Inspection on 25/08/09 for Cherry Acre

This is the latest available inspection report for this service, carried out on 25th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherry Acre 11/04/08

Cherry Acre 23/10/07

Cherry Acre 27/04/07

Cherry Acre 06/10/06

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Cherry Acre 21 Berengrave Lane Rainham Gillingham Kent ME8 7LS     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: Anne Butts     Date: 2 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Cherry Acre 21 Berengrave Lane Rainham Gillingham Kent ME8 7LS 01634388876 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: cherryacre5@aol.com Uday Kumar,Kiranjit Juttla-Kumar care home 17 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 to be accommodated is 17 The registered person may provide the following category 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 category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Cherry Acre Residential Home provides personal care and accommodation for up to 17 older people and is owned and managed by Mr Uday Kumar. The home does not offer nursing or intermediate care. The home occupies detached premises and is located in a residential area, close to local shops and on a bus route. The premises are large with ample parking and established mature gardens to the front and to the rear of the property, which are easily accessible. Residents accommodation is arranged over two floors. There is no passenger shaft or Care Homes for Older People Page 4 of 30 Over 65 17 0 2 7 0 2 2 0 0 9 Brief description of the care home stair lift to the second floor. A call bell is installed within each of the 17 single bedrooms to alert staff; all bedrooms have television aerial points. Telephone points can be installed if required at the individuals cost. No bedrooms have en-suite facilities. All bedrooms include a wash hand basin. The home employs care staff working a roster, which gives 24-hour cover. Ancillary staff for catering and domestic duties are also employed. Current fees range from £323 to £550 per week according to assessed personal need. Please contact the manager for further information. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 was a key unannounced inspection that took place over the course of one day and was carried out by two inspectors. We looked at the outcomes for people against the key national minimum standards. Judgments have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the Care Quality Commission (CQC) to be able to make an informed decision about each outcome area. We (the Care Quality Commission) spent time looking around the building and talking to people living in the home. We also spoke to staff, the manager and the registered provider. We looked at records maintained in the home including a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. Prior to our visit we sent out surveys to residents and staff. We Care Homes for Older People Page 6 of 30 had eight residents surveys and two staff surveys returned. We also looked at information that had been provided to since our last inspection. The owner has appointed a person to run the home on a day to day basis in the position of manager. They are not registered with the commission, but will be referred to as the manager within this report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home is currently not registered to admit people with a diagnosis of dementia; assessments need to fully explore any cognitive needs in order to ensure they do not admit anyone whose needs they cannot meet. The procedures in the home support people with their medication, there is some lack of clear guidance relating to the administration of a particular medication, which requires different dosages on different days. This is not identified on the Medication Administration Record (MAR) sheets and staff have to access a different document to check the dosage amount. The registered provider needs to ensure that this system is robust. Staffing levels meet the daily care needs of the people currently living in the home. Care Homes for Older People Page 8 of 30 People, however, who are fully dependent upon care staff for their mobility needs do not always have the opportunity to make an informed choice as to how they spend their day. Their perception is that they do not like to be a burden to staff. The registered provider needs to ensure that people are supported with this so that they can be confident about making a preferred choice as to how they spend their day. Records need to be clearly maintained to reflect how people choose to spend their day. The seating in the lounge area is still low with people sitting on two or three cushions. The registered provider told us that this is on his improvement agenda and that it will be addressed. Recruitment procedures are primarily sound and the manager demonstrated a good understanding of the checks required. There was one file which only had one reference and this was not addressed to the home. The home needs to ensure that all staff are subject to full recruitment checks. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their families benefit from having the opportunity to visit the home prior to moving in and the assessment process meets their needs adequately. However people would benefit from some parts of this process being more in-depth in order to fully explore individual needs. Evidence: At our last visit we found that there is a Statement of Purpose in place and that is provided people with the information they needed to make a judgement about the home. In order for people to be able to be confident that the home they will move into is able to meet their assessed needs, a full pre-assessment needs to be carried out. At our last visit we saw that the pre-assessment process was not robust. We looked at the assessments for two new people who had moved into the home. We saw that this process had improved and the manager had implemented a full assessment of need. Care Homes for Older People Page 11 of 30 Evidence: This covered all the areas as described in the National Minimum Standards for Older People. We saw, however, that there were some parts of the assessment which had not been completed. For example one assessment did not identify current medication needs or the level of personal support needs. We also saw that a pre-assessment identified that people could be forgetful or become confused. In order to ensure that they do not admit someone out of category, the home needs fully explore this in so that they do not admit anyone whose needs they cannot meet. We saw that one person needs had changed and the home had identified that they could not fully meet the needs of this person and had arranged for them to be reassessed, with a view to this person moving to a more appropriate home. This shows that they are aware of their responsibilities in relation to individual people and will take appropriate action. Training has