Care Home: Wisteria House

What the care home does well The visiting professional who returned a survey commented "Staff have a kind approach to residents and almost in every situation that we have been aware of meet any needs straight away". We found that both the staff and the management are committed to providing a good quality service. Staff communicate well with management and they are offered a range of suitable training. The physical environment has been much improved and there is a real commitment to ensuring that the home, including the physical environment is suited to the needs of people with dementia. We found that people were offered a range of activities and the meals were well cooked and that people generally enjoyed them. What has improved since the last inspection? This is the first inspection under this provider, however a visiting professional commented in a survey "Much improvement has been made over the last few months to Wisteria to bring it up to date and freshen up the decor". What the care home could do better: This is the first inspection under the new Registered Provider, and whilst it was apparent that many improvements had been made, there were still areas we found where improvements are required. The information that the home obtains before someone moves to Wisteria House is inadequate, and would not ensure that a person`s needs were known in sufficient detail. We found that the care plans were very general and did not contain clear direction for staff about how to meet needs. We also found that risk assessments did not identify how risks are to be managed. This was of particular concern as some of the people who live at Wisteria House have complex needs or very challenging behaviours. We found that such behaviours were not being properly monitored and again there was a lack of clear guidance to staff. We found that in some situations help and guidance had been sought in relation to these challenging behaviours, however there was a lack of understanding that further actions needed to be taken, including referring concerns through the "Safeguarding Process" or informing the Commission. We also found that staff recruitment was not as thorough as it needs to be to ensure that only staff suited to the work are recruited. The systems in place for ensuring that infections did not spread were not adequate, as there were insufficient hand washing facilities. Key inspection report Care homes for older people Name: Address: Wisteria House 4/5 Napier Street Stoke Plymouth PL1 4QX     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: Helen Tworkowski     Date: 2 3 0 3 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 31 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 31 Information about the care home Name of care home: Address: Wisteria House 4/5 Napier Street Stoke Plymouth PL1 4QX Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Louise Collins Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accomodated is 22 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (code DE) maximum of 22 places Old age, not falling within any category (code OP) - maximum of 22 places Date of last inspection Brief description of the care home Wisteria House is in a quiet residential area of Plymouth, close to local amenities. The home can accommodate 22 people, there are eighteen single rooms and two double rooms. Some of the rooms have en-suite facilities. On the groundfloor there is a dining room and a conservatory, and at the front of the house there is a lounge. There is a courtyard garden at the rear of the property. 0 Over 65 22 Care Homes for Older People Page 4 of 31 Brief description of the care home Information about the home and details of the fees charged is available from the Registered Provider, Mrs Colllins. Care Homes for Older People Page 5 of 31 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 was initially started on 16th March 2010, however the inspection was not carried out as there was an outbreak of diarhoea and vomiting in the home. The Inspection was resumed on 23rd March 2010, starting at 9.00 am and ending at 6.30 pm. The visit include talking with two of the people who live at Wisteria House, and three of the staff. We sat and observed what happened in the dining room over a period of an hour and a half. As part of the inspection process we looked at the care of four individuals, including looking at the records that relate to them. We looked at the way medication is managed and at the systems for recruiting and managing staff, and at the ways people are kept safe. The Registered Provider, Mrs Collins, showed us around the home. We sent surveys to ten staff, and received nine back, and to ten people who live at Care Homes for Older People Page 6 of 31 Wisteria House, and received all of them back. In addition we sent surveys for five visiting professionals, and received one back. Care Homes for Older People Page 7 of 31 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 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 Care Homes for Older People Page 8 of 31 order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking about moving to Wisteria House are provided with information about the home and what they can expect. People cannot be entirely confident that there needs will be known about, and therefore met,when they move to Wisteria House. This is because pre-admission assessments lack detail. Evidence: Information about the home in the form of the Service User Guide was available in every bedroom at Wisteria House. We did not look at the contents of the document as there have been recently agreed as part of the registration process. There was also copies in the entrance hallway. We looked at what the service knew about people before they decided to move to the home. A pre-admission assessment had been carried out for one person who had recently moved to the home. However, the information collected was very limited and insufficient to make an informed decision about the suitability of