Care Home: Wilton Manor Nursing Centre

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What the care home does well There is a pre admission process in place that ensures that the home can meet people`s needs prior to them moving in the home. The service users are provided with a warm, homely and well maintained environment that is appropriate to their needs. The meals are well managed that offer the service users choices and variety. There is a well organised activity programme with designated staff to support the service users. There is a well tended garden to the front of the service where seating is available. What has improved since the last inspection? The ground floor and some other parts of the service have been refurbished as part of the ongoing programme of renovation. The service users have been moved to the ground floor and staff say this has a positive effect and allows them to access the garden and give them a sense of freedom. The communal shower room has been refurbished to a good standard that allows easy access for people with restricted mobility. What the care home could do better: Assessments and care plans should be further developed to take into account individual risk and action plan put in place. The records of food and fluids are insufficient and do not reflect that people`s needs are met safely. Care and procedures in the management of the service users medicines should be looked into. There should be adequate staff at all times to ensure that people receive effective care and their needs are met. Some staff practices did not always promote the health and safety of people. This is in particular to the transfer and moving and handling of the service users. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wilton Manor Nursing Centre Wilton Avenue Southampton Hampshire SO15 2HA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anita Tengnah     Date: 1 7 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Wilton Manor Nursing Centre Wilton Avenue Southampton Hampshire SO15 2HA 02380230555 02380632076 welhamsa@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : BUPA Care Homes (CFC Homes) Ltd care home 69 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 69 69 The maximum number of service users to be accommodated is 69. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Wilton Manor is a care home providing care for 69 older persons in need of nursing care. The home is registered to provide care for older people with mental diseases associated with old age and those with a mental disorder, excluding learning disabilities. BUPA care owns the service. The home is located in the city centre of Southampton and is close to all the local amenities. Care Homes for Older People Page 4 of 33 Brief description of the care home The home was purpose built on three floors, and provides a modern environment with single occupancy accommodation, all of which have en-suite facilities. There is a wellmaintained garden at the front of the building. The current fee charged is £911 -£950. There is an extra charge for items that are not included in the fee. Care Homes for Older People Page 5 of 33 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: An unannounced visit to the service was undertaken as part of the inspection on the 17th June 2009. The inspection was carried over one day and we used an expert by experience who contributed in the formulation of this report. She observed care practices and talked to a number of the service users, staff and visitors as part of the visit. The registered manager was present through out the day of the visit and feedback was given as part of our process. We also walked round the home and looked at a number of the service users bedrooms, communal areas such as the lounge, dining area, laundry room and bathrooms. As part of the visit, staff and service users views were sought, care, staff and other records were looked at. Care Homes for Older People Page 6 of 33 We sent out our Annual Quality Assurance Assessment to the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We received the completed AQAA and this gave us good information about the service. This is included in this report, as was information gathered by the Commission since the last inspection to contribute in assessing judgements in this report. What the care home does well: What has improved since the last inspection? 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 33 Care Homes for Older People Page 9 of 33 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 33 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. There is a satisfactory pre admission process in place to ensure that people are assessed prior to care provision. The service does not provide intermediate care. Evidence: We looked at the pre admission records of recently admitted service users to the home. This indicated that the homes manager undertook a pre admission assessment prior to people moving into the service in order to ensure that the home can meet their needs. Other information and records were available for a service user who had transferred from another care home. The manager reported that information such as the statement of purpose is made available to all prospective service users. The service users are offered the opportunity to visit the home, however the staff Care Homes for Older People Page 11 of 33 Evidence: stated that the service users relatives visited. The manager reported that the service users were often quite frail and in poor physical and mental states to visit the service. The home has in place an advocacy service that is available to the service users that the manager stated worked well and offered good support. Care Homes for Older People Page 12 of 33 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. Care plans assessments and records are satisfactory, however those relating to nutritional needs and records of fluids are inadequate and put people at risk of harm. The healthcare needs of the service users and access to external healthcare teams is well managed. The medication management is not adequate and put people at risk of not receiving their medactions safely. Evidence: We looked at the assessments and care plans for five service users as part of this visit. Assessments of care needs included information such as moving and handling, fall assessments, pressure relief and skin integrity, personal care needs, and some of them contained nutritional assessments. The care plans contained information such as personal care and for one of the service Care Homes for Older People Page 13 of 33 Evidence: users who was a diabetic, there was good information about managing their needs and included blood sugar monitoring. There was evidence that staff were monitoring the service users weights and maintained monthly records of these. Fall assessments were in place and included bedrails, however there were no consents for these in the records seen. We looked at the records for the service users who are receiving thickened fluids. Information regarding this for one of the service users was displayed on their wardrobe in their bedrooms. This was brought to the attention of the manager at the time of the visit as this impinges on the privacy of the service user. The care plans and records we looked at for the service users receiving thickened fluids did not clearly demonstrate how these decisions were taken and and there was a lack of assessments and care plans to ensure that these are managed appropriately. There were no speech and language therapist (SALT) assessments in the records that we looked at. Clear details relating thickened fluids and pureed diets must be developed following assessments to ensure that these are managed safely at all times. We found that some care plans in relation to personal care needs were detailed whilst others needed further developments in order to ensure that all care needs identified are met. These were in relation to wound care and dietary needs risk assessments, care plans and fluid records. The care records showed that pressure risk assessments are completed and pressure relieving equipment were in place for those identified as high risk. Details such as the type of pressure relieving mattresses/ cushions and their managements were not available and should be developed. We looked at the record of one service user who was receiving treatment to pressure ulcers. Care plans were in place for the treatment of ulcers to their heals. These included the type and frequency that dressings were to be renewed. The care record indicated that the service user had a sacral ulcer and staff had applied a dressing. However there was no assessment and care plan in relation to this pressure ulcer. The lack of a detailed care plan has the potential of this person not having their wound managed appropriately and must be developed in order to inform staff practice and maintain continuity of care. Two relatives raised serious concerns regarding the lack of support that their relatives were receiving with fluids at the home. This was in particular to people who were left Care Homes for Older People Page 14 of 33 Evidence: in their bedrooms and could not access their drinks. We observed that two people could not access their drinks when we walked round the home. Other concerns were that their relatives were always very thirsty. We observed another service user who was agitated and thirsty without a drink close at hand. We looked at the records of fluids administered that the home maintained for the service users. These showed that the records were poorly maintained and demonstrated that people were not receiving adequate fluids. These included gaps of a number of hours and no records of fluids administered at night. Staff spoken with stated that the staff were not recording the fluids as required on the charts. These concerns were brought to the attention of the manager at the time of the visit, as action is required to ensure that people are supported and have their needs met at all times. The staff reported that the service users are supported to access medical attention and also access to other healthcare professionals as needed. The manager reported that the service has developed good relationships and the local primary supported them including support and reviews from the psychiatric nurses. We looked at the medicine management that the home undertakes on behalf of the service users. The home was using the blister pack system that ran over a twenty eight days cycle. Medicines were stored safely and the nurse in charge confirmed that only the registered nurses were responsible for the management of the service users medications. Records of medications that are administered are recorded on the service users medication administration record (MAR ) sheets. Some of the records show that medicines received into the care home are recorded but this was not available in all the records that we looked at. The staff reported that they use one pack of apperients and this is dispensed to all the service users that these are prescribed for. The registered person must ensure that all medications must be dispensed for the named persons as required. All medicines that are prescribed and dispensed for the service users individual use and should not be used as communal. We found that one person had been administered an apperient on two separate occasions but this was not on the MAR charts or the homely remedy list. It is unclear whether a person has received a medication that was not prescribed for at the time. Any changes in the prescription must be clearly recorded to demonstrate when and on whose authority the changes to prescribed medications are made, as this was not available. Care Homes for Older People Page 15 of 33 Evidence: Records of medicines that were prescribed as variable dosages were not maintained, such as whether one or two tablets were administered. There was no way of auditing these medications as accurate records were not available. One MAR record showed that prescribed dosage was not adhered to and any changes were not clearly evidenced such as on whose authority and reasons for these were not documented. Staff must ensure that all medications that are transcribed on to the MAR charts contain two signatures to eliminate risk of error as these were not available. The service users