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Inspection on 21/04/10 for Ashlee Care Home

Also see our care home review for Ashlee Care Home for more information

This is the latest available inspection report for this service, carried out on 21st April 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People told us they were encouraged to visit the service in order to familiarise themselves with the building, and to enable them to make a informed choice about their future. People told us they thought the service was "homely with a relaxed atmosphere". People said the routines were flexible and they could choose how they wished to spend their day. People told us they are "well looked after". They told us the staff team were: "caring" and "responsive" and provided "good care and support ". People told us they were satisfied with the food provided, and they "had activities available most days to keep their minds and bodies active". People are supported by a stable and trained staff team who are dedicated to ensuring peoples needs are met to a good standard. The staff spoken with demonstrated a good understanding of the needs of the people they supported. People have opportunities to provide feedback about the service, through the quality assurance systems in place. The service has received a number of thank you cards and some of the comments receive include some of the following: "Many thanks for looking after my relative" "I would like to thank all of the staff for their care of my relative, we really appreciate of all that you have done" "Many thanks for all of your care and kindness shown to my relative".

What has improved since the last inspection?

The service had one requirement from the last report in relation to ensuring the ramp was adjusted to enable people to access the garden areas. This has now been achieved and a new ramp has been fitted.

What the care home could do better:

The provider needs to address the risks associated with the brick wall that has collapsed and make the garden area safe in a timely manner. This is to enable people to use the garden. The service must be able to demonstrate that staff are not employed until all of the required checks have been undertaken and received. This is to ensure that staff members are suitable to work in this service and to safeguard people. We have made some good practice recommendations, which should be implemented in order to improve the practices in these areas.