the service. We Care Homes for Older People Page 11 of 31 Evidence: discussed with the Registered Provider the need to seek further information, from previous services or from Social Services, where there was limited information. Care Homes for Older People Page 12 of 31 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. People at Wisteria House generally receive the care and support they need. However,where people have more complex needs or difficult behaviours, the information and guidance to staff, and monitoring systems are not sufficient to ensure that people are always kept safe. Medication is generally well managed, some improvements are needed particularly around risk assessing the support needs of people who look after their own medication. Evidence: We sent surveys to ten of the people who live at Wisteria House. Four people thought that they always got the support they needed, four people thought that this was usually the case, two thought they sometimes or never got the help they needed. We looked at the care provided to four people who live at Wisteria House. We did this by talking to care staff about the care provided, by observing interactions between people, and by looking at records. Each person had a care plan, a dementia care plan and a night care plan. Some Care Homes for Older People Page 13 of 31 Evidence: individuals also had information about their history and background that might assist staff in providing a more individualised service. These documents had all been recently reviewed or updated. The Care Plans varied in the degree of detail they contained, but generally did not provide enough information to guide care. For example for one person it said that they were doubly incontinent, and all of Xs needs met by care staff, it did not explain what staff did to meet the needs. This is important as clarifies the actions to be taken, and can help ensure consistency. We noted that one person had diabetes, and whilst this was mentioned in parts of the Care Plan, there was little information about how this condition, how it is to be managed and who was responsible for monitoring the condition. We also found that some of the individual who lived at Wisteria House behaved in ways that not only affected their well being, but the well being of other people in the home. In such circumstances we would expect to see risk assessments and detailed guidance as to how behaviours are to managed and that people are kept safe. We found that where there was guidance it was vague. We also found that risk assessments, for the most part summarised the care plan and did not identify the actual risks, such as aggression to others or risk of falls. We asked about monitoring incidents and was told apart from the daily record, staff only completed the accident forms. There was no evidence that particular behaviours or difficulties were monitored to see if specific interventions were effective. The Registered Provider told us that assistance had been sought on a number of occasions from external professionals, such as Social Services and Community Psychiatric Nurses, regarding particular behaviours, however they had had not been given the support they felt they needed. We spoke with two people who live at Wisteria House about the home, one person said that she was very happy with the care, whilst another said that the care staff were very caring, that they respected his privacy and that he had observed staff behaving in a very patient manner when managing difficult situations. We also spent time observing people in the home to get a better understanding of their experiences. We observed that people appeared content and occupied. Where staff talked to people this was done in a very positive manner. As part of this visit we also looked at the way medication is managed in the home. Much of the medication is supplied by the pharmacist in blister packs. We found that there were generally good records of medication administration. People were offered their medication, and where they did not need it, there was a record of it being refused. We discussed with staff the need to ensure that where it was necessary to Care Homes for Older People Page 14 of 31 Evidence: hand write or amend the administration record, this should be checked and countersigned by a second person. There should be a clear written record of any changes made in relation to medication. A few of the people at Wisteria House self administer their own medication. The Registered Provider told us that no self administration risk assessments had been completed, as is required. We also saw that there was no record of how much medication was given to individuals to self administer, which meant that there could be no proper account of medication. The Registered Provider told us that no residents currently receive controlled drugs, and there is no controlled drugs cupboard. We confirmed to the Registered Provider that should any resident needs such medication then they must provide the proper facilities. We noted that some medication was stored, as directed in a refrigerator. There was no security in relation to this medication. When we looked around the home we found that in a number of the bedrooms there were creams. Some of these were out of date, or had the labels ripped off, indicating that they had originally prescribed for another person. Medication must only ever be used for the person it is prescribed for. Where it is appropriate for medication to be stored in an individuals room, a risk assessment must be carried out to ensure that it is safe to do this. We also found that there was no record of any creams or lotions being administered. We discussed with the Registered Provider ensuring that there is a complete record of administration. We were told that only staff who were trained gave medication, the Registered Provider told us that she was not clear if these staff had demonstrated their competence in medication administration. There is not always a staff member on duty at night who is