we spoke to and practice observed indicated that the staff were courteous when dealing with the service users. It was evident on the ground floor that the staff had developed good relationships with people and they were supported appropriately. The manager stated that only residents who have been assessed as more challenging have been moved to the ground floor in the last few days. This gave the service users with acute mental health needs a sense of freedom and they were able to move freely and have easy access to the garden which was recommended from previous visits. Care Homes for Older People Page 16 of 33 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 social activities for the service users are well managed and meet with their satisfaction. The meals are good, however staff support is inadequate and does not always meet with peoples needs. Evidence: The AQAA states that the service have increased the hours in activities and have revised the activities programme, incorporating more one to one time, due to the change in the dependency of the residents. A comment about activities was Could not be better. Excellent. The section relating to the activities management was looked at by our expert by experience that we used for this visit. The evidence gathered showed that the home has an activity coordinator and three part time staff that assisted her in the provision of activities. Some of the activities provided included reminiscence, gardening club,games, quizzes and external entertainers are also brought in. Care Homes for Older People Page 17 of 33 Evidence: The activity coordinator discussed the plan that the service has in place to meet the diverse needs of the people accommodated, such as the development of a gentlemans club and a ladies pamper day. On the day of the visit, about ten of the service users attended a church service that is available to them on a monthly basis with Holy Communion with a local Minister and an organist. The staff reported that activities such as spending one to one times was in place and records of activities were maintained. We observed that the service has in place a map of life is drawn up in order to gather information relating to peoples past hobbies and interests . The home was preparing for Millers Ark visit planned for the next day that the staff said was very successful last year.The service users have an opportunity to handle some of the small animals and enjoy others roaming in the ground. The pat a dog scheme was also available to the service users. The home has an open visiting policy and the relatives we spoke to confirmed that there are no restrictions on visiting. A record of visitors as maintained at the service supported this. We observed the lunchtime meals on the day of the visit. The meals were well presented and looked varied, appetising and fresh. The staff stated that the service users are supported to choose from the menu on a daily basis and offered choices. Information about different types of meals such as pureed and diabetic was recorded on the menu sheets. A choice of two main courses was available on the day of the visit. There is a small kitchen area on each floor where the kitchen staff served the lunchtime meals and a hot trolley was also provided. Staff were observed supporting the service users with their meals in a sensitive manner. Comments that we have received included that the meals are very good and no complaint A comment was have found anything that my relative would like to eat has been swiftly provided. Other comments were that there was a lack of staff to support people appropriately at meal times. Sometimes at weekends I see residents who have fallen asleep over their food and Care Homes for Older People Page 18 of 33 Evidence: others whose food gets cold One member of staff cannot cope with fifteen residents. Eighteen months ago I suggested that finger food might be served at weekends, but nothing has been implemented. We found that all the staff put on bib on all the service users in the dining room and none were offered a choice including a new service user who had been admitted a couple of hours previously. Staff should ensure that people dignity are maintained at all times when receiving care and practices do not become routine and devaluing. We observed a service user in the middle of the afternoon eating their lunch in their bedroom. The meal looked cold and when we later visited after two hours the residual of their meal was still in their room. Staff reported that they often picked at their meals. Their care plans contained little details about their eating needs and support that they required and must be developed. Care Homes for Older People Page 19 of 33 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. There is a satisfactory process to manage concerns/complaints received at the home. Training in safeguarding is available to the staff and the recruitment process is good. Evidence: We looked at the procedure that the home has in place to look at concerns and complaints at the service. The home has a complaint procedure and the manager stated that the staff have access to a complaint form that they completed on receipt of any concerns. The manager maintained a complaint log and this showed that there home had seven complaints/ concerns that they had investigated in a timely fashion and all of these have been resolved. Information from the AQAA states that they plan to enforce Mental Capacity and introduce Deprivation of Liberty understanding within the home for all the staff.Training in in safeguarding is also available for the staff and regular updates and the introduction of Mental Capacity and Advocacy within the home. The manager is aware and refers to social services any allegations of abuse as required. Information from the AQAA shows that the home has referred two concerns Care Homes for Older People Page 20 of 33 Evidence: to the safeguarding team to investigate. There was no information available in relation to the referrals made and any outcome. The home needS to develop a process where records and investigations of all allegations are recorded and these are available at the service. This must include any