Inspection on 31/03/10 for Dunedin Residential Care Home

This is the latest available inspection report for this service, carried out on 31st March 2010.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Key inspection report Care homes for older people Name: Address: Dunedin Residential Care Home 10 Connaught Gardens East Clacton-On-Sea Essex CO15 6HY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Laker     Date: 3 1 0 3 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 27 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 27 Information about the care home Name of care home: Address: Dunedin Residential Care Home 10 Connaught Gardens East Clacton-On-Sea Essex CO15 6HY 01255476484 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): dunedinres@tiscali.co.uk Mr Manilall Rambojun,Mr Mahmood Hussain Raja,Dr Tabraiz Name of registered manager (if applicable) Sandra O`Neil Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 20 The registered person may provide the following categories 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 Dementia - Code DE Date of last inspection Brief description of the care home Dunedin is an established care home, which provides residential care for older people with dementia. It is a large detached three-storey property situated in a quiet residential area of Clacton-on-Sea. There is registered accommodation for twenty service users. The home is situated close to the sea front, with local shops, GP Care Homes for Older People Page 4 of 27 Over 65 0 20 20 0 Brief description of the care home surgeries and churches close by. The property has impressive gardens to the front, side and rear of the property, with car parking to the side of the property. The lounge and conservatory overlook the rear garden, which is laid to lawn with fruit trees, a summerhouse and flower borders. Adjoining the lounge there is a dining room. Within the grounds is a privately rented property to the rear of the garden, and access to the property is via the front of the property driveway and side gate. This does not include access to the residential home itself. Accommodation for service users is on the ground, first and second floors, with passenger lift access. The accommodation comprises of one double and eighteen single rooms. Six rooms have en-suite facilities of a toilet and a wash hand basin. Catering and laundry services are in-house. The current range of fees, as at the inspection visit were said to be GBP 400.40 to GBP 462.00 per week with en-suite. Toiletries, newspapers, hairdressing and chiropody are an extra cost. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out on the 31st March 2010. An application for the home to provide care for people with dementia has now been approved. As part of the inspection we checked information received by Care Quality Commission (CQC), looking at records and documents at the care home and talking to the proprietor, care staff and the people living at the home. the manager was not on duty on the day of inspection. A tour of the premises was completed at the visit to the care home. The Annual Quality Assurance Assessment (AQAA) completed by the home was considered as part of the inspection process and is required by law. This contained information about what they felt they did well. The information was brief and did not always tell us how the service was seeking to improve the outcomes for people living at the service, beyond their present provision. We sent surveys to people living in the home and their relatives. There was a good response and the information contained in these was used to inform Care Homes for Older People Page 6 of 27 us on some of the outcomes for people using the service. The staff and the proprietor assisted the inspector at the site visit. Feedback on findings was given during the visit with the opportunity for discussion or clarification. We would like to thank the proprietor, the staff team, and people living at the service and their relatives for their help throughout the inspection process. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 27 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 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People considering moving into the home can generally be assured that their needs will be considered before any agreement to their admission. They cannot be fully assured that these needs will always be documented fully. Evidence: The assessment documents of the people who were most recently admitted to the home were considered at this inspection visit. These included the social workers initial assessment (COMM 5) of the person that detailed the basic reasons why the person needed to move to a residential care setting and gives some background to their previous history. This information is supported by the services own assessment which has been reviewed prior to the homes last inspection with new documentation now in place. It is divided into two sections physical health and mental health. This form covers Care Homes for Older People Page 11 of 27 Evidence: essential admission information about the individual and their needs in terms of daily living including such issues as mobility and skin health and the service users own perception of their mental health. In the two records reviewed some areas of the assessment could have been completed with more specific detail. For example one assessment reviewed was undated and gave no indication of where the assessment took place. It also included comments under the heading for sight just Wears all the time with no reference as to what was worn. Gaps and no entries at all were noted for mental health assessment, dexterity and physical wellbeing. The format used by the service would provide sufficient information to determine the suitability of the persons admission to the service, although this could be undermined by the lack of consistency in their completion. The manager stated at the homes last inspection that consistency in documenting care was an area being addressed via training and supervision and the AQAA identified a need to keep on top of paperwork. The intention of a full assessment is to ensure that the service is satisfied that they can meet the persons needs, that there are the resources in staff and equipment to support their needs, and where these need to be arranged prior to admission, time is given to do so, and that the existing group of people living at the home will not be disadvantaged by the admission. This provides a well-planned and positive admission. However this is reduced where all the information known about the person is not included. The services Annual Quality Assurance Assessment says that they provide prospective residents with their colour brochure and encourage people to visit the home to look around and to ask staff any questions they may have. They also