Inspection on 14/04/10 for Ashville House

This is the latest available inspection report for this service, carried out on 14th April 2010.

CQC found this care home to be providing an Excellent 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.

Other inspections for this house

Ashville House 13/02/06

Ashville House 01/09/05

Ashville House 25/01/05

Ashville House 09/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Firstlings

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for older people Name: Address: Ashville House Fairfield Road Downham Market Norfolk PE38 9ET     The quality rating for this care home is:   three star excellent 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: Jane Craig     Date: 1 4 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 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: Ashville House Fairfield Road Downham Market Norfolk PE38 9ET 01366383428 01366383428 jayne@ashville-house.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): FJJ Healthcare Ltd Name of registered manager (if applicable) Mrs Jayne Anne Masterson Type of registration: Number of places registered: care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 42 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Ashville House is a care home providing personal care and accommodation for 42 older people. It is owned by F.J.J. Healthcare Limited, a company owned and managed by Darrell Jackson, Kate Jackson and Elizabeth Fielding. The home is located in the market town of Downham Market and is close to the shops, pubs and other amenities. The home is a large detached house set in its own grounds. A purpose built extension has been added to this home and this is of a very high standard. Thirty-four of the Care Homes for Older People Page 4 of 31 Over 65 42 0 Brief description of the care home bedrooms are single and twenty of these have an en-suite facility. One of the four double rooms has an en-suite facility. As a result of this extension, the facilities at the home have been significantly improved, for example, there is now a hairdressing room, two additional lounges, a purpose built laundry room and food stores, a staff room and a car parking area. A passenger lift provides access to the first floor. In April 2010 the weekly fees ranged from £390 to £530. There were extra charges for personal telephones, hairdressing, chiropody and personal newspapers. Information about the home, including the latest inspection report is available from the manager. 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: three star excellent 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 last key inspection on this service was completed on 6th June 2007. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 14th April 2010 by one regulatory inspector. At the time of the visit there were 41 people resident in the home. We met with some of them and asked about their views of Ashville House. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the registered manager, the owners of the home and members of the staff team. We looked around the home and viewed a number of documents and Care Homes for Older People Page 6 of 31 records. As part of the inspection process we sent out surveys to a random selection of people living and working at the home, in order to gain their views about various aspects of the service. We had a good response from both groups and information from surveys has been taken into account when making judgements about the service. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? At the time of our last inspection there were no requirements or recommendations to improve practice. The AQAA shows us that since the last inspection the service have Care Homes for Older People Page 8 of 31 identified areas where they felt they could do better and actions they have taken to improve the service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process helped to ensure that the home was suitable to meet the needs of the people who moved in. Evidence: People thinking of moving into the home were provided with a service users guide, which gave them essential information about the service and the facilities they could expect. New residents were given a a copy of the information booklet, which had been produced following a suggestion by a relative. The annual quality assurance assessment (AQAA) told us, We have used the views of residents and relatives regarding their experiences when drafting the booklet for new residents. The majority of people who completed surveys indicated that they received sufficient information about the home to assist them to make a choice about moving in. Anyone who wished to move into Ashville House was assessed by the manager or one of the owners before being offered a place. This helped to ensure that the persons Care Homes for Older People Page 11 of 31 Evidence: needs were understood and could be met at the home. It also reduced the risk of failed placements. The assessment identified the persons main health and personal care needs and included information about the persons preferences with regard to routines and support. The AQQA told us that, with the persons consent, they would contact the persons GP and other professionals to ensure that they had accurate information regarding the residents needs. The manager told us that she allocated a member of staff to spend time with new arrivals to help them to settle in. There was a checklist of tasks to be completed to help the person feel comfortable and orientated to the home. New residents also spent time with the manager or senior staff drawing up their care plan. Their reasons for deciding on residential care were recorded and appropriate goals and support were agreed. 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. Care met the assessed needs of people who use the service and was provided in a personal and dignified manner, however, medicines were not always managed in accordance with best practice guidance. Evidence: Care plans were drawn up in consultation with residents and families, if they wished for them to be involved. Residents histories, care needs and directions for support were set out in a single document. The plan was quite brief but contained all the essential information, including residents wishes with regard to their care. For example, the plan for one person told staff that they liked to wear night clothing in their favourite colour and another recorded the residents wish not to be woken during night checks. Care plans included directions to assist people to make choices and to maintain their independence. One persons plan stated that they could carry out most of their own personal care but liked staff to check on them regularly in case they may need some assistance. Residents confirmed that staff supported them to do what they could for themselves. One person said, I like to be independent, they know its a struggle and they do what I cant. Care Homes for Older People Page 13 of 31 Evidence: Some of the