investigation that the home has undertaken internally relating to the staff and any disciplinary actions that have been taken, as this was not available at the service in relation to a recent investigation that the home undertook. The outcome such as disciplinary actions/ dismissal and any referral to a professional body or POVA list must be maintained. Care Homes for Older People Page 21 of 33 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. The service users are provided with a well maintained and homely environment that met their needs. The laundry room is satisfactory and appropriate to the needs of the service users. However further development is needed with the management of personal clothing. Evidence: The AQAA states that as part of the refurbishment programme automatic closures fitted to all bedroom doors as per Fire Regulation requirement. Kick plates have been fitted to some bedroom doors. The service has improved signage with regard to dementia care to lounges, bedroom, toilets, and communal areas. Equipment for the control of infection was available to staff. The staff practices observed on the day indicated that they were aware of the homes infection control procedures. We walked around the home and looked at a number of bedrooms at random. The service was clean, warm, homely and it was evident that people are supported to bring with them items of personal belongings in particular on the first and second floor. The ground floor has been recently completely refurbished and looked in very good state of repair that included new carpets and furnishing. the manger has stated that Care Homes for Older People Page 22 of 33 Evidence: the home had undergone a complete refurbishment in 2007/08. The bedrooms on the ground floor looked clinical and would benefit people to have a homely environment with their personal belongings around them. The manager stated that was not possible for one of the service users due to their behaviours. Relatives and the service users we spoke to said that they can spend as much time in their rooms and they love having all their belongings around. Comments we received included the home is very nice . One visitor said there is a nice atmosphere here. A staff comment was the day I think I would not have my own mother here, is when I would leave. The manager has informed us that that only residents who have been assessed as more challenging have been moved to the ground floor. This has allowed them easier access to the garden. The staff said that this was working well and the service users were also accessing the activities room more. The home has an in house laundry and staff reported that all the service users laundry was managed internally. A staff member stated that the bedding and towels are renewed regularly in order to maintain them in good condition. The home was planning to have closed baskets for underwear in order to be more discreet. We saw the laundry staff delivering the service users laundry to their rooms and these looked well presented and hanging on a rail. Some relatives raised concerns that their relatives clothes did go missing or Someone elses clothes ending up on the wrong wardrobe. Staff stated that the clothing had been marked with the room numbers. The staff said that there was probably a problem as the service users have moved floors recently. We observed that clothing had room numbers that showed through the top. Consideration should be given that clothing are managed appropriately with the service users names to maintain peoples dignity and eliminate the risk of the service users wearing other peoples clothing. The AQAA states that the service have introduced a programme where the housekeeper audits residents clothing to ascertain suitability, condition etc and relatives and friends informed if replacement is required. Care Homes for Older People Page 23 of 33 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. The staffing levels and availability of staff are not always adequate to meet the needs of people using the service. There is a satisfactory recruitment process. All necessary record of checks must be maintained and available. There is an ongoing training programme in place to support the staff in their roles. Evidence: We looked at the planned staff roster that was maintained at the service and spoke to the staff, the service users and visitors at the time of the visit to seek their views about the staffing at the home. Six of the visitors that we spoke to praised the homes staff for general care, palliative care or settling in their relatives. One visitor said there is very good care here. Another comment was they are very good here. The staff are very good they often offer us a drink while we are visiting Another visitor said I have never heard anyone speak unkindly. Care Homes for Older People Page 24 of 33 Evidence: One member of staff said how much one resident had improved since they had arrived at the home Some visitors raised concerns about the staffing levels at the home. We observed that two staff members were on duty most of the time in the middle floor dining-room with over 10 residents which was not adequate. As a result, several residents who needed assistance were not eating their food. One visitor said that sometimes at weekends I see residents who have fallen asleep over their food, and others whose food gets cold. The staff said that periods at mealtimes and soon after were difficult as there are not enough of us and everyone needs a lot of help. The staff stated that a number of the service users needed assistance with feeds in their rooms and you do your best One visitor said they waited 15 minutes for their buzzer during the inspection to be answered, although there seemed to be quite a few members of staff on the floor after lunch. One call bell was heard going off for about 10 minutes before it was answered. Two visitors complained about language difficulty and that they cannot understand some of the staff. They both remarked that if I cant understand them, how can my relative. This was brought to the attention of the manager at the time of the visit. The manager reported that they have three registered nurses RN , one