improved so that staff can meet the needs of the people living in the home. Prospective residents and their relatives are welcome to visit the home prior to moving in. The home does not provide intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people benefited from improved care plans, the further development of these would enhance the individual support provided. Healthcare needs are met with people having access to healthcare professionals as required. People are supported with the medication. Evidence: Since our last visit the manager has fully implemented the new care planning system and we saw that this was in place for all people living in the home. We looked at the care plans for four people. The care plans are based on a clinical model and therefore this reduces their effectiveness in relation to being person centred. They identified areas of support needed, but not all areas gave clear individual guidance on how to support the person. Some parts of the care plans were more informative than others and identified choices Care Homes for Older People Page 13 of 30 Evidence: and preferences. Other parts, however, were more generic and did not give clear guidance to staff. For example the parts of the care plans which referred to how to assist people with their moving and handling did not show how a person needed to be assisted or what they could or could not manage. Some of the information was spread out within the care plans which meant that this has the potential for staff to miss relevant information. A care plan for one person, however, identified that there were some behavioural issues and although parts of the support guidance was generic, it also identified individual triggers and how to support the person with this. There was limited information in relation to life or biographical histories, although staff we spoke to were able to demonstrate a good knowledge of this. The manager told us that she is currently working with the key workers to implement a life history for people. Staff reported to us that they found the new care plans more informative and gave better guidance. The manager needs to ensure that all parts of the care plans are relevant to the individual and give clear guidance to staff. There are a variety of risk assessments in place to support people including ones for movement and handling. As with the care plans, some parts are generic and lack clear guidance on individual needs and others are specific to the individual. Discussions with the manager evidenced that she is aware of how to further develop these so they fully support the individual. At our last visit we saw that the dates of reviews of assessments were misleading, but at this visit we saw that the manager had addressed this. This now meant that people can be confident that their needs are reviewed on a regular basis. Records evidenced that people were supported with their healthcare needs and that people had access to the District Nurse, G.P., chiropodist, dentist and other healthcare professionals. We saw that one person had an oxygen cylinder, and they told us they used it. Records, however, evidenced that it was no longer in use and the manager confirmed that this was the case. The home needs to ensure that where people are no longer using specialist equipment they are fully supported through any transitional period. Some of the records viewed, weight charts for example and some assessments, were not dated or signed and the home needs to ensure that this happens, so that they are able to ensure that they can monitor any changes in need. We observed the management of the lunchtime medication and also reviewed the Care Homes for Older People Page 14 of 30 Evidence: storage and medication administration record (MAR) Sheets. People were assisted with their medication in a sensitive manner. We saw, however, that three people were offered pain relief as a matter of routine, rather than because there was a need. We asked the carer about this and she said it was because it was written on the Mar sheet so it would always be offered. Consideration should be given to this and whether it is appropriate to offer people medication that it used on an as and when basis routinely. The home primarily uses a monitored dosage system, which is where medication is dispensed from the chemist into individual packs. We checked these against the MAR sheets and saw that there were no errors. The MAR sheets are provided by the dispensing chemist with the prescription details, however sometimes during the month people need additional medication and this is handwritten onto the MAR sheets. We saw that these were accurate but there needs to be a system in place to ensure that these entries are countersigned to validate accuracy. Some people are also prescribed a medication which did not have the administration details on the MAR sheets, which meant that staff had to access this information elsewhere. This has the potential for errors to be made and the registered provider needs to ensure that there is clear guidance readily available for staff. There are clear protocols for homely remedies, the home maintains records of any known side effects for medication used in the home and only staff who are trained administer medication. People living in the home are treated with dignity and their right to privacy is respected. It was observed on the day of our visit that staff spoke to residents in a polite manner and treated people with respect. People living in the home were complimentary of the support provided and said that they felt they were treated with dignity. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with a range of social and recreational activities. Some people with higher mobility needs do not always have the opportunity to make an individual choice as to how they will spend their day. Residents are able to maintain contact with family and friends as they wish. People benefit from a healthy varied diet which meets their assessed needs. Evidence: We spoke to people about their experiences about living in the home. People told us that they were happy and that they found the staff kind and caring. There is an activities co-ordinator who also undertakes domestic duties in the home. On the day of our visit we did not see any one participating in any activities. Discussions with people showed that there was a varied level of interest in participating in activities. Three people we spoke to said that they did get bored and another said that there was not enough to do in the way of organised activities. Other people said that they preferred to spend their time either reading or watching television. Another person said that they enjoyed the entertainment and another person said that they did not get bored. We saw that the care plans did identify some individual preferences and we Care Homes for Older People Page 16 of 30 Evidence: were also told that people have the opportunity to go out on trips. An improvement plan put