directions for staff were not completely clear and could be open to different interpretations. However, there were good systems of verbal communication and the staff we spoke to were clear about the needs of each person and their preferences for support. For example, one plan indicated that thickener could be used in the residents drinks but did not specify when this was to be used or to what consistency. The staff we spoke to were able to describe how this was used and it was apparent that the person was receiving consistent support. Of the nine residents who completed surveys, seven told us that they always received the care and support they needed and two told us they usually did. One person wrote, I am well taken care of. Several staff and residents we spoke to during our visit told us that the home had high standards of care. Care plans were reviewed each month. They were amended between reviews if the residents care needs changed. The manager told us that care was mainly evaluated after discussions with the resident about their care, and through verbal feedback from the staff team. Progress notes, which were also used to assist in the evaluation process, were not written every day. This could mean that the progress of health related issues, such as pressure sores may not be reported on consistently. Despite the lack of daily reports, six out of the seven staff who completed surveys told us that they were always given up to date information about the people they supported and one told us they usually were. People in the home were able to access health care services. Ongoing involvement of healthcare specialists and visits from the GP and district nurses were recorded on care plans. Residents were also supported to access appointments with chiropodists and opticians. One of the staff who completed a survey commented that the staff had good relationships with doctors, district nurses and ambulance services. There were moving and handling plans on residents files. Records of falls were audited, which helped to identify residents who were were at high risk of falls. Residents who had a history of falls were referred for specialist advice from the falls team. Residents thought to be at risk of developing pressure sores were referred to the district nurses for advice about equipment and treatment. All of the residents who completed surveys indicated that staff made sure they received the medical care they needed. From observations carried out at the time of our visit and conversations with people living in the home, it was apparent that staff treated people with dignity and respected Care Homes for Older People Page 14 of 31 Evidence: their privacy. Staff did not enter residents rooms without being invited. They spoke to people politely and with respect. One resident told us, They treat us beautifully, and a member of staff commented, Everyone is polite and caring. We looked at the systems for storing, recording and administering medication. One resident administered some of their own medication. They had been assessed as being capable and safe to do so and there was a note on the assessment that it was reviewed every month. All staff with responsibility for managing medication had received appropriate training. Medication in daily use was stored in locked trolleys or the medication refrigerator in a ground floor office. We looked at the temperature records for the medicine refrigerator and found them to be within the accepted range. Staff did not check the temperatures of other storage facilities to ensure that medicines were being stored at temperatures recommended by the manufacturer. Most medicines were administered via a monitored dose system (MDS). Medicines that were not suitable for packaging in this way were also stored in the trolleys. However, some strips of tablets and sachets of medicine had been removed from their original packaging. Although there was no risk that peoples medication could be mixed up, removing them from the boxes meant that staff did not check the instructions on the dispensing label against the medication administration record (MAR) chart when they were giving out these medicines. We also found that residents who were prescribed Movicol were not being given the medication out of their own stock. The manager told us this was because of a lack of storage space in the trolley. The practice of sharing medication is not good practice and prevents staff from being able to audit whether medication has been given correctly. The manager carried out a monthly audit of some of the practices relating to medicines management but this did not include checking stocks of medicines, that were not in the MDS, against the records, to ensure they were being given correctly. We were unable to carry out an audit of medicines that were not in the MDS. This was because some of the records of medicines received into the home were not complete. There was also a lack of records of stock carried over from the previous month, which made audit difficult without tracing back records over previous months. We were unable to check the record of returns because the book was still with the pharmacist. There were no gaps on any of the MAR charts we looked at. There were codes to show when and why medicines had not been given. Some of the entries on the MAR charts were handwritten, these were not routinely Care Homes for Older People Page 15 of 31 Evidence: checked to reduce the risk of transcribing errors. However, the ones we looked at matched the information on the medication labels. Some of the instructions on the MAR charts had been changed from a regular daily dose to when required(PRN). There was no information to show that this had been authorised by the prescriber. Several residents were prescribed PRN medication. We were told that all of these residents were able to decide whether they needed their medication so that it was never left to the discretion of staff. Care Homes for Older People Page 16 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service had choice and control in their daily lives and the level of social and recreational activities met their needs. Evidence: The residents we spoke to about their experiences of living at Ashville House all made positive comments. One person said, I like everything, I am extremely happy, and another said, This is a pretty good home. My family say they dont need to worry about me now. Several residents and staff who returned surveys commented that the home had a friendly, happy and homely atmosphere. Staff told us that they made sure that residents had choices in all aspects of their daily lives. One member of staff said, We get to know people and what they like, we try to give people a nice quality of life. Another said, The home is run for the residents not the convenience of the staff; there is no-one here who does not put the residents before themselves. Care plans contained information about the residents preferred daily routines. The manager told us that these were kept under