Care Home: Windsor House

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What the care home does well The home has a core of staff who have worked at the home for a number of years offering stability and continuity of care to the 12 residents who live at the home at present. Residents comments both in the surveys and when spoken to on the day of the visit tell us that they are happy and the staff are helpful. Comments such as `I enjoy living here`, `I am happy at Windsor House` and `all staff are caring and help us when we need it` are just a sample. The midday meals are offered with choice and individual likes and dislikes are discussed by the cook and care staff with a wide variety of choices at teatimes available according to preferences on the day. What has improved since the last inspection? A new Service Users Guide is now in a format that can be easily read and a new, easy read Statement Of purpose is nearly completed with the required relevant information to inform people of the service provided at Windsor House. Since the last inspection the Manager has changed all the care plan documentation to ensure risk assessments are in place and this is an improvement. However, there still needs some improvement to ensure all areas of care are included in the assessment process and that all monitoring and reviews of risk assessment are signed and dated. Although it is not documented, residents are offered social support in various ways to occupy and stimulate, either through activities or one to one support. Residents tell us that they have things to do during the day and are happy and content. The staff have now had the fire training that was required and some training programmes have been brought more up to date, although more knowledge and training for staff is still required. A full survey of the hot water/heating system has been carried out and a new pump is about to be installed to ensure the heating throughout the home is at a suitable temperature. The staff appraisals and supervision are now taking place on a regular basis as the Manager now has some allotted time for management tasks. The home has purchased a carpet cleaner so carpets can be shampooed when required. There were no unpleasant odours detected during this visit and the areas seen appeared clean and fairly tidy. What the care home could do better: The new style care plans need to be more detailed with information on the social care support required and show how the resident has interacted with the information written, by encouraging them to sign and date alongside the staff signature. The medication in the home needs to be stored in a suitable cabinet as recommended and that controlled drugs stored separately from the other medication. The room temperature for storing medication needs monitoring to ensure the medication is held at a safe temperature. The quality assurance process for the service offered in the home should include all stakeholders, enabling the Manager to evaluate, improve and monitor the service as an ongoing process. Key inspection report Care homes for older people Name: Address: Windsor House Kirkley Cliff Road Lowestoft Suffolk NR33 0DB     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: Ruth Hannent     Date: 2 1 0 1 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Windsor House Kirkley Cliff Road Lowestoft Suffolk NR33 0DB 01502566664 01502516943 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Saivan Care Services Ltd care home 17 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: 17 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Windsor House is a large bay fronted property set on the sea front at Lowestoft. It benefits from having the lounge and dining areas at the front of the house. It is close to the local shops and transport links. The home provides accomodation over three floors and primarily has single rooms with no en suite facilities. The home does have a small number of double rooms and singles with en suite facilities. The current scale of charges is from £362.00 to £380.00 per week. Additional charges are made for items such as chiropody and newspapers etc. 2 6 0 3 2 0 0 9 0 Over 65 17 Care Homes for Older People Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection report has been completed following a visit to the home that took place over a period of five and a half hours. Included in the detail of the report is information sent to the Commission prior to the visit. This included an AQAA (Annual Quality Assurance Assessment) completed by the Manager, comments received from professionals, families and residents and any information or intelligence that had been received by us since the last key inspection. Care Homes for Older People Page 5 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The new style care plans need to be more detailed with information on the social care support required and show how the resident has interacted with the information written, by encouraging them to sign and date alongside the staff signature. The medication in the home needs to be stored in a suitable cabinet as recommended Care Homes for Older People Page 6 of 29 and that controlled drugs stored separately from the other medication. The room temperature for storing medication needs monitoring to ensure the medication is held at a safe temperature. The quality assurance process for the service offered in the home should include all stakeholders, enabling the Manager to evaluate, improve and monitor the service as an ongoing process. 