Key inspection report Care homes for older people Name: Address: Ashlee Care Home 89 Nottingham Road Long Eaton Derbyshire NG10 2BU     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: Claire Williams     Date: 2 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 29 Information about the care home Name of care home: Address: Ashlee Care Home 89 Nottingham Road Long Eaton Derbyshire NG10 2BU 01159721732 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.ashleecarehome.co.uk Mr Arjoon Rao Mahadoo Name of registered manager (if applicable) Mr Arjoon Rao Mahadoo Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Mr Arjoon Rao Mahadoo is registered to provide accommodation and person care for persons of both sexes whose primary needs fall within the following category, Older Persons not falling in any other category (OP). Within the maximum number of 21 service users, one person named in cnnection with an application processed in January 2007 may be admitted in the category of Dementia (over 65 years) DE(E). Date of last inspection Brief description of the care home Ashlee is a care home for twenty-one people aged 65 years and over. It is a detached house in a residential area of Long Eaton close to the town centre and local facilities. The service has seventeen single and two shared bedrooms, five single rooms have ensuite facilities. The service is on two floors accessed by stairs and a passenger lift. People have access to a garden area. Care Homes for Older People Page 4 of 29 Over 65 21 0 Brief description of the care home The fees for residency at Ashlee at the time of this inspection ranged from £355 to £420 per week. Services not included in this fee include: Hairdresser, Cost varies dependent on service required, Private Dentistry, and Chiropody. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This key inspection was unannounced and took place over one day. Key inspections take into account a wide range of information and commence before the site visit by assessing any information received such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for the people using the service and their views on the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for providers, which is a legal requirement. This assessment gives the provider an opportunity to let us know about their service and how well they Care Homes for Older People Page 6 of 29 think they are performing. The information provided in the AQAA is reflected within this report. At this inspection visit two people were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at care plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. Three members of staff were spoken with at some length. Their views and opinions of the care provided, the support and training given to them is included within this report. We also had the opportunity to speak with relatives who were visiting throughout the day. Their comments are included within this report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The provider needs to address the risks associated with the brick wall that has collapsed and make the garden area safe in a timely manner. This is to enable people to use the garden. The service must be able to demonstrate that staff are not employed until all of the required checks have been undertaken and received. This is to ensure that staff members are suitable to work in this service and to safeguard people. We have made some good practice recommendations, which should be implemented in order to improve the practices in these areas. Care Homes for Older People Page 8 of 29 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the service can support them, as accurate assessments are undertaken before admission is agreed. Evidence: In the self assessment the provider told us, pre-admission assessments are undertaken on all people before they are admitted to the service. We looked at the records for two people who had recently moved into the service. The records in place confirmed assessments had been undertaken and a judgement had been made to confirm that the service is able to meet these peoples needs. Both assessments, were detailed and included the required information to enable the service to develop a plan of care. People who we spoke with, told us they were encouraged to visit the service in order to familarise themselves with the routines and to meet the staff and people thta live here. Some people told us Care Homes for Older People Page 11 of 29 Evidence: I came for a period of respite first to see what it was like, and then decided to stay. I like it here. My family visited lots of different homes in the area, but they liked this one best so I chose to come and live here. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The providers self assessment stated that care plans and risk assessments were in place, which were efficient and effective in terms of determining a persons specific requirements. They said the current format is clear and well presented and people are involved in the creation and development of their plans. They told us the plans give staff clear instructions on how to administer specific care, and they also provide detailed information on each person, which enables the home to provide a tailor made service. The service is currently introducing a new care planning system, and they are in the process of transferring all of the information across onto the new format. The files for two people whose care we case tracked, contained a plan of care, at which had been recorded onto the old format and some of this information had been transferred onto the new format. The information was sufficient to direct staff on how to deliver Care Homes for Older People Page 13 of 29 Evidence: peoples care and meet their needs. However some elements of the plan were task focused rather than person centred, and a plan for peoples social needs had not been recorded for these two people. Both files demonstrated that risk assessments had been completed, but not in all of the required areas. The acting manager addressed these issues and provided evidence to support that detailed person centred plans and risk assessments were in place on the new format, for both of these people within 48 hours of our visit. This means staff now have access to all of the required information in order to deliver individualised support. Although the staff team, (at the time of our visit) did not have access to full and detailed plans of care. We found (in our discussions with them), that staff were able to think in a person centred way, and they were able to demonstrate how to meet peoples needs. All of the people we spoke to told us they receive support which is provided in a safe, respectful and dignified manner, and our observations, supported this. People we spoke to made the following comments about the care they receive: The staff are very good, kind and gentle when they support me with my personal care, they never rush me and are very patient. The care we receive is good, and they encourage us to do things for ourselves, I am satisfied. The staff are very good and always meet my needs, I am happy with the care I receive. We spoke with some relatives and they made the following comments: The staff seem to know what they are doing, and I think my relative receives a good standard of care. The staff are always respectful when supporting my relative and I am satisfied with the way they look after them. The staff always keep me informed of my relatives well being, and they always seem to be well cared for when I visit. I think the staff do a good job, and my relatives needs are met to a good standard. Feedback provided in the surveys we received demonstrated that people, their relatives, and healthcare professionals were satisfied with the service provided. Comments made include some of the following: Care Homes for Older People Page 14 of 29 Evidence: The staff give individual attention, and always give the required care and support to my relative . The staff take good care of me and there is nothing I can think of, which can be done to improve this service, I am happy here. The service are respectful of people and their visitors. The staff complete daily records of peoples well being, and these were found to be detailed and include reference to any changes to peoples needs. The staff spoken with told us they have detailed hand-overs before each shift, which ensures they are aware of peoples current needs. There was evidence to support that care plans are reviewed, however monthly