competent to give medication. We discussed this with the Registered Provider who confirmed that no one currently needs medication at night, but that the on call person would come in at night if some one required such medication. Care Homes for Older People Page 15 of 31 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 people who live at Wisteria House are able to make choices about how they spend their time and are offered a range of activities in the home. Meals are well presented and well cooked. Where people need assistance it is given in a way that maintains dignity. Evidence: On the day of this visit entertainers were visiting the home for a music session. This appeared to be well attended and appeared to be enjoyed. We asked staff about whether they thought people had enough to do, and they confirmed that various activities were offered- such as knitting, skittles, flower arranging, and singing. When we talked with staff about what individuals like or did not like staff knew about individual preferences. We asked one of the people who lives at the home about rules, we were told that there were no rules about getting up or going to bed, that was up to the individual. Staff confirmed that whilst there was a list of people who liked to be got up earlier, that this was always the individuals choice, and no one ever got up if they did not want to. Care Homes for Older People Page 16 of 31 Evidence: Some of the people in the home manage their own money, the home holds money for other individuals, and pays for any necessary expenditure. There were records of this expenditure. The staff and one of the people who lives at Wisteria House told us that the food is very good. The dining tables are well laid, and meals are well presented. We were also told that there was a choice of food, and staff were very happy to make an alternative. The Registered Provider advised us that she has plans to develop meal times so that people are offered more choice. We were shown copies of pictures of meals that were to be used on a menu board. We observed one person being helped to eat, this was done in an unhurried manner and in a way that respected the individual and their dignity. A document called a nutritional screening assessment had been recently introduced. We discussed this with the provider and that the contents duplicated what was in the Care Plan. Care Homes for Older People Page 17 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an open culture at Wisteria House and people feel confident in being able to raise concerns. However some issues were not raised as alerts and people were not always kept as safe as they should have been. Whilst there is a complaints procedure however there is no proper record of complaints, to check if issues have been appropriately dealt with. Evidence: We asked one of the people who lives at Wisteria House if he would feel confident in raising any concerns or issues, he said he did feel he could. All three of the staff we spoke with said that they felt that if they saw something wrong that they could report it and it would be dealt with. We were told that there was very good communication in the home, staff communicated well with each other and the management. Information about how to make a complaint was included in the information provided to each person who lives at the home. Eight of the ten people who live at the home who responded to the survey said that they knew who to speak to if they were not happy and how to make a formal complaint. Eight of the staff responding to our survey said that they knew how what to do if a concern was raised. We saw the staff training matrix and that showed that staff received training in relation to safeguarding. The information that we were provided in the Annual Quality Assurance Assessment (AQAA) told us that there had been no safeguarding alerts to Care Homes for Older People Page 18 of 31 Evidence: Social Services. However, we were subsequently told told that an alert had been made. The Commission was not advised of any of the incidents as is required under regulation or of the Safeguarding Alert. We were also very concerned that there were other incidents occurring in the home, that should have warranted a referral to Safeguarding. Help and advice had apparently been sought from other agencies, however no safeguarding alert had been made. We asked about the homes record of complaints as it is written in the AQAA that two have been received and dealt with. We were shown a hardback book, kept in the entrance hall that contained no complaints. We discussed with the provider the need to set up a system for recording and storing information relating to complaints in a manner that respected the confidential nature of such information. All nine of these staff who responded to our survey said that they knew what to do if someone had concerns. Care Homes for Older People Page 19 of 31 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 home is clean and well decorated. Thought and care is being given to ensure that the home suites the needs of the people accommodated, particularly those with dementia. The home is clean but staff are not always carrying out proper hand washing, this could spread infection. Evidence: The Registered Provider, Mrs Collins, explained to us that since taking over the home major works have been carried out to improve the fabric of the home and to make it more suited and comfortable for the people who live at Wisteria House. Mrs Collins showed us around the home and showed us that many of the bedrooms and communal spaces have been re-plastered, redecorated and refurnished. Mrs Collins explained that they were trying to ensure that the decor suited people with dementia, for example they had chosen plain carpets so that people did not have problems with depth perception caused by changes of pattern or colour. New handrails in bathrooms were brightly coloured and contrasting to the tiling. All the rooms were clearly labeled large photo and text to show the rooms