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 7 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does offer information to potential residents enabling them to make a judgment about the home but some details need to be in more user friendly format for the Service User Guide. Residents needs are assessed prior to admission but more details in the preassessment would give a more holistic view of person centred care needs. Evidence: The manager has a statement of purpose and service users guide in place. This was reviewed in September 2008 and again in 2009. The format has improved in the Service Users guide with bold large print and easy to read text. The Statement Of Purpose is in the process of being updated and this was discussed with the manager who plans to review it further. Whilst the present guide contains helpful information it also requires reviewing to ensure that it meets Standard 1 of the National Minimum Standards as some information is missing, for example the complaints procedure. This Care Homes for Older People Page 9 of 29 Evidence: was also mentioned at the last inspection and needs to be updated and in an easier format as previously recommended. There has been a lady resident recently admitted to the home who was spoken to regarding the admission process. This person had nothing but praise for the home and could not wait for her meeting to discuss the offer of a permanent placement as her trial period was coming to an end. Other residents who commented in our surveys all said that they had received enough information about the home at the time of admission. The pre assessment process is carried out by the Manager but some of the questions could be improved upon to ensure the focus is on the full needs of the potential resident. Basic one word answers were written and did not give a person centred approach to the kind of answers required that would give a good insight into this persons needs and aid the writing of an individual care plan for this person. Care Homes for Older People Page 10 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need further development to ensure person centred care is evidenced as taking place. The health care needs of residents are being met. The safe management of medication needs to improve to ensure guidelines and regulations are followed and residents are receiving medication that is correctly handled. The residents are treated with respect but staff do need to be aware of how they speak when in earshot of others. Evidence: The home care plans have changed and more risk assessments have been incorporated but not in all the appropriate areas. The details in the care plan do not take into account the social needs of the individuals and the personal care was limited in details required. For example one person who has a pressure mat by the bed and Care Homes for Older People Page 11 of 29 Evidence: needs a handling belt for all transfers has no record of why that mat is in situ or why the belt is required. Nor is there a risk assessment for this equipment that is used yet information in other parts of the care plan tell us this person does fall. Another person has had a significant weight loss but this has not been picked up, assessed or action taken place to monitor weight more closely. The residents have no social care plan and there are no records of a life before residential care. The home needs to build the care plans for the residents to ensure a full picture of all their individual needs is recorded and that the reviews, that were noted to be carried out monthly, give clear evidence of how the care is monitored and action taken as care needs develop. There is also a need for care plans to show how the resident has actively been involved with the care plan development and review. No resident signatures were noted on the three care plans looked at and not all documents were dated and signed by a staff member. The home is supported by two health care practices with district nurses visiting on a regular basis to apply dressings. Comments received from health professionals show us that the home offer basic care support. The Manager informs us that one surgery is very supportive and that liaison with this practice is excellent but does not always get the same support from the second practice used. The home has not used the services on a Community Psychiatric Nurse yet did discuss some issues of behaviour management that was causing some problems in the home. Appointments are held with the optician, chiropodist, continence nurse and psychogeriatrician and information about the visits are recorded in the care plan. The home is supported for all its medication needs by the local pharmacist who uses a blister pack system for all the residents tablets. PRN medication is stored in the home with a large number of boxes of pain relief tablets and bottles of liquid medication held in the cabinet. At present the medication is stored in a large sling file style cabinet that is unsuitable and unsafe for the storage of medication. The safe storage of all medication as detailed under the Misuse of Drugs (Safe Custody) Regulations should be followed, with storage being in a suitable and fit for purpose medication cabinet. Discussed with the manager was the management of controlled drugs as during this visit the blister packs containing controlled drugs were on the same ring binder as all the other medication. This blister pack should be stored away from the other medication, in the controlled drugs cabinet to ensure safe management. The home does record the administration of these drugs in a control drugs registered and all these records along with details on the Medication Administration Chart were noted to be correct. Care Homes for Older People Page 12 of 29 Evidence: On the day of this visit the office where the drugs are stored was very hot. Although the room temperature is not recorded this should be happening to ensure the recommended temperature of 25 degrees is not exceeded. If this is found to be the case the drugs will need the correct cabinet secured in a cooler room or an air conditioning unit fitted. Staff were noted to be knocking on doors before entering and that conversations were polite and respectful during this visit. One survey had been received prior to this inspection stating that conversations between staff were not always suitable and may be overheard by residents and visitors. This was discussed with the Manager who will address the concern with staff. Care Homes for Older People Page 13 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not make records or have a social care plan to evidence people are having their social needs met however, residents are contented and appear happy. Visitors do come and go when they