review and residents were regularly asked whether they were still happy with what was written down. Residents we spoke to confirmed that they had choices. One person said, It doesnt Care Homes for Older People Page 17 of 31 Evidence: matter when you go to bed, we have complete freedom. Another commented, They go along with what we want. There was a good range of activities on offer in the home. The manager told us that staff found out about peoples interests and tried to organise activities around this. There were a number of clubs and groups, such as the knitting and stitching group, art group and cookery group. The activity co-ordinator leads the majority of the activities and some staff with areas of special interest lead small interest groups. The manager was developing a book club and there was a well established gardening group that took responsibility for a specific area of the garden. During the week of our visit there had been a classical music evening, an art session attended by a local artist and a religious service. Six of the people who returned surveys indicated that there were always activities that they could join and three people said there usually were. Residents we spoke to during our visit were satisfied with the level and range of activities. One person said, There is something for everyone; I pick and choose what I want to do. Another person said, There is always something to look forward to, they celebrate things and make an effort on special days. Several of the staff who completed surveys wrote that entertainment and activities was something the home did well. There was open visiting in the home, which helped people to be able to keep in touch with family and friends. One of the residents who completed a survey wrote, The home is always accessible to visitors. The home had links with the local community, for example, there was a continued joint project with the local school. People were able to use community facilities with the help of relatives or staff. One member of staff said, If people want to go out we take them. There were a number of group outings, especially in the summer months. The manager told us that they were trying to arrange more individual outings with people who did not like going out with a group. Six people who completed surveys indicated that they always liked the meals, two said they usually did and one said only sometimes. There were mixed written comments, with one person saying that good, cooked meals were something the service did well and another person commenting, The meals are not always good, they could be better. We also heard mixed comments during our visit. For example, one resident told us the lunchtime meal was tasteless, but another said the food was, fantastic. Another person told us that staff arranged occasional banquets and residents were able to invite guests to dine with them. The minutes of the residents meeting showed that the topic of meals was always on the agenda and the manager and staff tried to act upon peoples suggestions and comments. The menu showed that people were offered a varied diet. People told us they could have something different if they did Care Homes for Older People Page 18 of 31 Evidence: not like what was on the lunchtime menu and they had at least three choices in the evening. The lunchtime meal on the day of our visit was a social occasion. The dining room was pleasantly laid out with sufficient space to accommodate people with walking aids and wheelchairs. Staff provided assistance in a sensitive manner. Care Homes for Older People Page 19 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. People using the service could be confident that complaints would be dealt with appropriately. Safeguarding guidance and staff training helped to protect people from abuse and harm. Evidence: There was a clear complaints procedure on display, which told people that complaints were taken seriously and would be acted upon. The contact details for the Care Quality Commission were out of date. Everyone who completed a survey said they had someone they could speak to informally if they were not happy at the home. Three people said they did not know how to make a formal complaint. The manager said that she would include an up to date copy of the complaints procedure in the new information booklet to ensure that all residents would have access to the procedure. Staff who returned surveys indicated that they knew how to respond if anyone raised concerns. The AQAA told us that there had been no complaints made directly to the home and CQC had not received any concerns or complaints about Ashville House. Staff received training in safeguarding vulnerable adults and had the Norfolk County Council procedure to refer to. The policy and procedure for Ashville House gave staff an overview about safeguarding, including definitions and types of abuse but lacked a Care Homes for Older People Page 20 of 31 Evidence: clear procedure for reporting incidents outside the home, including contact details for external agencies. Staff we spoke to were aware of their responsibility to report any allegation or suspicion of abuse or harm. One member of staff told us, I would like to think it would not happen here but can never say never, I would always report to a senior. There had been no safeguarding referrals in the past year. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service lived in a clean, comfortable and safe home. Evidence: The AQAA told us that the property is maintained to a high standard and that there is an ongoing decoration programme, with refurbishment taking place as required. The parts of the home we looked at were decorated and furnished to a good standard. All areas we saw were in a good state of repair. We pointed out that a lock was missing from one of the bathrooms and this was attended to before the end of our visit. There were safety measures in place, such as radiator guards. Bedroom windows had restricted openings, which provided added security for residents. There was equipment throughout the home to help people to remain independent and to assist people with restricted mobility. Since our last inspection there had been significant improvements to the gardens and they gave residents a pleasant place to look at, sit or walk. One resident told us that the gardens were beautiful and well worth the effort of walking around. Residents involved in the gardening group were responsible for planting and caring for the raised flower beds and other residents joined in as they wished. Everyone we spoke to was happy with the general environment and their bedrooms in particular. The bedrooms we looked at were personalised with furniture and Care Homes for Older People Page 22 of 31 Evidence: ornaments. Some had views of the gardens or the river and one person we spoke to said they had A fantastic room and view. Bedrooms varied in size and shape. Some bedrooms did not have en-suite facilities. There were four shared rooms. There was an additional charge if a