Inspection on 18/01/10 for Alton Manor Ltd

This is the latest available inspection report for this service, carried out on 18th January 2010.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Extracts from inspection reports are licensed from CQC, this page was updated on 11/04/2010.

Key inspection report Care homes for older people Name: Address: Alton Manor Ltd 8-12 Herbert Road Southsea Hants PO4 0QA     The quality rating for this care home is:   two star good 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: Annie Kentfield     Date: 1 8 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 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: Alton Manor Ltd 8-12 Herbert Road Southsea Hants PO4 0QA 02392462910 02088630955 vikram@st-partnership.com www.altoncaregroup.com Alton Manor Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Elaine Herridge Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 34 The registered person may provide the following categories of service only : Care home only (PC) to service users of the following gender; Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection 34 34 0 Over 65 0 0 34 Care Homes for Older People Page 4 of 31 Brief description of the care home Alton Manor opened as a new service in August 2009. The home is located in a pleasant residential area of Southsea and the home is converted from three adjoining period houses. The building is accessible and there is a private garden area at the rear of the building. There is limited parking at the front of the home with additional onstreet parking. The home offers 26 single bedrooms and 4 shared bedrooms, all with en-suite facilities. There is a range of communal space for residents and a passenger lift to access the upper floors, with an additional stair lift between two of the upper levels. Information about fees and any additional charges are available from the home. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The service was registered in August 2009 and we carried out the first inspection with an unannounced visit on 18 January 2010. The visit was carried out with one inspector who was in the home from 11am to 6pm. The registered manager, three members of staff, seven residents and two visitors were involved in the visit and we spoke to residents privately and in the communal areas, we also looked at some of the care records, medication records, and staff training and recruitment records. Before the visit we received ten completed surveys from people living in the home; these had been completed with assistance from members of staff. We also received the Annual Quality Assurance Assessment (AQAA) from the registered manager. This is a self-assessment that all services complete and gives us information about the home and a picture of what the home has identified as areas for further development and improvement. Care Homes for Older People Page 6 of 31 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. Care Homes for Older People Page 8 of 31 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 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. Before moving into the home, the care needs of new residents are assessed to ensure that the home is able to provide a service to meet their needs. Information about the home and the services provided is available to new residents and their representatives. However, the service has not yet developed a clear strategy of care to support their stated aim: to provide a specialist dementia care service. Evidence: All residents have a pre-admission assessment to assess their care needs before moving into the home. We saw evidence to demonstrate that information about new residents is gathered from residents, their relatives and health and social professionals who may be involved in their care. This information is used to draw up an individual plan of care for each resident. Information about the home and the services provided is available in the entrance hall of the home. This includes a brief brochure and a statement of purpose. The home Care Homes for Older People Page 11 of 31 Evidence: brochure states that the home offers a high standard of dementia care. However, the service has not yet developed a clear strategy of care to demonstrate how they will achieve positive outcomes for people with dementia. The home has a staff training programme in place and it is planned that all staff will have completed at a later date, training in dementia care awareness. The manager told us that both she and the deputy manager have done some dementia care awareness training. We looked at staff understanding of the Mental Capacity Act. Training in the new legislation and Deprivation of Liberty Safeguards has not yet been undertaken. During our visit, the manager contacted the training organisation and relevant training is to be arranged. The manager told us that she would also request a copy of the Mental Capacity Act - Code of Practice and some of the information leaflets. Deprivation of Liberty Safeguards may affect people living in the home if and when they are unable to make decisions about important issues because of lack of capacity. People may be at risk of their rights not being promoted and protected if staff do not have a working knowledge of this important legislation and how if affects people in the practice of the home. The information about the home includes details of the bedrooms and room sizes. Four of the bedrooms are shared and one room is used only for short term respite care. The manager told us that although this information is not included in the statement of purpose, one bedroom is used for respite care because it is smaller in size. We were also told that shared rooms are available if people choose to share a room, although this is not stated in the homes information. We spoke to one relative of a resident who told us that they did not think that their relative minded sharing a room. We spoke to two new residents and their representatives who told us that they had visited the home before moving in and had chosen the home after looking at other residential care homes. One new resident told us that they were able to choose the bedroom they moved into and were happy with the bedroom and facilities provided. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a plan of care that is reviewed at regular intervals. The home has not developed person centred care planning and individual plans do not contain sufficient detail about personal choices and preferences and other person centred information. This may means that people may be at risk of receiving care in different ways from different carers and their personal choices overlooked. There are systems in place to ensure that people receive their medication, as prescribed. However, some medication that is prescribed to be given as and when required does not have a detailed care plan and there is no written information to guide care staff. This means that there may be a risk of people not receiving some medicines in a safe and consistent manner. Evidence: We looked in detail at the care records for three residents. Records show that people have access to community health care services such as GP, community nurses, chiropodist, dentist and optician as well as specialist services, as needed. Records of contact with health care services are recorded in the care records. Care Homes for Older People Page 13 of 31 Evidence: The care plans that we looked at had not been signed by the resident or their representative. The manager told us that it was planned for all residents or their relatives to be consulted and asked to sign plans of care, as and when this could be arranged. Records show that any risks to people or the need for specialist equipment is recorded in the plan of care with written information for care staff on how risks are to be managed, or equipment safely used. However, one assessment for a person who needs additional support with the use of bed rails did not contain sufficient information about all of the risks when using the bed rails. This was discussed with the registered manager who told us that the risk assessment would be reviewed and updated immediately. Staff maintain daily records of care and care plans are reviewed monthly, by the registered manager. Separate records are kept for some aspects of personal care and records of weight. The manager uses a mental health assessment tool every six months and these are used to inform the care plan review and any changes to care needs. However, care plans did not contain a detailed plan of care about how levels of dementia may affect behavior and how this must be safely managed by care staff. This means that people may be at risk of their care needs relating to their dementia or behaviour may not be met consistently at all times. Some of the care plans that we looked at did not contain sufficient detail about what staff must do to ensure that people receive their care in the way they prefer. For example, one care plan recorded that a person needs assistance with mobility and with continence care. Although it was evident that staff are working in a person centred way, this is not reflected in the written records of care. Lack of detail means that different care staff may be working in different ways and people may not receive their care in a consistent manner. The home has not developed person centred care planning that is recommended as good practice in providing a dementia care service. We looked at the management of peoples medicines and all medication is securely stored in a separate room that is kept locked. The registered manager confirmed in the annual quality assurance assessment that staff who dispense medication have received appropriate training in the safe administration of medication. The home has Care Homes for Older People Page 14 of 31 Evidence: appropriate storage and recording systems for the administration of any controlled drugs. The medication administration records were up to date with one exception, where a medicine had been dispensed but not signed for. The medication record book contained a reminder to staff that all medication must be recorded and signed as given or not, and the registered manager checks the medication records regularly to ensure that staff are following the homes medication policies and procedures. One resident had been prescribed a medicine that has been prescribed to be given as and when required and for specific reasons relating to their levels of anxiety. Although staff had been recording when the medicine was dispensed, there was no specific care plan in place to provide written guidance for care staff about why and how the medicine must be dispensed. This means that staff may be dispensing the medication in different ways and this puts the resident at risk of not getting the medicine as prescribed or when needed. The management of homely remedies or over the counter medicines is safely managed and each care record contains evidence of consultation with individual GPs about the use of non-prescribed medicines. We spoke to some of the residents and their relatives or representatives. People told us that they are happy with the care they receive in the home. One person told us that staff respect their privacy and they are able to get up and go to bed at the time they choose. We spoke to another resident who told us that staff are always available when they need help or if they have to use the call bell alarm system. We found evidence of staff working in a person centred way by using innovative ways of developing a communication system for a resident who needed this. 