reviews had not been completed recently for some people. There was limited evidence in the care plans to demonstrate that people or their families had been consulted and agreed with the information in place. The providers self assessment stated that people using the service had access to outside professionals for any needs requiring specialist input. Records were seen to demonstrate that peoples health care needs were monitored and met. We looked at the arrangements for the handling and management of peoples medicines by the service. This demonstrated that people received their medication as prescribed. However we did find a couple of omissions which included: Handwritten medication instructions not being countersigned by two staff, and codes were being used to record that a person did not have their medication, but the reasons for this had not been defined on the Medication sheet. We found that the lock on the medication fridge had broken. This was addressed immediately and a new fridge was ordered. The temperature of the medication fridge was not being monitored and recorded on a daily basis to ensure the medication was being stored at the correct temperature. This practice was resumed following our visit. Although we was told internal audits are undertaken, there was no record to support this. Information provided in the self assessment told us that staff had received medication training, and the records we looked at confirmed this. An assessment of competence has not yet been undertaken to ensure staff are following the procedures in place. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their life style, and they have access to recreational activities which meet their needs. Evidence: The providers self assessment told us they provide a number of social activities for people. These included keep fit classes, Arts and Crafts sessions, Karaoke afternoons and many more. In addition to this the service said they are visited twice a month by Long Eaton Primary and Junior School. The visiting school children play various games with people ranging from cards to board games. Records were kept in peoples daily notes to support the activities people had taken part in. On the day of this inspection people were observed participating in a keep fit class in the morning, and playing skittles in the afternoon. Staff were also observed spending one to one time with people living in the service. Visitors that were spoken with confirmed that activities took place at the service on a regular basis. Feedback in the surveys also confirmed this. People told us they were happy with the provision of activities provided, and they confirmed they were consulted about what they would like to participant in. As mentioned previously the Care Homes for Older People Page 16 of 29 Evidence: files we looked at did not contain a care plan in relation to peoples social and cultural needs. However these were updated after our visit. This ensures the staff have access to the required information to ensure peoples social needs and preferences are met. We spoke to those people who chose to spend their time in their rooms. They told us this was their personal choice as they Like to spend time on their own watching their programmes. People told us they was aware that activities were available and they said I will join in if I am interested in an activity, but I prefer to be in my room. People told us they were able to choose how they wished to spend their day, and their decisions was respected. The providers self assessment stated that people were able to practice their religion within the service or by visiting places of worship. This was confirmed at the inspection and records were seen to demonstrate this. We joined people for their lunch-time meal. The tables were set with tablecloths and condiments so people could help themselves. The menus for the week was not displayed but people told us We know what the meals will be each day. People told us they are offered choices at each meal time. We looked at the diary which recorded the meals people had, and this demonstrated that people had the same meal options each week. Some people told us It would be nice to have a change. People spoken to and feedback provided in the surveys told us The food provided was satisfactory. Observations confirmed that those people that required support to eat a meal was supported in a respectful manner. We visited the kitchen and spoke with the acting cook who were able to demonstrate her knowledge of peoples dietary requirements. We looked at training records which demonstrated that the acting cook had an up to date Basic food hygiene certificate, which will expire in June 2010. We was told that refresher training would be provided before this time. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place ensure people have confidence to raise their concerns, and are safeguarded from harm. Evidence: As stated in the providers self assessment a complaint and safeguarding policy and procedure were in place. During our discussions with people, and their visitors they told us they knew how to complain and said they would not hesitate to raise any issues with the staff team or the manager. They appeared confident that any concerns they had would be taken seriously and addressed promptly. The feedback provided in the surveys also confirmed that people was aware of how to raise any concerns. People told us: If I was not happy I would go straight to the manager and tell him. We are regularly consulted about things, so we can raise any issues at any time, but I dont have any issues and am quite happy. People told us they have access to the complaints procedure in the information about the service which they was provided with, when they moved in. The procedure is also displayed in the service. The service has not received any complaints since our last visit, and we have not referred any issues. A format for recording complaints is now in place, and this covered all of the required areas to ensure any issues are addressed Care Homes for Older People Page 18 of 29 Evidence: appropriately. The staff we spoke to demonstrated their awareness of both the complaints procedure and their role and responsibilities concerned with dealing with any potential abusive incidents. The staff and the records we looked at confirmed, they had received training in these areas. The service have not had any safeguarding incidents since our last visit. The records seen also demonstrated that staff have recently attended training in relation to the Mental Capacity Act. This ensures staff are aware of, and promote peoples rights to make decisions in their daily lives. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment which is comfortable and meets their needs. However improvements are required to make the garden area accessible so people can use this area. Evidence: The providers self assessment told us they have a safe and well maintained environment with regular checks and updates carried out on their fire risk assessments, fire prevention and fire fighting equipment. Furthermore, the manager and the handy person carry out a monthly evaluation of the services s physical environment to ensure that the premises is kept well maintained at all times We undertook a brief tour of the building, and all areas we visited were found to be clean, comfortable, homely, warm and well lit. We did identify some areas that were looking worn and in need of renewal such as the toilet and bathroom areas. We also identified that a shower chair that was in use, was ripped and worn. The acting manager agreed to replace this items and renew the areas identified. Relatives that were spoken with confirmed that they were happy with the standards of hygiene and maintenance at the home. Comments included, the place is always kept spotlessly clean and there are never any odours. Care Homes for Older People Page 20 of 29 Evidence: People we spoke to and feedback in the surveys confirmed that people are encouraged to personalise their bedrooms and those visited reflected peoples preferences. People told us the building suited their needs and they confirmed they had access to equipment, which encouraged and promoted their independence. People told us: I think the place is decorated in a homely style, and I like my room, it is just as I want it with all my things around me. I like this home, and I think it is very homely as it is small and cosy. Work has now been completed in relation to adjusting the ramp that leads into the garden. This will