resident wished to be the sole occupant of a shared room. This charge did not apply if the resident was agreeable to sharing. One of the proprietors told us that when a room became vacant they looked at whether it may be more suitable for one of the people currently using the service before it was offered to a new person. At the time of our visit all areas of the home were clean and fresh smelling. Everyone who returned surveys indicated that that it was always like that. The AQAA told us that all staff had received training in infection prevention and control and we noted that there was guidance for staff on display in the staff office. There were ample hand washing facilities around the home and staff wore gloves and aprons when attending to individual residents, which helped to minimise the spread of infection. A member of staff told us that infection control was seen as important at Ashville House. Care Homes for Older People Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are protected by the services recruitment process and benefit from a well trained and supported staff team. Evidence: The AQAA stated, There is a defined staffing level for each shift and this level is always met even if this requires the person on-call to come in and work. The records we looked at confirmed this and the manager told us that she had some flexibility to bring in extra staff if needed. Three of the residents who completed surveys indicated that staff were always available when needed and six said there usually were. Most people we spoke to during our visit confirmed that they did not have to wait long for attention. One resident said, Basically there are enough staff but sometimes during handover they are a bit short so I try not to ring then. Another person told us, I think there are enough staff to help people. During our visit we noted that call bells were answered quickly and residents were attended to promptly. We looked at the files of two newly appointed staff. They had both completed application forms and had face to face interviews. To help to ensure fairness and equity, applicants with experience were asked slightly different questions than staff without. We were told that references were returned before the applicants started work but those we saw were not dated so this could not be evidenced. Preemployment checks were carried out to ensure that applicants had not committed any Care Homes for Older People Page 24 of 31 Evidence: offences that precluded them from working with vulnerable adults. Staff who completed surveys all confirmed that the manager had carried out all the relevant checks before they started work. New staff went through a thorough induction training programme that was supervised by the manager. The programme, which met the Skills for Care Common Induction Standards, comprised discussions, self study and shadowing senior staff. The new staff have assessments of competence to ensure that they develop the practical skills to match the theory. The AQAA told us that staff training is a priority of the service. All staff had an individual training plan that was identified during the supervision process. Mandatory training in health and safety topics was kept up to date. Staff who completed surveys said they received training that kept their practice up to date and helped them to meet the needs of people using the service. One wrote, They are proactive in respect of staff training and development, and another told us that the owners were very good about funding any training that was necessary. Over half of the care staff held a National Vocational Qualification (NVQ) in health and social care, at level 2 or above. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service, and staff, benefit from a safe and well managed home. Evidence: The manager has the appropriate qualifications and experience to run the care home and since our last inspection she had registered with the Commission. The manager was supported in her role by a deputy manager and senior care staff. She told us she was also very well supported by the owners, who continue to have an active role in the running of the home. Staff who completed surveys and those we spoke to said that they received regular supervision from the manager. Staff and residents told us they thought the home was organised and well managed by the manager and the owners. One said, The good standards come from the top, and a resident wrote, Very good management, I feel they really care about the residents. There were a number of systems in place to monitor the quality of the service, which Care Homes for Older People Page 26 of 31 Evidence: included seeking the views of residents and relatives. The report of the last years survey showed that people were satisfied with the service and there were some very positive comments, especially from relatives. Where comments were less favourable, there was a was a list of actions required and taken. These were mainly around food and changes were made to the menus. The manager held residents meetings and the minutes showed that any suggestions they made were acted upon. The AQAA told us that health and safety issues are taken seriously, and the manager wrote,All staff are kept up to date with the required training in order for them to feel confident in their work and to ensure that they and the residents are kept safe and secure. The training included formal fire safety training and the deputy manager said that they often brought up fire procedures during the handover discussions. Staff we asked were clear about their role in the event of a fire. Fire safety equipment was tested and serviced regularly. The AQAA told us that maintenance and servicing of other installations and equipment was up to date. 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 Medicines must be given from the container that the pharmacist provides. The container must have the persons name on the label and the full instructions for the care worker to refer to. This is to ensure that medication is administered safely and in accordance with the prescribers instructions. 14/05/2010 2 9 13 There must be a clear and accurate record of all medicines received into the home. This is to ensure that there is a clear audit trail. 14/05/2010 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 Care plans should include more specific directions with regard to health care practices to ensure that staff have clear written instructions to refer to. There should be daily progress notes to record the residents progress and general well-being and to assist in the evaluation process. The temperature of the room used to store medicines should be monitored to ensure that they are stored at the temperatures recommended by the manufacturers. There should be a protocol for accepting and recording verbal instructions for changes of medicines from regular doses to when required (PRN). 2 7 3 9 4 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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