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 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 not have an activities organiser, however, a variety of activites are on offer on an informal basis. The home has not yet developed person centred care. This means that peoples social, cultural and spiritual care needs may not be met in an organised and consistent way. Residents are offered a choice of freshly prepared meals and specific dietary requirements or preferences are catered for. Visitors to the home are made welcome. Evidence: The manager told us that the home does not have an activities co-ordinator and social and leisure activities are usually arranged in the afternoons by individual care staff. Events and games happen informally and the home does not have a planned programme for residents or outside entertainment or events at present. Although we saw some evidence of individually planned social and recreational resources for one resident, this has not been developed for all of the residents. The manager has not yet developed a person centred approach to care planning for daily Care Homes for Older People Page 16 of 31 Evidence: living and social activities for a specialist dementia care service or on an individual person centred basis. Although the homes brochure states that the home has an activities co-ordinator, the manager told us that this would be considered when more residents have moved into the home. On the day we visited the home, staff organised a game of bingo in the afternoon and some of the residents joined in. The home has some games that are available and we were told that some of the staff use reminiscence cards with the residents. We also saw some artwork on display that had been produced by residents with a member of staff. We received surveys from 10 people living in the home and people were asked if the home arranges activities they can take part in. Two people responded with always, five people responded usually and three people responded sometimes. The communal areas of the home are on the ground floor and although the dining room and two sitting rooms form a large open plan area, there are divided areas and dividing doors so that there is the opportunity for residents to choose where they would like to be. One sitting area has a television and the other doesnt have a television. The communal areas lead to the garden at the rear of the house. The garden is of medium size and sheltered, with limited seating areas for residents. The access to the garden is not level and some of the area is grassed which could present difficulties for people who are in a wheelchair or use mobility aids, to independently access the garden. Residents have access to the services of a hairdresser who visits the home and sessions are offered in a private room. This room was also being used by the chiropodist during our visit. The use of this room ensures that people receive treatments with privacy and dignity. When we spoke to some residents at lunchtime, the feedback about meals in the home was good. People told us that the food is good and there is always an alternative choice to the main meal on offer if it doesnt meet their taste or preference. One person told us that the cook has consulted with people about what food they like and various menus have been tried in order to establish what specific foods and menus meet peoples preferences. Care Homes for Older People Page 17 of 31 Evidence: Hot and cold drinks were offered throughout the day and staff make a note of each persons personal preferences. We spoke to the cook and looked at the current 4 week menu. Emphasis is placed on providing attractice and nutritious meals with two cooked meals each day, plus breakfast, and a supper of drinks and biscuits at around 8pm. We spoke to two visitors in the home and they told us that staff are always welcoming and helpful when they visit. One person told us that staff are always helpful when they phone the home to speak to their relative or leave a message. Care Homes for Older People Page 18 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 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 a written complaints policy and procedure and this is available for people living in the home, and visitors, to look at. People are safeguarded from the risk of harm or abuse with a policy and procedures for staff to follow. Policies and procedures are backed up with training for staff in safeguarding awareness. Evidence: We have not received any complaints about the service and the annual quality assurance assessment (AQAA) stated that none had been received by the home. The AQAA told us that the manager operates an open door policy to running the home and aims to speak to residents and relatives to ensure that any concerns or problems do not escalate into complaints. This was confirmed in comments from relatives and residents that we spoke to. In the event of receiving a complaint, the home has a formal complaints procedure and information about this is available to residents and visitors. We have not received any reports that residents are at risk of harm or abuse. The home has a policy and procedures for staff to follow in the event of suspected or actual allegations of abuse. We saw the staff training programme and noted that staff are due to take part in specific safeguarding awareness training in the weeks following Care Homes for Older People Page 19 of 31 Evidence: our visit. Care Homes for Older