enable people to access this area. However since completing this work and fitting a handrail, a brick wall, which separates the service with the adjourning property has collapsed. This means due to the potential risks, the garden continues to be unaccessible for people. Plans are in place to address this and make the garden safe for people to access. Visual cues had been purchased, such as pictorial signs for toilets, bathrooms and dining areas. These assist people to orientate themselves when moving around the build Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a competent staff team. However the recruitment practices has the potential to place people at risk. Evidence: The self assessment told us the service provides sufficient staff members and skill mix on duty at all times to meet peoples needs. They said they place great emphasis on staff training, and an annual staff training planner is in place to ensure that people are cared for by well trained staff members. They said the management follows a strict recruitment policy and will not offer any individual a position in the care home unless they pass the rigid screening process and have all of the required information in place. People we spoke to told us the staffing levels were Enough to meet our needs. People said they Never have to wait too long for assistance. People spoke positively about the staff team and some of the comments made include the following: The staff look after me very well I am very happy here. The staff treat me with care, respect, and dignity, I am very happy with the care I receive. The staff attend to all our needs, no matter how busy, they are. Care Homes for Older People Page 22 of 29 Evidence: I am very happy, and content here. Discussions with the staff team confirmed that the staffing levels were sufficient to enable them to deliver person centred care. They demonstrated their enthusiasm, commitment and motivation to ensuring they support people to a good standard. We looked at the staff training matrix and this demonstrated that all of the staff have completed the required mandatory training. Decisions with staff members and their records confirmed this. The staff told us they are encouraged to undertake National Vocational Training at level 2 and nearly all of the staff have completed this, and have moved onto level 3. This ensures people are supported by a competent and skilled workforce. We looked at two newly employed staff members files. We found that majority of the required checks had been undertaken to ensure both staff members were suitable to work with vulnerable people. However we found gaps in both of the employment histories provided, and the references were not dated so we were unable to verify when this were received. The last person to be employed had a police check that had been completed by their previous employer, and this has been ported across. A risk assessment and additional evidence was not in place in keeping with current guidance to support that this person was suitable to work with people. The acting manager confirmed that he would process a new police check immediately, and both staff members were also asked to provide a revised full employment history. There was evidence to support that both staff members had completed both a service specific induction, and the Skills for Care induction standards. This ensures the staff members have the skills and knowledge for their role. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opinions are sought and acted upon to ensure the service is managed in the best interests of the people that live at the service. Evidence: The provider told us in their self assessment that people have the opportunity to participant in periodic meetings with the management and staff in order to discuss their opinions about the service. They also regularly complete satisfaction surveys, the results of which are collected and used to assist the staff and management in ensuring that the service is run in the best interests of people. We looked at the quality assurance report for 2009 and at the questionnaires that had been received by the service. The comments within the surveys were very positive regarding the care provided and it demonstrated that people were satisfied with the service they received. People told us they are consulted about the service delivery, both informally and Care Homes for Older People Page 24 of 29 Evidence: formally at the meetings they have. People said they can raise any comments at any time concerning any improvements they think could be made. The staff members we spoke to, told us they felt supported in their role, and they said I am very happy working here it is a lovely small home and the people are well cared for. I feel very supported and the providers are very nice and are always contactable. The staff files demonstrated that they have access to supervision, and team meetings. However the frequency of the supervision does not currently meet the National Minimum Standard, but the staff spoken with told us The office door is always open, so we only have to ask if we need any advice or support. Since our last visit the service has reviewed the way they manage peoples finances. They have decided not to hold any money in safekeeping for people. Instead the service pay for all additional costs, such as Chiropodist and hairdressing and then they invoice the person and their families the total cost. People and their families told us they were happy with the current systems in place. The information provided in the self assessment told us that all aspects of health and safety were monitored, reviewed and up to date. The service have received many compliment cards and some of these comments include: Thank you for all that you have done and the way you have looked after our relative. Thank you for the love and kindness given to my relative during their stay with you. Thank you for the care and support you give my relative, it is wonderful the way they have settled in the home. Thank you so much for all your care you have given, you have been very kind and caring. The service is currently seeking to appoint a manager as the provider covers both of these roles. The manager will be able to support the provider to ensure standards are maintained and the service is meeting peoples needs. Care Homes for Older People Page 25 of 29 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 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The garden area must be made safe. This is to enable people to access this area. 31/08/2010 2 29 19 A person must not be employed to work in the service until all of the required recruitment checks have been received. This is to ensure people employed are suitable to work with people. 30/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Peoples care plans should be rewiewed on a monthly basis. Any identified changes should be reflected in the plan of care. People should have a person centred plan of care developed in consultation with them, and which covers all of their holistic needs. 2 7 Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 3 8 All people should have risks assessemnts completed which cover all of their helath care needs. these should be reviewed on a mothly basis. Handwritten medication instructions should be countersigned by two people to ensure they are validated. All codes that are used on the medication record should be defined. This is to ensure that clear records are in place to demonstrate why people have not had their medication administered as prescribed. The medication fridge temperture should be monitored on a daily basis. Regular audits should be undertaken of the medication practices, to identify and address any shortfalls. These audits should be recorded. People who are responsible for the administration of medication should have an assessment of competency undertaken, to ensure they are following the procedures in place. A controlled drug register should be obtained in order to record the receipt and adminstration of controlled drugs. All people should have a care plan completed reflecting their social and cultural needs and prefrences. The menu should be displayed, which should reflect what choices are available each day. Peoples dietary requirements should be recorded within their file, so the catering staff can access these, and be aware of their preferences. 4 5 9 9 6 7 9 9 8 9 9 10 11 12 9 12 14 15 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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