function. This can help people find there way around the home. Some of the furniture in bedrooms has been renewed. We discussed with Mrs Collins the need to have variable height beds, if people needed them. Mrs Collins explained that they had plans for the garden area to make it safe secure and to provide a seating area with planters so that people could be involved in Care Homes for Older People Page 20 of 31 Evidence: growing things. We found that all of the rooms were clean and rooms were decorated and furnished to reflect the occupants taste and preferences. Some of the rooms have en suite bathrooms, although not all of these facilities could be used by the occupants. A new level access shower had been installed and had proved to be very successful. We were told that the lift was awaiting re-furbishment. The house was clean and there were no unpleasant smells. This visit was postponed due to there being an outbreak of diarhoea and vomiting in the home. We understand that there had been an outbreak in the area. We saw that there were aprons and gloves available for staff to use, however we were concerned that not all of the bedrooms, bathrooms, laundry and toilets had liquid soap and paper towels for people to wash their hands. We were told that staff go to the kitchen to wash their hands, although this was stopped during the inspection. Hand washing facilities must be available where personal care is given, unless a risk assessment can show this is not appropriate. We noted that in the information provided by the home that they do not have an action plan to deliver best practice in prevention and control of infection. Care Homes for Older People Page 21 of 31 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. Staff are well trained and well supported to carry out their roles. The pre-recruitment checks are lacking in thoroughness, and this could mean that staff not suited to the work are recruited. Evidence: We spoke with three of the staff who work at the home. All three of the staff talked about how much they enjoyed the work and that there was a good team of people who communicated well. They all said that they felt well supported and that if they had a concern the they would be confident in report it. We sent surveys to ten of the staff and recieved nine back. All of the staff said that they had been given training that was relevant to their role, and training that helped them to understand the needs of people. Seven of the staff said that they met regulalry with their manager. Seven of the staff, responding to our survey said taht there were always or usually enough staff. The three staff we spoke with confirmed that there were generally enough staff. IN discussions with the Registered Provider, Mrs Collins, she said that she wanted to recruit additional staff to focus on planning activities for the people at Wisteria House. Nine of the ten people who live at the home, and who responded to our survey said that there was always or usually staff available when needed. The Commission had received a concern that there were insufficient staff on duty at night, however from our discussions with staff, and with Mrs Collins, we could find no Care Homes for Older People Page 22 of 31 Evidence: evidence of this. We looked at the recruitment records of three people who have recently started work at the home. We found that there was an application form and evidence that an interview had been conducted. One of the things that is required is a complete employment history, and confirmation of any gaps in employment. None of the applications we saw had complete work histories. We would also expect to see that two appropriate written references are taken for each indivdiual. Whilst we found that there were two referneces for each person, some of these references had been received after the start of employment. We also found that for one person two refernces had been taken from the same employer, and that they contained information that would have warranted further investigation. We found that further checks had been made of suitability, in the form of Protection of Vulnerable AdultsFirst Check, and through a criminal records bureau check. No one had started without a POVA first check, however it was not clear as to whether the indivdiual had been working unsupervised until their CRB check was recieved. We noted that one individual had a criminal conviction on their record. Their was no evidence that a risk assessment of the indivduals suitability had been made in relation to this conviction. The Registered Provider, Mrs Collins said she was not aware of the conviction, as it had been dealt with by another manager. We asked about induction training and was told that whilst this was done with new staff there were no records available to show that that inducutions had been completed. However, all of the nine staff responding to the survey said that their induction had told them what they needed to know when they had started the job, very well (8) or mostly (1). We were shown a training matrix which indicated that staff had received training in the important aspects of the work. In the information supplied in the AQAA we were told that the Majority of staff had completed or were in the process of completing a training course on demenita, which would be equivalent to an National Vocational Qualificiation (NVQ) in Dementia - level 2. We asked the three staff we spoke with about their training. All three staff said that the training was very good, and One person who had started in December said taht she had done training in first aid, food hygiene, moving and handling, fire safety, food hygiene, adult protection, bnutrition and well being, and was also completing a dementia course. Care Homes for Older People Page 23 of 31 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 of the home demonstrated a real commitment to improving the service so that it meets the needs of people with dementia. The lack of risk assessments and monitoring of accidents makes it difficult