People Page 20 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. Residents are offered a clean, comfortable and homely environment to live in. Specialist equipment to maximise independence is available. Procedures are in place and equipment is provided to ensure that good hygiene and control of infection is promoted and maintained. Evidence: People who sent us surveys told us that the home is always fresh and clean. The home employs a part-time cleaner and part-time laundry assistant. We visited all areas of the home and generally the home was clean, pleasant and hygienic. However, one room had a strong odour of urine, we were told this was being addressed and the manager told us that odour controlling cleaning products are used and carpets are regularly cleaned. The home has a sluice room and a laundry room. These are kept locked to ensure the safety of residents in the home. Residents who move into the home are encouraged to bring personal possessions with them to personalise bedrooms and provide a homely and pleasant environment. The bedrooms vary in size and one bedroom that is smaller than other rooms is reserved for short term periods of respite care. Care Homes for Older People Page 21 of 31 Evidence: Where bedrooms are shared by two people, there are portable screens in the rooms to provide privacy. The communal rooms are attractively decorated and furnished with matching tables, chairs and comfortable armchairs. All of the bathrooms and toilets have liquid soap, paper towels and anti-bacterial hand gel available to ensure good practice in infection control. Staff confirmed that they have access to gloves and aprons in the promotion of good practice in hygiene. The bathrooms have assisted bathing facilities and one ground floor bathroom has an overhead tracking hoist. The flooring in this bathroom is worn and where the flooring has been carried up to surround the bath, parts of this have become damaged and loose. This is a potential risk of infection as the surround cannot be properly cleaned. Immediately following the inspection, we received confirmation from the registered manager that this had been repaired. The decoration in this bathroom is tired and worn and the manager told us that there are plans for this room to be decorated at a later date. We found some toiletries being stored in shared bathrooms. This was discussed with the manager as a risk of infection or cross infection. The manager told us that this would be addressed and personal toiletries only stored in bedrooms when not being used. The manager told us that people do not lock the doors of their bedrooms, although keys are available. Bathrooms and toilets are lockable to ensure privacy. The manager told us that the policy for locking doors may be reviewed when the home has more residents and is fully occupied. Care Homes for Older People Page 22 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. The home has a recruitment policy to carry out pre-employment checks on new staff, however, gaps in information have the potential to place people living in the home at risk of harm. The staff team are positive and energetic and the home is committed to providing a programme of training suitable for the work they do, this is still being developed. Staff supervision systems are in place but are not supported by up to date written records. Evidence: At the time of our visit, there were 19 residents in the home with two more people staying for a short period of respite care. The manager told us that as a new service, the plan is to operate for a period of time before reaching maximum capacity of 34 people. Currently there are three staff on duty during the day, with two staff on duty at night. In addition, the manager works Monday to Friday and the Deputy Manager is in charge at weekends. The home employs a cleaner/laundry assistant, kitchen staff, and a maintenance person. During our visit, staff were in evidence at all times in the sitting rooms and during the lunchtime period were available to assist residents who need support at mealtimes. Care Homes for Older People Page 23 of 31 Evidence: During the visit we spoke privately to four residents and two people who were visiting the home. Comments received indicated that people are satisfied that staff are available when they need them and we received positive comments about the positive and friendly approach of the staff and the manager. We spoke to one person who prefers to spend time in the privacy of their own room, they told us that staff are prompt to seek healthcare appointments when they are needed, and if they need help from staff, this is always available. We saw evidence of a staff training programme, a list of training sessions has been booked with an independent training provider in the following months. Records of training that staff have completed are kept in individual records. The manager did not have an overall staff training matrix that easily identifies what training has been completed and when updates are due, for all members of staff, and also demonstrate that all staff have received training in all areas of basic training to promote safe working practice. We spoke to one member of staff who told us that some of their training was still current from a previous employment, certificates to evidence this were in the training file. During the visit, we identified that staff training in the Mental Capacity Act and Deprivation of Libery Safeguards is not yet arranged. The manager contacted the training provider during our visit, to arrange this. We looked at staff recruitment records for three new members of staff. The records show that pre-employment checks are carried out to demonstrate that staff