encourage people to stay for coffee or lunch to familiarise themselves with the home. They feel they have received positive feedback about their admission processes in the past. The AQAA does not describe the assessment process and how this provides assurances about the quality of the admissions to the home. As part of the inspection process, the Commission sent surveys to people living at the home and their supporters. Five surveys returned by people living at the home all indicated that they felt they had received enough information about the home before they moved in, and in discussions with people on the day of inspection they said that whilst they mostly had not visited the home prior to moving in, their relative had visited and gained information that they brought back to them. Some people recalled being visited at their previous residence by the manager to discuss how they lived and what they liked and didnt like. The service does not provide intermediate care. Care Homes for Older People Page 12 of 27 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. This judgement has been made using available evidence including a visit to this service. People who use this service will have their health needs met, and are protected by the homes management of medication. They can also be sure that their care needs will be documented sufficiently well to ensure the individual healthcare need is clear to staff and that it can be met. Evidence: The care plans for two people living at the home were considered at this visit and their support was case tracked. The plans demonstrated a response to the assessment documentation seen and contained elements of the individuals personal, social and health needs of daily living. The plans have all been reviewed with new paperwork and templates in place. The AQAA also states We have person centred care plans which are fully updated and a keyworker system which commences from the time they enter the home. Care plans include a short personal overview of the person intended to support staff in gaining an immediate insight into the person and the issues that affect them. Overall the care plans were seen to contain information that gives indications of Care Homes for Older People Page 13 of 27 Evidence: the persons abilities and care needs. There was evidence of some areas of their health, personal and social needs being identified and instructions provided to staff in how to support these. There are general considerations made in the plan of how the persons independence can be supported and the instructions that would provide staff with sufficient information to meet the persons needs to a safe level. This requires more detail to ensure they are also maximising the persons abilities. There were also some areas which required further clarification in daily living needs compared to the information gathered during the assessment of needs process or in daily records. This was particularly significant where daily records did not correlate with problems identified from the pre admission assessment. Some evaluations were noted to be repetitive and comments such as appears well and content did not indicate how the service users overall need is met in an individual way. The service also uses a weekly and monthly summary of the person to review their plan of care. The information needs to be consistently transferred to the care plan to ensure they reflect actual needs and practice. Care plans contained a range of risk assessments relating to the persons daily living. These include moving and handling and risk of falls. Risk assessments were also on files for safe use of bath and the risk of scalding. The assessment states that staff testing temperatures prior to a person stepping into the bath will reduce the risk. Bathrooms have thermometers and the records of the water temperature recording was generally up to date. The health support provided by medical visits professionals visits were monitored in specific forms for the GP and District Nurse, The forms contained details of the reason for the visit as well as the outcomes. This information was transferred to care plans and medication records where appropriate. People spoken with who lived at the home said that they felt they are well cared for by staff. One person said I dont complain they do their best and they look after me. and one relative survey returned stated We find the staff all very kind and caring. The services AQAA said that the service encourages independence where possible and choice and respects equal opportunities and dignity through the provision of up to date well organised care plans that are reviewed by the manager and deputy. Overall the care plans do provide an adequate level of information to staff in meeting individuals needs. These are developing in their focus on the person and their abilities, but require more attention to the consistency of information gathered through needs assessments, risk assessments and daily records. People who live at the home feel the staff support them and this indicates that staff also work in an intuitive manner in providing support. This ensures that peoples basic needs are met, but does not demonstrate how they are using information gained to provide a consistent approach to improving the quality of the care they provide. The medication administration, storage and recording practice of the service was observed during the inspection visit. There was a good application of dispensing undertaken by staff with clear understanding of responsibilities in signing and securing medications. The only Care Homes for Older People Page 14 of 27 Evidence: minor issue identified related to two signatures not being evident on transcribed medications. This was discussed with the proprietor and noted. Medication audits may be of benefit in this area to ensure best practice and adherence to the Royal Pharmaceutical Society of Great Britains guidance relating to medication. The rapport between staff and people living at the home was good, and throughout the day of the inspection staff were attentive and respectful to peoples needs. They chatted and joked readily with people obviously enjoying their interaction. People spoken with during the inspection spoke fondly of the staff and wanted to tell us how much they appreciated the support they received. Care Homes for Older People Page 15 of 27 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. This judgement has been made using available evidence including a visit to this service. People in the care home can expect that the daily routine and activities in the home are flexible to suit their individual needs and wishes and they can make choices with regard to their social, cultural, religious and leisure activities. Evidence: The people living at the home spoke to us about the way in which they made choices and filled their day. They