wish and are made welcome. Meals are offered with choice, well balanced and enjoyed by the residents. Evidence: The home has made attempts at providing activities but find the 12 residents who are living at Windsor House at present prefer one to one stimulation. Although the home has not recorded the social support provided in care plans or daily records, residents informed us that they are occupied with enough to enjoy their days. One staff member had cut out an article in the newspaper and was discussing this with an interested resident. During the afternoon a DVD quiz was taking place with interaction with 6 residents. In the morning the hairdresser was working and talking with two residents who were having a perm. Comments sent to us in the surveys tell us that I would change nothing as I am very happy here and I enjoy living here at Windsor House. On chatting to two residents in the afternoon, both stated they are content and do not want to do much. The staff are in and out to make sure we are OK and I am happy Care Homes for Older People Page 14 of 29 Evidence: reading or doing the crossword were some of the comments. The home does not record the social support given and records need to reflect the way people spend their days to ensure people are supported and that their well being is taken into account. A number of visitors were observed during the afternoon and the visitors signing in book show the home has people coming and going at various times of the day. One person commented on the visits from the local church and another mentioned friends who call regularly and are made welcome. On the day of this visit the cook had discussed the menu with residents and a choice of liver and bacon or chicken had been decided. On talking to the cook it was clear the residents can have a choice at teatime of hot or cold food with examples given of something on toast, soup or sandwiches. The care staff take over the tea time meal preparation with the cook leaving access to any food required. (Care staff have passed the food handling certificate). The meals are good and The cook will always cater for us, were some of the comments told to us. Drinks through out the day were available regularly. On discussion with the Manager there are at least 7 recognised times for having a hot drink and more if required. If the pushing of fluids is required then a jug of juice is placed by the side of that resident at all times. Care Homes for Older People Page 15 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience 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 not received any complaints to date and residents say they will complain if they are unhappy. The home needs to improve the methods of communication with all interested parties to ensure the complaints procedure is easily available and easily read. Residents are protected by the homes procedures to ensure they are safeguarded from abuse. Evidence: The home does have a complaints procedure that is displayed in the entrance to the home. This information is not detailed in the brochures offered to potential customers but the Manager showed us evidence of the changes that have been made to a draft version that is near completion and will be easier to read and hold the relevant information about how to make a complaint in the very near future. A few days prior to this visit a concern was received by the Commission and on discussion with the Manager and evidence of the work to be carried out it appears the problem is about to be resolved. The home does need to ensure the complains procedure is in the information offered to residents. It is on display in the entrance to the home. All comments are positive in Care Homes for Older People Page 16 of 29 Evidence: the surveys with the only mention of the home need decorating as a possible negative. I know I can talk to any staff member if I am unhappy about anything, was one comment told us during this visit. The Manager has a list of phone numbers on the office wall and is aware of when to contact the safeguarding team if concerns arise. The staff have all received training in vulnerable adult protection and the majority have now completed a distance learning course on this subject with a sample seen at this inspection. The files of a new staff member show that the CRB and references are obtained prior to that person being allowed to offer care to residents alone. Care Homes for Older People Page 17 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and tidy but need to offer more suitable furnishing and linen to improve the environment further. By the time of this inspection report being published the heating should have been repaired to ensure suitable room temperatures can be available at all times. Evidence: The home has 12 residents at present and during a tour of the building a sample of bedrooms that were in use and those waiting for new residents were looked at. Each area seen appeared clean and tidy and there was no unpleasant odours. The Manager informed us that a new carpet cleaner is now used regularly to keep the rooms clean by the maintenance officer or care staff if this officer is not on duty. The fire records show us that the equipment in the home has been serviced 11/10/09 and two new extinguishers purchased in the last year. The Manager now has a building fire risk assessment dated 18/06/09 and staff have received fire training. The home is an old style building with difficulty in getting to some areas of the home due to steps up and down as you move around the home. There is a large lounge that looks over the sea front but due to the shape and size, chairs have to be placed around the wall edge and not everyone can see the television easily. There is a Care Homes for Older People Page 18 of 29 Evidence: smaller lounge which is also a passage way through to other areas in the home. On the day of this visit this room was taken up by the hairdresser in the morning and was used by visitors talking with their family member in the afternoon. The dining room is light and attractive and residents enjoy their meals in this room. It was noted that coloured plastic beakers were in