Care Home: Woodside

What the care home does well One of the relatives visiting the home told us that they were: `very happy with the service and everyone was lovely`. The home is well maintained with comfortable furnitures and homely furnishings. People visiting the home were made welcome and we saw that they and the people living there were spoken to nicely. People who were thinking about moving into a home were able to have a look around before deciding if it was a good home for them. If they could not visit they could get someone close to them to have a look around instead. What has improved since the last inspection? At the time of the last key inspection it was noted that the dining tables did not have condiments and serviettes available for the people living there. It was pleasing to note that the tables had been set with serviettes making them look more homely. At the time of the last inspection it was noted that when the bathrooms were not in use they had been locked using the star locks. The star locks were no longer in use. The temperature of the fridge in the unit kitchen was being monitored to ensure that food was being stored at a safe temperature. What the care home could do better: It was important for there to be a period of stability in respect of staff and management in the home to ensure that the standard of the service being provided does not decrease. Care plans (ISS) should be updated on a regular basis to ensure that the staff have up to date information on which to base the assistance they provide to the people living in the home. This will ensure that the people living in the home will receive assistance in the way that they want. It important that staff receive an update on peoples` needs as they go on duty to ensure that they have the most current information available. People living in the home should be assisted to make choices and evidence maintained of the choices they make. Any issues arising in the home should be brought to the attention of the management team by care staff and records kept showing that the matters have been attended to. This will show that people are listened to and safeguarded. The manager should ensure that staff transferring from other homes have had the appropriate training to care for the people living in the home. Testing of fire equipment must be carried out at the required intervals and records maintained to show that the equipment is in good working order. Key inspection report Care homes for older people Name: Address: Woodside 40 Woodside Road Selly Park Birmingham B29 7QS     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: Kulwant Ghuman     Date: 2 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Woodside 40 Woodside Road Selly Park Birmingham B29 7QS 01214713700 01214713411 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Notknown Birmingham City Council (S) 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 accommodated is: 22 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: Dementia - over 65 years of age (DE(E)) 22 Date of last inspection Brief description of the care home Woodside is a care home providing personal care and accommodation for 22 older people with dementia. The City of Birmingham, Social Care and Health department own Woodside. Woodside is a compact single-storey building, set well back on the corner of Woodside Road and Warwoods Lane, and ten minutes walk from Pershore Road, with its shops and frequent buses to and from the city centre. All bedroom accommodation and facilities are found on the ground floor, which is split up into two units known as Laurel and Willow. The accommodation and facilities are of Care Homes for Older People Page 4 of 30 Over 65 22 0 0 8 0 1 2 0 0 9 Brief description of the care home good quality with bathrooms that are well adapted, corridors that are wide and bedrooms that are of a good size. There is off road parking to the front of the building, and an enclosed garden to the rear. Some bedrooms have en-suite facilities. The home offers both long and shortterm care including a respite service for carers. Fees at the home are dependant on the financial assessments carried out by the placing social workers. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by two inspectors during December 2009. The home did not know that we were going to visit. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law. The home sent us a completed Annual Quality Assurance Assessment (AQAA). The AQAA is a document that provides information about the home and how they think that it meets the needs of people living there. Two of the people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Two other files were also looked at for specific issues. Care Homes for Older People Page 6 of 30 Following the last key inspection two random inspections were carried out by the pharmacist inspector to monitor the management of medicines. Following the first random inspection in February 2009 a warning letter was sent to the home as issues identified in the key inspection had not been improved. At the second random inspection good improvements were noted with the management of medicines and no further actions were taken. We looked around some areas of the home and sampled some care, staff and health and safety records. During the course of the inspection we spoke with one of the people living in the home, one visitor, the manager, and three staff to get their views on the home. We observed interactions with staff. We sent ten Have your Say surveys to people who live in the home and their relatives, seven to staff and five to professionals who visited the home. We received eight surveys that had been completed by people living in the home, six from relatives, four from members of staff and four from visiting professionals. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: It was important for there to be a period of stability in respect of staff and management in the home to ensure that the standard of the service being provided does not decrease. Care plans (ISS) should be updated on a regular basis to ensure that the staff have up to date information on which to base the assistance they provide to the people living in the home. This will ensure that the people living in the home will receive assistance in the way that they want. It important that staff receive an update on peoples needs as they go on duty to ensure that they have the most current information available. People living in the home should be assisted to make choices and evidence maintained of the choices they make. Any issues arising in the home should be brought to the attention of the management team by care staff and records kept showing that the matters have been attended to. This will show that people are listened to and safeguarded. The manager should ensure that staff transferring from other homes have had the appropriate training to care for the people living in the home. Testing of fire equipment must be carried out at the required intervals and records Care Homes for Older People Page 8 of 30 maintained to show that the equipment is in good working order. