice in the home ensures that adult protection issues are responded to when identified. Evidence: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated during the site visit to the home. The appointed manager promotes an open house policy which encourages people to openly discuss any problems that arise. There was evidence in the documentation of the home involving families in problems that had been identified. The home has relevant guidelines on the protection of vulnerable adults and staff have received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. There have been two safeguarding investigations in the past year which resulted in placements being suspended to the home. These investigations have been completed. Care Homes for Older People Page 17 of 30 Evidence: The organisation has robust policies and procedures in respect of protecting monies and valuables and in the recuitment of staff. Thus protecting residents from abuse or exploitation. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Wilton Lodge provides a comfortable and clean environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room and rooms are homely and reflect the residents personalities and interests. Evidence: The home is generally well maintained, furnished and decorated to an adequate standard. There are areas that are in need of repapering and updating and these were discussed. A plan of action is in place. The home is currently registered for 11 residents, but due to the lack of communal space, Angel Health Care are contemplating reducing the amount of residents living in the home. It has been discussed at previous inspections that the layout of the home is not suitable for those residents who are not independently mobile due to narrow entrances to the dining area and narrow steps. As yet there have been no changes to the environment but estimates are being requested for ramps that will enable residents to be safe when moving independently around the home. The home does not have a shaft lift but does have a stair lift to all floors of the home. Care Homes for Older People Page 19 of 30 Evidence: One resident was seen to be struggling with the step from the dining area and her mobility needs are to be regularly risk assessed to ensure her safety at all times and any changes to her mobility status. The lounge and dining room areas are fairly small but are pleasantly decorated. The lounge remains very overcrowded and thus unwelcoming. Three chairs were identified as placing residents potentially at risk from cross infection and were a choking hazard. These chairs were removed when identified during the site visit and therefore an immediate requirement was not issued. However this should have been identified by staff and on the regulation 26 visits by the organisation. The majority of the other furniture in the home is of a good quality and suitable for the people who live there. The outside area is accessible to residents in the good weather and furnished with garden tables and chairs. The AQAA stated that further improvements to the home and outside areas are planned. There are adequate communal bathrooms and a wet room in the home with specialist equipment which enables frail residents and those with a physical disability to enjoy the facilities available. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms hoists and wheelchairs if required. Call bells are provided in all bedrooms but in the lounge and dining area the call bells were not in reach for the residents and this needs to be fully risk assessed as it was not evidenced at this visit that residents are supervised in the lounge area at all times. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. Information in the AQAA confirmed they were up to date. Training records evidenced that all staff receive fire safety training. However one door was found inappropriately wedged open by a chair and a resident. This was adressed during the site visit. Care Homes for Older People Page 20 of 30 Evidence: Polices and procedures for infection control are in place and evidenced regular review. There was some confusion in respect of the appropriate use of aprons and gloves and this was discussed and rectified during the visit. The laundry area is in the cellar of the premises and was well organised and has the equipment necessary to provide a good service. The floor is in need of resurfacing to ensure it is sealed to prevent cross infection and this will be undertaken in the near future. The staff member who is allocated the cooking duties also does the cleaning and laundry. There are policies in place for infection control measures in this area. Residents clothes were seen to be well looked after and clean. The home was clean and there were no offensive odours identified. 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. Robust recruitment procedures are in place to protect residents and the staff training ensures they are aware of their roles and are able to provide the support and care the residents needs. Evidence: The staffing rota was reviewed and demonstrated that the staffing levels are sufficient for meeting the needs of the residents at this time. At present there are four residents living in the home and two staff are deployed to support and care for residents and organise the meals cleaning and laundry chores. The night shift is covered by two staff one waking and one sleep in. The staffing levels of the home need to be reviewed regularly against the documented needs of the residents and adjusted as required to ensure residents receive a consistent approach to their care. Three staff have completed a National Vocational Qualification (NVQ) level 2 in care with further carers due to commence the NVQ in the future. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. All the paperwork is kept within a locked room. The induction programme is now in place and has been introduced for all staff. Files seen confirmed this. Care Homes for Older People Page 22 of 30 Evidence: A sample of individual staff training files were viewed and it was evident that staff had received training in English for overseas staff, Food hygiene, Fire safety, Moving and Handling, POVA, medication and challenging behaviour, Health & Safety and have an induction programme in place. Care Homes for Older People Page 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management approach at Wilton Lodge is open and encourages residents, relatives and staff to be actively involved in the lifestyle provided in the home. Evidence: The management structure of the home has changed since the last key inspection in that there has been no registered manager for the past five months. An appointed manager has been in post for approximately three weeks. She has experience in working with elderly people who have a dementia type illness. She has been enrolled on a management course. The director of the home is working closely with the staff of the home to ensure that the outcomes for the people who use the service are positive. There have been two safeguarding investigations which identified shortfalls in the management of the home and affecting the outcomes for the residents. A plan of Care Homes for Older People Page 24 of 30 Evidence: action has been put in place and is being followed. The quality assurance systems in the home include questionnaires which are sent out to residents and relatives and other visitors to the home. The formal quality assurance and quality monitoring systems have enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. The quality assurance results will continue to be audited and action taken to address any suggestions of improvement will be documented. There are no residents at present who are responsible for their own finances relatives and solicitors support the majority while the home does not handle the financial affairs of residents. Staff supervision was discussed and staff supervision and appraisals are being undertaken on a regular basis. It was discussed that all staff do need to be regularly supervised and appraised as part of their induction process. Staff spoken with confirmed that they receive supervision and it is suggested that a plan of the years supervision sessions is developed and followed. There are policies and procedures in place to guide staff in care practices and the AQAA received stated they have been updated and reviewed since the last key inspection. However the files reviewed did not evidence this clearly. Fire safty policies and procedures were not being followed by staff and to protect the residents welfare this needs to be adressed with further training. There are still concerns about the layout of the home in respect of steps and residents are still struggling with the steps from the dining area. It is confirmed that advise is being sought from experts. Staff were vigilant in protecting residents who do wander from harm and doors to the cellar, bathrooms and cupboards were locked. Care Homes for Older People Page 25 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 26 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 1 19 13 That the registered person ensures that all parts of the home are so far as reasonably practicable free from hazards to their safety.That unnecessary risks to the health and safety service users are identified and so far as possible eliminated. That the safety and well being of service users are promoted and protected. 08/10/2010 2 19 23 That the registered person are suitable for achieving the aims and objectives set out in the statement of purpose. That service users live in a safe and well maintained environment. 08/10/2010 3 26 13 That the registered person shall make suitable arrangements to prevent cross infection and the 08/10/2010 Care Homes for Older People Page 27 of 30 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 spread of infection in the care home. That the laundry floor is impermeable. That the use of aprons and gloves is appropriate. That all furniture is intact and safe. That the safety and well being of service users are promoted and protected. 4 31 12 That the registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. That the service users health and welfare is promoted and protected at all times by the a robust management structure. 5 38 23 That the registered person 08/10/2010 ensures that fire safety policies and procedures are implemented and fully understood by all the people in the home. That the furniture in use is suitable and in good working order. 08/10/2010 Care Homes for Older People Page 28 of 30 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 That the safety and welfare of service users are promoted and protected. 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 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. 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