use. This was mentioned on the last report as they are not suitable for this client group. Consideration on appropriate glasses to ensure drinks are offered in tumblers that are age appropriate is recommended. Residents spoken to are happy with their own rooms and like living in this home. On looking in some rooms it was noted that quite a bit of the furniture is shabby in appearance and needs replacing. This was also the case with linen. In one particular shared room odd sheets and blankets were poorly fitted on to the bed. One had a hospital style named blanket and the sheets were worn and faded. Another single room showed a shabby bed cover. The home needs to improve the furnishings and linen to be able to offer a suitable and comfortable environment. The Commission has received concerns about the heating in the home. This was discussed in length with the Manager. On walking around the home there was a big contrast in the heat in different rooms according to which part of the house we were in. The Manager showed us the quote that had been obtained and also the bill for a full heating survey to take place. This has identified that a new pump is required and is to be fitted the week after this inspection. The bathroom facilities are in need of updating and improvement. The downstairs bathroom is the main one used regularly at present and is also used by the district nurse on her visits for dressing replacement. The home does need to offer an alternative bathroom for the number of residents registered as the recommended number is 1 bathroom to every 8 residents. There is a very small front garden where residents can sit and watch people coming and going. At present the wall between the pavement and garden is being repaired due to a car knocking it down. There is a small gate allowing residents to come and go as they wish leading from the dining room. The main entrance has a number of steep steps making that entrance unsuitable for anyone with mobility problems. Care Homes for Older People Page 19 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does have competent, qualified staff who have a skill mix to ensure residents needs are nearly met but some improvement in the deployment of staff would ensure all the areas are met such as social support. The staff need to be brought up to date with training to ensure the deliver of care is relevant and that staff are knowledgeable. Evidence: The staff at Windsor House have a core within the team who have worked there for a number of years and there has been a minimal turnover of staff. The rotas were seen during this inspection with three staff available in the morning, two during the afternoon and two waking staff over night. The Manager on this day was covering office duties but does often cover care shifts. The team seem to turn their hands to many tasks and sometimes care, clean, launder or cook. The cook works 5 days per week but all teas and the 2 other days of meal preparation has to be covered by the Carers or Manager. The cleaning is carried out by the Maintenance Officer, along with odd jobs, running errands and carrying out health and safety checks. With only 12 residents in the building at present this is manageable but does limited the actual time being offered for social support and if the home increases in resident numbers to the 17 that is on the registration certificate staffing that is allocated to care should be able Care Homes for Older People Page 20 of 29 Evidence: to do that job and not have to worry about cooking or laundry tasks. At present 9 staff hold the recognised NVQ2 qualification in care with some longterm staff members, who are near retirement, not wishing to complete the course. The Manager tells us that all newly recruited staff are to achieve this qualification with one new staff member in the middle of completing the Skills for Care induction and then will be placed on the course. This newly recruited staff members personnel file was looked at during this inspection. All the relevant paperwork, ensuring this person was a suitable and capable person to work with vulnerable people, was seen. The Manager informed us that no person will be employed without a fully completed application form, 2 suitable references, POVA first and three forms of identification. A staff member spoken to told us that they do have a contract with terms and conditions. The half completed induction pack was also seen for the newly recruited staff member. Staff training is slowly improving and more courses are being booked or have taken place in the past year. The Manager showed us the packs for distance learning and the Mulberry House training packs that are slowly being used to develop staff. This past year the home has completed fire awareness, infection control and moving and handling. Overdue is first aid, dementia awareness, Mental Capacity Act training and deprivation of liberty training. The home needs to improve and bring up to date all the mandatory training to ensure all staff are updated with their knowledge. Care Homes for Older People Page 21 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager is keen to develop and learn so the care service can improve. Quality measuring is taking place but could be enhanced if more stakeholders were included and development plans created by using the results found. The safety within the home is improving and records are more up to date. Supervision of staff needs recording clearly to show how the outcomes will enhance the quality of the service given to residents. Evidence: The Manager has worked at the home for a number of years starting as the Cook, then Deputy Manager and now Manager. She has her NVQ level 4 in management and has been registered by the Commission to manage Windsor House. At the last inspection it was stated that not enough office time was allocated which has now improved slightly with the Manager aiming to have at least 20 hours to do the Care Homes for Older People Page 22 of 29 Evidence: management tasks. This, according to the manager, is not always possible, as sickness or annual leave means time spent in the kitchen or working as a carer prevents