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can make informed decisions about whether the home is suitable for them and they can be assured that their needs will be met. Evidence: As identified at the last inspection the current acting manager is not the registered manager for the home until they have been registered with us as the registered manager for that particular home. This is a minor issue but could be seen as being misleading and the service user guide should make clear that the individual is in a temporary, acting capacity in the home. The service user guide was available in bedrooms and the AQAA told us that there was an easy read format available. The service user guide makes it clear that the fees for staying in the home are assessed by the placing social workers and is means tested. Care Homes for Older People Page 11 of 30 Evidence: We looked at two files to see if the admission process identified the needs of the people moving into the home and whether the home had made an assessment as to whether their needs could be met in the home. The files showed us that assessments by placing social workers were received before the individuals came to the home for a pre admission assessment. It was pleasing to note that when the home felt that they did not have enough information on which to decide if the individuals needs could be met a longer preadmission assessment period was requested. Unfortunately, it was not evidenced that any additional information was gathered during an extended assessment process for one of the people case tracked. There were residential agreements in place on the files we looked at showing us that people living in the home or their representatives knew what fees had to be paid to live in the home. The home does not provide intermediate care but does have some beds that provide interim care for a maximum period of 6 weeks where individuals were ready for discharge from hospital but who still needed some support before returning to their home. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and social care needs are met. They are supported to manage their medication and their privacy and dignity is maintained. Evidence: We case tracked three people living in the home. This means that we looked at their care plans, risk assessments, medical visits and medication records. We spoke to staff who supported them, watched interactions between them and the staff and where possible got comments from them or their representatives. Unfortunately, due to the level of dementia in the home it was not possible to get much information from the people living there. Case tracking enables us to decide if the needs of the people living in the home are being met in a person centred way. One of the individuals whose care we looked at had lived at the home for a considerable amount of time. The Individual Service Statement (ISS) that told the staff how the individuals care needs were to be met was last updated in 2007. This meant that the current needs of the individual were not identified. The individuals care needs had increased but at the time of the inspection were again decreasing. No Care Homes for Older People Page 13 of 30 Evidence: short term care plans were in place to indicate what the staff were currently to do for the individual. It is important that staff have up to date information to guide them as the individuals are often unable to tell the staff what help they need and there are a lot of staff changes in the home. Staff we spoke with told us that they got to know what the needs of the individuals were by talking to other staff and through hand overs. On the day of the inspection the handover was not happening until over 2 hours after people had come on duty. We were told that it was later than usual due to the inspection however, it was never as soon as they came on duty. This could potentially put people at risk and a system should be put in place that ensures that people get hand overs before they go to assist the people living in the home. The ISS for this individual indicated that weights had to be recorded weekly, this was obviously out of date as weights were not being recorded weekly and there was no evidence that showed that the individual was being given fortisips in addition to meals as indicated in the ISS. During observations at lunch time the individual was seen to be given appropriate support and they looked well groomed. However, not all the staff spoken with were knowledgeable about individual preferences in respect of make up, jewellery and skin care regimes meaning that the individual may not always receive the care they wanted in the way they wanted. For another person, the ISS, which did not have a lot of detail in it, was acceptable as they were fairly independent in their personal care and could tell the staff what help they wanted. The third individual had not been in the home for very long but no instructions were available for staff on how to assist the individual. We were told that an ISS had been written up however it could not be located. The pre admission assessment for the individual indicated that they needed a lot of prompting and reassurance with using the toilet but no continence aids were identified. The daily records showed that just over a week later the individual was wearing incontinence pads. There was no reason recorded for this. We looked at weight records and it was noted that these were not being recorded on a monthly basis. For one individual, who was slightly built, weights were being monitored every two months and although there was a general downward trend of weight this did not appear to have been discussed with any medical person. Risk assessments were in place relating to falls, mobility and bathing or showering. Care Homes for Older People Page 14 of 30 Evidence: The health care needs of the people living in the home were being adequately met and records showed that visits were arranged with chiropodists, district nurses, opticians, general practitioners and with local hospital services if needed. On the day of the inspection the GP was carrying out his weekly surgery at the home. The home had a monitored dosage system for the management of medicines. The management of medicines in the home was good. We were able to carry out audits as medicines had been appropriately booked in, had been checked against prescriptions when they had been received into the home and daily audits of boxed medicines were carried out ensuring that people received their medicines as prescribed. There were protocols in place for medicines that needed to be given on an as and when required basis. This meant that the staff knew the circumstances in which this medication should be given. There were cream charts available that staff needed to complete when they applied them. Cream charts were not found when requested and the only ones that were found showed that none had been completed for several days. Therefore it could not be determined if people were having creams applied as required. The was no evidence seen to suggest that peoples privacy or dignity was not being observed. Individual bedroom doors were kept locked because individuals wandered into other peoples bedrooms. We were told that the bedroom doors were opened if anyone wanted to go into their bedrooms. One person had a key to their bedroom. We also observed that bathroom doors were kept locked. We were told that this was a long standing practice and done for health and safety reasons. The need to lock bedroom and bathroom doors could indicate that there were insufficient staff to supervise the people living there adequately. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated as individuals and they assisted to maintain contact with their friends and relatives and the local community. Evidence: The records seen during this inspection indicated that people could live lifestyles that suited them. There was good evidence that people were taken out by friends and relatives and on occasions by staff. There was an activity planner on the wall indicating what activities should be happening and the hair dresser was in the home on the day of the inspection. In addition, an entertainer came into the home and there was to be a Christmas buffet tea that evening. There was not much evidence of any other activities taking place during the day of the inspection apart from people sitting in the lounges and central area of the home. One person used the smokers lounge on a regular basis enabling them to have a cigarette without affecting other people living in the home. Care Homes for Older People Page 16 of 30 Evidence: Relatives were seen to come and go throughout the day and it was evident that they felt at ease visiting the home. During lunchtime one visitor ate with their relative and another relative assisted people to sit down at the tables and provided them with drinks and generally conversed with them. One relative spoken with during the inspection was very happy with the service being provided at Woodside. We observed lunchtime and saw that people received the assistance that they needed and the meal looked to be well presented and nutritious. The choices for the day were written up on the notice board. Staff told us that they went round the previous day and asked what people wanted to eat. We looked at the menus and the choices written up on the board. The alternative on the board was different to what was on the menu. No one was observed to have the alternative but most people appeared to enjoy their meal. One person told us that they had had better when asked if they enjoyed their meal and another person told us that they did not like the food at the home. Senior staff told us that the staff had not been giving people choices and what they had eaten was not being recorded. A new system for recording what people wanted to eat was being put in place. It was pleasing to note that the tables had been set with serviettes and so on making them look more inviting. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were generally safeguarded but issues were not always followed up to ensure that they were fully safeguarded. Evidence: No complaints had been raised with us regarding the service and none had been recorded in the home. We were told about a relative raising an issue about smoking and what the home and done in response. There were no records to evidence this. Whilst we were looking through the records we noted an entry indicating that an electric razor had gone missing from a bedroom. There was no evidence in the records that this issue had been followed up by senior staff and it had not been recorded in the complaints records. Staff spoken to told us the individual had a wet shave indicating that the issue had not been addressed. Another entry in the records indicated that one person living in the home had been hit by another person living in the home. There was no evidence that this issue had been followed up. The complaints records included several compliments about the care provided in the home. Some safeguarding concerns had been raised in respect of someone living in the Care Homes for Older People Page 18 of 30 Evidence: home. The issue was appropriately raised when it came to light. After a period of some difficulties in managing the situation the issues appeared to be better managed at the time of the inspection. People living in the home were being safeguarded however, the constant changes of staff could be unsettling for people with dementia and the management structures must take this into account when making changes. Staff who were moving to the home were coming from other homes owned by the local authority where they had been displaced due to closures of the homes they had worked in. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are homely and suited to the needs of the people living there. Evidence: The lounges were found to be comfortable, clean and warm. The dining area was suitable and spacious. The corridors were wide and had support rails in place. It was noted that the borders had been torn along one corridor. The lighting throughout the home was suitable. The bathrooms and showers had been adapted to enable the people living in the home to be assisted when bathing. Bathroom doors were kept locked however the star locks noted during the previous inspection were not being used. One of the shower rooms had had a leak and the ceiling was in need of redecoration. There were also wall tiles that had cracked that needed to be replaced. This had been the situation at the last inspection and no improvements had been made. Bedrooms that we looked at were found to be meeting the needs of the people living in them. There were various bedroom sizes. Some bedrooms had their own en suite facilities available. For bedrooms without these facilities there were communal toilets and bathing facilities available. The small unit kitchen had a fridge in it for storing small amounts of food. The temperature of the fridge was being monitored to ensure that food was being stored at a safe temperature. Care Homes for Older People Page 20 of 30 Evidence: The home was clean and odour free throughout however, it was noted that the clinical waste bins were located in the sluice rooms meaning that protective clothing had to be taken from toilets to the sluice rooms. There was no rationale forthcoming for these to be kept in the sluice room and were moved to the toilet areas during the inspection. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are available to support the people living in the home. The home would benefit from a period of stability of staff. Evidence: The staffing rotas showed that there were usually 4 or 5 care staff on duty. In addition there were senior staff on duty. During the night there were two waking night staff and one person on call in the home. We did not look at the recruitment process on this occasion as no new staff have been employed. Staff coming to the home have come from homes that were owned by the local authority but have closed down and the staff have transferred to Woodside to fill gaps where Woodside staff have gained positions in other homes. Due to the ongoing change over of staff and the changes in the management team it was difficult to determine from the training matrix whether staff had had the appropriate training to care for people with dementia. Of the 17 staff identified on the matrix only 6 were identified as having NVQ level 2. This is below the required level of 50 and cannot insure that people are being cared for by staff with the appropriate skills and knowledge. The AQAA however, told us that of 19 staff 16 had NVQ level 2 or above. Care Homes for Older People Page 22 of 30 Evidence: The training rota was in the process of being updated. There had been quite a turnover of staff due to back filling. It was difficult to guage how much training people had had and when. The fact they had come from other homes should mean that they have had training in core subjects but the manager must ensure that this is the case. Staff we spoke to during the day had some knowledge of the needs of the people living in the home but their knowledge was not extensive and we had some concerns about the level of communication skills of one person in particular. This was discussed with the manager who was aware of the situation. Staff told us that they were provided with information about peoples needs during hand overs but that this information was given to them sometime after they had been working on their shift meaning that they did not have up to date information about peoples needs. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is safe for people to live in but the home would benefit from a period of stability of staff. Evidence: The current acting manager had been in post for about a month and was not sure how long she would be in post. The manager appointed to the home on a permanent basis was on secondment which could be coming to an end in February 2010. There has been no registered manager in post for the home since June 2008. There has been a substantial change in the management team and the care team. The constant changes in the staff team means that their is a loss of leadership in the home and this is evident in the organisation of paperwork and the general ambience of the home. The home is going through a difficult period as it is due to close in June 2010 and staff morale is low. It is important that there is a period of stability for the staff and the Care Homes for Older People Page 24 of 30 Evidence: management team so that the level of care provided to the people living in the home is not disrupted and the people living in the home are not affected by continual changes. A representative of the local authority visits the home on a regular basis to support the manager and ensure that the service is monitored. The AQAA told us that the quality monitoring system in the home had been improved and regular financial checks were undertaken in the home but these were not looked at during this inspection. There was evidence that some of the health and safety checks were not being undertaken as required. The last recorded weekly fire alarm test was 1.12.09 and the emergency lighting test 10.11.09 and fire awareness training was overdue. There was evidence that equipment in the home was serviced on a regular basis to ensure it was safe for use. Staff meetings were not being carried out on a regular basis and although there had been some meetings with the people living in the home there was no evidence that the issues raised had been followed up. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 systems should be in place 31/01/2010 to ensure that staff receive information about the people living in the home when they come on duty. This will ensure that people are safeguarded and staff have up to date information about how to assist the people living in the home. 2 9 13 Records for the administration of all prescribed medicines must be kept up to date. This will ensure that people receive their medicines as prescribed. 31/01/2010 3 18 13 All issues arising must be investigated and a record of the actions and outcomes maintained. This will ensure that people are listened to and protected from abuse. 31/01/2010 Care Homes for Older People Page 27 of 30 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 service user guide should be accurate in the information it gives. This will ensure that people have the correct information about who is responsible for the running of the home. Pre admission assessments should ensure that all relevant information is gathered. This will ensure that all the needs of individuals will be planned for. Short term care plans should be in place where it is known that the changes are temporary or until such time that the ISS can be updated. This will ensure that staff know how to assist people in the short term. Individual Service Statements should be updated on a regular basis. This will ensure that peoples current needs are known and can be provided for. Weights should be monitored on a regualr basis and trends of gain or loss discussed with medical personnel to ensure that there was no underlying cause. Records should be kept of the food and drinks people have had to show that they are receiving a varied and nutritious diet. People should be given choices at mealtimes to ensure that individual needs are being met. All areas of the home should be adequately maintained and decorated. This would ensure that all areas of the home were homely and suited to the people living in the home. Staff should be provided with information about peoples needs when they come on shift. This will ensure that staff have the necessary information they need to assist the people living in the home. The training matrix should be updated to ensure that staff have the skills and knowledge to care for people with dementia. Staff should have the training that provides them with the skills and knowledge needed to care for the people living in the home. 50 of staff should have achieved NVQ level 2 or equivalent. This will ensure that staff have the skills and 2 3 3 7 4 7 5 8 6 15 7 8 15 19 9 27 10 29 11 30 12 30 Care Homes for Older People Page 28 of 30 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 knowledge to support the people living in the home. 13 31 An application for registration of a care manager should be put forward to ensure that there is an accountable individual who is in day to day control of the home. Testing of fire equipment should be carried out at the required intervals to ensure that they are in good working order. 14 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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