to check whether all reasonable measures are being taken to keep people safe. Evidence: Wisteria house is currently being managed by the Registered Provider, Mrs Collins. This arrangement was agreed in May 2009 as satisfactory, as an application was to be made by a Manager to be Registered. It is of concern that a completed application has not yet been received as was agreed with the Commission. Mrs Collins told us that she worked as part of a management team in the home, and that the three individuals all had different areas of responsibility. It was however of concern that Mrs Collins, in spite of the fact that she is in the home on an almost daily basis, had not been made aware that a safeguarding alert had been made in relation to one on the people who lives at the home, nor of the fact that a prospective employee had a criminal conviction. Care Homes for Older People Page 24 of 31 Evidence: It was however apparent that since Mrs Collins had taken over the home she had determined to make improvements. These improvements had already started in relation to the physical environment, including ensuring that the home suited the needs of people with dementia. Mrs Collins has also demonstrated a commitment to providing good quality dementia care by ensuring staff are well trained. She has a number of plans to improve further the quality of care in the home, and is communicating a clear sense of direction and demonstrating good leadership. The Registered Provider has a duty to inform the Commission of any events that seriously affect the well being of people who live at Wisteria House. During this inspection we became aware of a number of concern where a few of the people at the home had exhibited very difficult behaviours, and had resulted in a safeguarding alert being made. The Commission was not made aware of this situation, as it should have been. The home keeps some monies on behalf of people who live at the home. There was a record of the money and of any expenditure. We found the home to be in good repair. We were told that an Environmental Health Officer had recently visited the home and that improvements had been required, but that these have been already been actioned. We asked to see copies of risk assessments in the home, and whilst a fire risk assessment could be found, other in relation to the risk of scalding or from Legionella could not be found. Two accident books were in use, these were being used to record not only accidents but incidents. There was no evidence of any monitoring of incidents or accidents by management. Care Homes for Older People Page 25 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Comprehensive and detailed needs assessments must be carried out with regard to a persons needs before they move to Wisteria House. People need to be confident that their needs will be met when they move. 01/05/2010 2 7 15 Care plans must be 01/05/2010 comprehensive and detailed, and all relevant aspects of support, including diabetes care. People need to confident that staff will know how to meet their needs. 3 8 13 Risk assessments must be developed and implemented to ensure that any risks are eliminated or managed. People need to be confident that they will not be exposed to unnecessary risk or harm. 01/05/2010 Care Homes for Older People Page 27 of 31 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 4 8 12 Where people have complex 01/05/2010 or challenging behaviours, there must be written management strategies, developed with relevant professions. Appropriate monitoring and records must be kept to inform these strategies. People need to confident that they will recieve the support they need. 5 9 13 A record of all medication 01/05/2010 administered, must be kept. Any amendments to prescriptions must be recorded and countersigned. People need to be confident that they will receive all the medication prescribed. 6 9 13 A self medication risk assessment must be completed with each person who wishes to look after their own medication. People need to be confident that they get the support they need if they wish to self medicate. 01/05/2010 7 16 17 A record must be kept of all complaints made and any actions taken in response. 01/05/2010 Care Homes for Older People Page 28 of 31 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 People need to be confident that any concerns will be dealt with appropriately. 8 18 12 All incidents of abuse must be reported and dealt with, in line with relevant guidance. People need to be confident that they will be protected from abuse or harm. 9 26 13 Proper systems must be in place to control the risk of infections. Infections can seriously affect the well being of the people who live at Wisteria House. 10 29 19 If a propspective employee has a criminal record, a risk assessment must be carried out to check their suitability for the work, in the light of the disclosure. Only suitable people may work with vulnerable adults. 11 29 19 New staff must only be 01/05/2010 employed following suitable satisfactory recruitment checks, including obtaining a complete work history, 2 written references, and a checks of suitiability (POVA and CRB). 01/05/2010 01/05/2010 01/05/2010 Care Homes for Older People Page 29 of 31 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 Only suitable people may work with vulnerable adults. 12 31 37 The Commission must be 01/05/2010 informed of all incidents of a serious nature as specified in this regulation. The Commission must be aware of issues that affect the well being of the people at Wisteria House. 13 38 13 Risk Assessments must be 01/05/2010 carried out in relation to ensure the health and safety of the people who live and work at Wisteria House. These must include in relation to hot water, risk of Legionella, and maintenance of a safe environment. People must not be exposed to unnecessary harm. 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 30 of 31 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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