in place by the registered provider identifies that this is an area that they are currently addressing. Daily papers are delivered for residents and there is a variety of books and magazines provided. On the day of our visit we saw that a large proportion of people spent the majority of their day in their rooms. The manager told us that this was individual choice. We spoke to one lady, who needed assistance with all her mobility needs. She told us that staff will ask her if she wants to go into the lounge, but said that as she does not like to be a burden to staff she will usually say no. The registered provider needs to ensure that where individual mobility needs restrict people then assessments need to record action taken and show how people are supported with making a choice about how they spend their day. Visitors are welcome at any reasonable time and people told us that visiting times are flexible. We joined service users for lunch and found that it was appetising and well presented. There is a choice of meals available and people confirmed that they were asked what they would like. People were given a choice of drinks with their meal including a glass of beer or wine if they chose. The pace of the meal was unhurried and people were supported in a sensitive manner. The evening meal usually consists of a selection of sandwiches although people told us that they could have a hot snack if they preferred. The cook confirmed that afternoon staff would prepare this if requested. People can chose where they have their meal, with many people choosing to eat in the dining area and others preferring their own rooms. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives or representatives can be confident that their complaints are taken seriously and acted upon. Staff have been trained in adult protection procedures. Procedures for management cover, when the manager is not available need to improve. Evidence: There is a complaints procedure in place and people we spoke to all said that they would be happy to raise any concerns with the manager. The manager told us that there had been a complaint since our last visit. We looked at records at how this was managed and saw that they dealt with this in an appropriate manner. We (the commission) have not received any complaints about the service. At the time of our last visit there had been an adult protection alert open following an incident in the home. Prior to our inspection this time, the alert had been investigated and closed by the Safeguarding Adults team. At the time of this visit the home was subject to another unrelated adult protection alert following an incident in the home, whereby, a hoist was not available. The manager was on annual leave and the action taken at the time of this incident did not demonstrate that there was a robust on call system in place that would enable staff to be able to get in touch with the nominated contactable person. There is guidance in Care Homes for Older People Page 18 of 30 Evidence: place for staff to for the management of incidents. The registered provider also told us that he had taken action to address the support provided at the time of this incident. This adult protection alert has now also been closed. Staff have benefited from training in adult protection issues and staff we spoke to were able to demonstrate a knowledge of action they should take. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a homely and clean environment. Not all areas of the home promote individuals health and safety. Evidence: The home is set out over two floors and sits in its own grounds with car parking to the front and a large lawn area to the rear. The home is non smoking. There is a large communal sitting room and a separate dining area. Since our last visit the registered provider has addressed some health and safety issues in the sitting room, in that radiators are now covered, a wall heater has been serviced and a loose junction box and been fixed. The carpets, however, are in need of cleaning and the lounge furniture, although domestic in nature, is still low. People have to sit on two or three cushions and people we spoke to all said that they had some difficulty in getting out of some of the settees and chairs. Returned surveys also commented that the furniture in the lounge is too low. We spoke to the registered provider about this and he told us that there is an improvement plan in place to address this. At the time of our visit the television was on in the lounge area and we saw that there was a poor reception, we asked people about this and they said that this was usually the case. Some televisions in the bedrooms also received a poor reception. One person said that they would like to have access to Sky TV. Care Homes for Older People Page 20 of 30 Evidence: Other areas of improvement in the environment include the restoration of the windows to the dining area and the completion of the redecoration of some of the bedrooms. All toilet facilities are now available for use and no longer used as a storage area. All bedrooms are single occupancy. We looked at a selection of peoples bedrooms and spoke to people living in the home. People were generally happy with their rooms and they were personalised with peoples own possessions. Bedrooms were primarily clean and tidy but we saw that one room had furniture with broken drawers and the window restrictor, which is in place to ensure that there is not a risk to the persons whose room it is, could be detached. Therefore, having the potential to pose a health and safety risk. In this room there were also electrical leads trailing across the floor and posing a trip hazard. The registered provider needs to ensure that all areas of the home including individual bedrooms do not pose a health and safety risk to people living in the home. Comments from returned surveys included always clean and tidy and the washing facilities are always clean. The registered provider has had plans approved for a lift to be installed. He told us that this is still within his improvement plans and it will be an area that he will address. Feedback from people living in the home indicated that those people living on the first floor felt that they would benefit from the use of a lift. On the day of our visit the laundry and kitchen areas were clean and fit for purpose. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by a staff group who have a good understanding of their needs. Improved training has further supported staff in providing care to people. Staffing levels need to be kept under review in order to meet the assessed needs of all the people living in the home. Evidence: We spoke to three members of staff on the day of our inspection and received three staff surveys. Staff spoke positively about working at the home and all said that they felt well supported. Comments included I enjoy my job and feel that the new manager is an asset. We looked at four staff files in relation to the recruitment procedures for the home. The manager has taken over responsibility for this from the owner. At our last visit we identified that the application form and interview process were not robust. The manager has improved this with a more in depth application form and also implemented records for interview notes. Records we looked at all contained evidence that staff were in receipt of a clear Protection of Vulnerable Adults (POVA) first and Criminal Records Bureau (CRB) check. We saw that on three of the four files viewed appropriate references were in place, however on the fourth file there was only one Care Homes for Older People Page 22 of 30 Evidence: reference and this was addressed to whom it may concern. This is not in line with regulation and the manager needs to ensure that all staff have the appropriate references in place. The manager advised that she is also working with a management consultancy agency to ensure that their procedures are in lines with regulation. We looked at the induction process for new staff and the manager was able to evidence that they undertake an induction in line with the Skills for Care common induction standards. Staff surveys all confirmed that they had undertaken induction. Training has improved and a previous requirement relating to training has been deemed as met. For example staff have benefited from training in protection of vulnerable adults, infection control, food hygiene and movement and handling. The majority of staff have been enrolled on a distance learning training course for dementia and some members of staff are also undergoing training in end of life issues. All current staff at the time of our visit had also been enrolled on a National Vocational Qualification (NVQ) course in care. A requirement was made at our last visit about staffing levels. At this visit we were told that there were always two members of care staff on duty at all times. In addition there is a housekeeper and a cook and the manager is available during office hours. The registered provider told us that they use a care staffing forum to ensure that they have sufficient staff. We were also told that extra staff are rostered on duty to support people with appointments and on the day of our visit we saw that this was in place. There are sufficient staff to meet the essential care needs of people living in the home, staffing levels indicated that people with higher needs who remain in their rooms may not always benefit from person centred support. Staff surveys told us that sometimes staffing levels needed to be higher and there was a mixed response from service users with people saying that there was usually enough staff but sometimes they felt that the home was short staffed. The registered provider does need to keep this under review. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a manager who is committed to ensuring that he home is run in their best interests. A lack of robust support when the manager is not available has the potential to put service users at risk. Improved quality assurance systems are supporting people to have a say in how the home is managed. Evidence: At our last visit in February 2009, the registered provider, who is also the registered manager, had employed a new manager to take over the day to day running of the home, and the registered provider confirmed that this has happened. He told us that he is taking a back seat in order to allow the manager to improve the service. The manager told us that she was currently in the process of starting to apply to be the registered manager of the service. At the time of our visit this was ongoing. As all services need a registered manager we are making a requirement in relation to this. Care Homes for Older People Page 24 of 30 Evidence: The manager has made some improvements in the service which have been reflected throughout this report. She said that she is confident the systems she is putting into place will help monitor practice and support the improvement of the service. There are still some areas which need development and monitoring and these have also been reflected throughout this report. The manager has introduced new monitoring and auditing systems in order to monitor and improve the quality of the service provided. One area that has benefited from this is the monitoring of falls and this has now been reduced and the manager has sought assistance from the falls clinic. The manager is also introducing clear guidance for different areas of good practice in the home. For example in relation to emergency procedures she has introduced a clear system for staff to follow and she told us that this had been beneficial. Quality assurance processes have improved and the manager told us that residents and families have been involved in this. The home has sought peoples opinion on the meals and has devised a new menu after hearing what people had to say. The manager is aware of new legislation in relation to people with regards to the Mental Capacity Act and Deprivation of Liberty safeguards. She told us that currently there is no one living in the home subject to this. The home has a system in place so that all appropriate maintenance checks are carried out. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 The registered provider shall 31/01/2010 not provide accommodation unless the needs of the service user have been fully assessed. In that for new residents all areas of support are fully assessed including cognitive needs to ensure that the home can meet the individual needs and to ensure that people are not admitted out of category. 2 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines in the care home. In that the dosage instructions are clearly available for staff. 31/01/2010 Care Homes for Older People Page 27 of 30 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 3 19 23 The registered provider shall 31/01/2010 ensure that all parts of the home as far as is reasonably practicable are free from hazards. The registered provider must ensure that he adheres to his improvement plan with regards to communal furniture. Bedrooms must be free from hazards. 4 31 31 Any person who carried on 31/03/2010 or manages an establishment or agency of any description without being registered under this part in respect of its (as an establishment or, as the case may be, agency of that description) shall be guilty of an offence. Care Standards Act 2000 (11 (1)) made for a registered manager by date set 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 27 it is recommended that the registered provider keeps staffing levels under review and monitor the individual assessed needs of the people living in the home at all times. This is so that peoples ongoing changing needs are kept under review. Page 28 of 30 Care Homes for Older People 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 2 31 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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