are suitable to work in the home. However, some of the records had gaps in information, for example, two out of the three people had not fully completed the application form with a full previous employment history and there was no explanation for this. One person had two written references but this did not include a reference from their most recent employer. Two people had applied for an up to date CRB or criminal record check but this had not yet been received although a POVA first check had been received. The other person had already received a satisfactory criminal record check. We could not find a record of the new staff - initial induction to the home. The manager told us that this had been carried out, but not recorded. Supervision and monitoring of the progress of new staff had not been recorded, however, the manager told us that new staff were monitored to ensure that they were suitable. The lack of complete and robust recruitment and induction records means that people may be at risk of harm, and the home cannot fully demonstrate that new staff are suitable to Care Homes for Older People Page 24 of 31 Evidence: work in the home. The manager told us that new staff receive a handbok and a copy of the Code of Practice for care staff produced by the General Social Care Council. Following the initial period of induction to the home, staff follow a nationally agreed induction to care - Skills for Care. The annual quality assurance assessment told us that 8 out of 12 care staff have already achieved an NVQ (Nationa Vocational Qualification) in care, at level 2 or above. At present, no other staff are enrolled to achieve this. Care Homes for Older People Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed by a qualified and competent manager. People are protected by policies and procedures to promote and maintain the health and safety of residents and staff. Quality assurance systems are being developed. Evidence: The registered manager is qualified in care and management and has previous management experience in another care home providing a service to older people with dementia or a mental disorder. We received the homes self assessment (annual quality assurance assessmentAQAA) when we asked for it and this gave us a picture of the service and where further improvements are planned. For example, the AQAA told us that the home plans to involve residents and relatives in more meetings in the home. The AQAA also tells us that care plans and care records need to be continually developed to improve the standard of care in the home. Care Homes for Older People Page 26 of 31 Evidence: The service has a stated aim to provide a specialist dementia care service. However, the AQAA did not provide sufficient evidence about how the home plans to achieve good outcomes for people with dementia. The service has not yet incorporated person centred care planning into the practice of the home. Practice in the home has not yet incorporated a working knowledge of the Mental Capacity Act and how this may affect people living in the home. A suitable activities programme has not yet been developed to meet the individual social and cultural needs of the residents in the home. Information in the AQAA confirms that the home has policies and procedures in place for ensuring that the home meets relevant health and safety legislation: health and safety risk assessments, internal audits, maintenance and equipment checks. A food safety inspection was carried out by the Environmental Health Department in September 2009. Requirements were made with regard to completing food risk assessments and maintaining the kitchen ventilation system. The manager confirmed that these requirements have been complied with. The home has a policy that individual finances and legal affairs are not managed by the home. Expenses that are incurred for chiropody, hairdressing, newspapers etc are paid by the home and separately invoiced to residents or their representatives. This ensures that peoples financial interests are safeguarded. The service is in the process of developing quality assurance systems to measure how well the service is providing good outcomes for people living in the home. We were told that regular satisfaction questionnaires will be used, and a newsletter produced with the outcome of any surveys. Care Homes for Older People Page 27 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 28 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 9 13 The registered person must 31/03/2010 ensure that there are appropriate systems in place for the safe administration of medicine received into the home, dispensed, or returned. In the interests of people receiving their medication safely and as prescribed: a separate plan of care must be in place for medicines that are prescribed to be taken as and when required. To ensure that staff have clear and written guidance on why and how some medicines must be offered at required times of the day. Care Homes for Older People Page 29 of 31 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 7 It is recommended as good practice in providing a dementia care service; to develop a person centred approach to care planning and practice. Good practice guidance on person centred care is available on the commission website www.cqc.org.uk It is recommended as good practice for all hand written entries onto the medication administration record sheets, to be signed and witnessed as being correct. This is to avoid any possible errors in transcribing the prescribing instructions from the original pharmacy container or prescription. 2 9 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. 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