management tasks being done. Staff supervisions have been completed for nearly all staff and annual appraisals were seen with just a few staff needing to be seen to catch up with one to one meetings. The details written in the supervisions folders do need to be a bit more work focused and relate to the care practice that should be carried out around care standards and outcomes. As mentioned more time has been spent in the office and paperwork and planning has shown an improvement. Records were up to date such as the servicing of building equipment. The details were all filed and ready for inspection. Seen was Gas safety certificate April 09, Legionella testing September 2009, 5 year electrical checks August 2007, insurance and service for the hoist and lift August 2009. Training planning for staff has improved and records were seen of plans for the future. The quality assurance questionnaire formats had been rewritten and were ready to go out to families and residents. Professionals and stakeholders involved in the home have not been asked to contribute to the quality monitoring to date and need to be included to enable a full picture to be seen of the care quality. Risk assessments in care plans were seen which is an improvement from the last inspection but they were not dated or signed by the staff member. There is also room for more person centred risk assessments that were mentioned earlier in this report. During a tour of the home is was noted that any personal creams, lotions and soaps belonging to residents were no longer in the bathrooms as previously found and all the cleaning chemicals were locked away. All electrical items have been PAT tested in the last year and the records were seen for August 2009. Staff do now have the correct induction using the Skills for Care model to include safe working practices. The home has received a visit from the Environmental health Officer with limited recommendations made for the kitchen that, according to the Manager, have now been carried out. The safer food, better business folder is now being completed from June 2009 and was seen during this visit. Appropriate notifications have been sent to the Commission and the Manager was able to relay the procedures for referring any safeguarding concerns to the correct safeguarding authority. Care Homes for Older People Page 23 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 Based upon an up to date 14/07/2009 assessment, residents must have care plans in place that cover all their needs, with input from them where possible and these must be kept under review. So that residents care needs are fully met and their preferences are, taken into account. Care Homes for Older People Page 24 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The risk assessments must 01/04/2010 be in place for all potential risks and show what action is taken, how it is monitored and reviewed, dated and signed. To ensure that each identified risk is constantly reviewed for the safety of the residents. 2 7 15 The residents care plans must contain details of how all care needs are to be met and should be signed and dated by the resident where possible. To ensure all personal, health and social care needs are discussed and planned with the individual resident. 01/04/2010 3 9 13 The home should hold the blister pack containing controlled drugs in a separate compartment in 01/04/2010 Care Homes for Older People Page 25 of 29 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 the recognise medicine cabinet. To ensure that all controlled drugs are recorded, stored, handled, managed and disposed of with the guidelines set for controlled drugs. 4 9 13 The home must purchase a medication storage cabinet that is recommended under misuse of drugs (safe custody) regulations. To ensure all medication including controlled drugs are stored safely and securely. 5 9 13 Temperatures within the room used to store medication must be recorded and should not exceed 25 degrees. Medication can deteriorate if stored at a high temperature. 6 12 16 The home does need to develop social care support plans and record the outcomes of social interaction with residents. To evidence that residents are stimulated and have social support needs met. 01/04/2010 01/04/2010 01/05/2010 Care Homes for Older People Page 26 of 29 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 7 16 22 The Manager needs to complete the easy read format on how to make a complaint. To ensure residents understand how to complain. 01/04/2010 8 30 18 The training for all staff must be up to date. To ensure that latest legislation and training such as The Mental Capacity Act is know by the staff team. 01/07/2010 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 1 The home needs to continue the improvement and content of the documentation offered to potential customers such as the Statement of Purpose to ensure all information as listed under standard 1 of the National Minimum Standards is included. The home should look at all the bathroom facilities to ensure there is adequate equipment in suitably decorated bathrooms to ensure bathing can be done in all bathrooms unused at present. The bedrooms should be furnished and provided with linen that is of a suitable standard to provide comfortable bedrooms for all residents. The home needs to ensure that the heating system is adequate to provide the heating required for a large building. The staffing in the home will need to be reassessed if the 2 21 3 24 4 25 5 27 Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations numbers of residents increases to ensure that time for social support for residents is part of, and carried out, as required in person centred care. 6 33 To aid the Manager, development/training time should be allowed for building knowledge to enhance her skills within up to date care practices. The quality assurance process should include comments from all stakeholders and an improvement plan written to aid service development. 7 33 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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. 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