on each floor and four carers on two floors and three carers on the ground floor throughout the day periods. Night duty has two registered nurses and seven carers. On the day of the visit the staff confirmed that there were only three carers on each floor and they said that staffing was not adequate and they felt rushed and cant get to the residents and this was not right. The duty roster showed that during the last four weeks there were nine to ten carers on day duty and night duty had fourteen shifts where there were five to six carers. Staff told us that they often help each other and move from other floors as the people were requiring more support with their daily care needs. The home has a recruitment process in place and we looked at a sample of two new staff records as part of our visit. This showed that they completed an application form, two references were sought including one from the last employer. Other records maintained were proof of their identifications. A POVA first check record was available Care Homes for Older People Page 25 of 33 Evidence: that included the date that this was completed. The service had record of criminal record bureau (CRB) available, however this did not contain the disclosure number and the date it was completed. The registered person must ensure that this is reviewed and information is available as required. The service has an induction process that the manager stated the staff underwent the homes short induction followed by the corporate induction. The AQAA states that at the start of employment , the staff receive full induction in a supernumerary status to ensure they are fully able to fulfil their job description. The service has an ongoing training programme in place and staff spoken with said that training was good. The AQAA states that the service offers offer an ongoing training programme to enable staff to be able to be kept updated of any changes in legislation, health and safety. The development of a training matrix that is easily accessible would be useful in identifying any gaps in staffs training and updates in particular to mandatory training. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a registered manager with clear lines of accountability for the home. The internal audit and system for managing the service users personal allowance is good. The home has a satisfactory process for the health and safety of the service users. However the staff practices do not always protect the service users from the risk of harm. Evidence: The home has a registered manager who has day to day management responsibility for the service. The manager is a registered nurse and has also completed the Registered Managers Award (RMA). The staff and the service users we spoke to said they would approach the manager with their concerns. Care Homes for Older People Page 27 of 33 Evidence: The manager carried out monthly audits on medication, admission and nursing audits for care plans. The manager operated an open door policy and has surgery Mondays and Thursdays to allow relatives and friends to come and discuss any issues. As part of their internal audits there is monthly unannounced visits, quarterly service users meetings are also held at the home. A visitor mentioned that they had been telephoned several times to do a survey on behalf of the home. The home has developed a supervision programme for the staff, this needs to be further developed and planned to ensure that these are completed at regular intervals and embedded in practice. The AQAA States that there is a programme for the servicing of equipment and information provided shows that this has been carried out this year. The service has policies and procedures in place, however these have not been reviewed/ updated since 2006 to ensure that these meet with current good practice guidance and any changes in regulations. The staff reported that the home does not manage any of the service users money. Invoices are raised for items that are not included in the fee such as chiropody, hairdressing, clothing and are sent out. The staff stated that receipts of transactions are maintained and sent with invoices. Personal allowances are kept in individual accounts and there is a regular audit carried out. The health and safety of the services users are supported through staff training in health and safety. We observed during our visit that a staff member was pulling a service user backward in a wheelchair with no foot plates on. The care records did not demonstrate the reason for such a practice. This was brought to the attention of the manager and must be addressed. We also observed that one carer used the hoist alone while transferring a service user in the lounge. The care records that we looked at indicated that two staff are required for all hoisting, the nurse in charge confirmed that two staff are required when transferring service users with the hoist to ensure their safety at all times. The registered person must ensure that staff adhere to safe practices when attending to the service users at all times and they are not put at risk of harm. Care Homes for Older People Page 28 of 33 Care Homes for Older People Page 29 of 33 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 30 of 33 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 8 14 The registered person must ensure that assessments and care plans are developed in relation to the service users nutritional needs and records are maintained. So that you can ensure that their needs are met safely. 15/08/2009 2 9 13 The registered person must 15/08/2009 ensure that arrangements are in place for the handling, recording and safe administration of medicines received in the care home. So that people receive their medicines and are not put at risk of harm. 3 18 17 The registered person must 15/08/2009 ensure that all allegations of abuse and any action taken are recorded and available at the home. Care Homes for Older People Page 31 of 33 So that people receiving care are protected from risk of harm and abuse. 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 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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