told us that they have their own routine of activities that they enjoy such as watching TV, knitting and gardening. One person grows tomatoes and others in particular four ladies, enjoy watching all murder mystery programmes and a new television has been purchased for the home. Additionally a reflexologist visits the home. The weekly activities programme posted in the home included daily walks, watching TV, bingo, ball games, darts and armchair exercise which related to individuals needs and wishes documented in seperate evaluation records in each care plan. The services AQAA states they plan to Develop memory boxes and complete the activities centre which was under construction at the homes last inspection and would like to develop more outings and bring in some more entertainment. Staff spoken with also said We also ask our residents what they would like to do as they have choices. We like to take them out when we can and have external entertainers in Care Homes for Older People Page 16 of 27 Evidence: for birthdays etc. A lady comes in from Age Concern every Thursday who chats with the residents and Holy Communion is held once a month. Services alternate and provide a choice for people with different beliefs. People living at the home were generally satisfied with the opportunities on offer for engagement and occupation. They had good relations with each other and readily joined in discussions with each other and staff. At the time of this inspection there were only eight residents in house with two in hospital although the home is registered for twenty people. One person spoken with stated I can always find something to do but if we do not want to join in they do not force us. Social care plans are now included in person centred care plans and detail how the service promotes an individual approach to meeting peoples social needs. The quality of meals was not commented on in the surveys returned to the Commission by people who lived at the home. However those spoken with on the day of inspection had no undue complaints. The service operates a four week planned menu with a minimum of two choices on offer at each main meal. Food was home cooked and presented in an appetising way. Dietary requirements and preferences are catered for and records of these are kept in the kitchen. Nutritional records are also in all care plans. Staff were observed asking people for their choices and demonstrated a knowledge of the individuals preferences and needs when doing so. Care Homes for Older People Page 17 of 27 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. This judgement has been made using available evidence including a visit to this service. People who live at the care home can expect that they will be protected by the homes complaints and safeguarding adults systems. Evidence: All the staff have undertaken training in the safeguarding of adults from abuse The last POVA course attended by staff was in March 2010. Staff spoken with during the inspection were able to give a good account of the safeguarding process both in the home and the responsibilities of other organisations. The service has a policy relating to the reporting of abuse and protecting staff that whistle blow. Both documents meet the expectation of the local guidance and the National Minimum Standards for Care Homes 2001. There have not been any reported safeguarding issues for this service in the last twelve months. The complaints procedures which have been revised and updated since the last inspection are publicised in the home and people spoken with were clear that they had the right to bring up matters that concerned them with the manager. The service maintains a complaints log that details the issue under consideration and its outcome. The AQAA details that the home has received no complaints since the last inspection and states We have an open door policy and welcome all comments. We encourage service users to be open and honest with no fear of the comments affecting the way in which we support or work with them. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People living at the service can expect the premises to meet their needs and expectations and that they support independence, choice and dignity. Evidence: A tour of the premises was conducted and all communal areas, the laundry, kitchen, sleep-in room, bathrooms and some bedrooms were visited. Since the last inspection the home has a new wet room, the heating system has been serviced and a new thermostat, valves and water gauges installed. The hairdressing room facilities have been updated and new furniture has been purchased for the lounge and dining room. There is also a new sign to the exterior of the building and ramps have been installed making the home more accessible for those with limited mobility. Since the last inspection the home has been registered as suitable for delivery of dementia care and therefore coded keypads for security have been added to exterior doors and stairways to ensure service users safety. Additionally new window restrictors have been fitted to windows which at the last inspection were noted to have an inadequate chain variation which broke easily. The bedrooms are mainly single and provide adequate space for the recommended furnishing including armchairs. The rooms were pleasantly laid out with low windows to enable residents to see out when seated, and had been personalised with residents Care Homes for Older People Page 19 of 27 Evidence: choice of decor and belongings. Residents spoken with during the inspection were very proud of the home and the way it was presented. One resident said It is very clean and it isnt home but it is very close as they are all like a family here another commented If you need something done or fixed they do get round to it. The provider attends to most of the maintenance issues himself but since the last inspection has become more proactive in maintaining the appearance of the premises and ensuring that any alterations benefit the service. Overall the home is reasonably maintained and the decor was neutral and fresh. The manager said that other areas that require attention were to be included in the annual renewal plans over the coming year. Communal areas were light and spacious with comfortable furnishings with no noticeable odours. Overall the impression is of a homely environment where people are comfortable. Care Homes for Older People Page 20 of 27 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. This judgement has been made using available evidence including a visit to this service. People living at the service can expect that there would be sufficient staff available to meet their needs and to be supported by staff that have the knowledge and skills required to meet their needs. Evidence: The staff arrangements and numbers are currently two care staff, and the manager on duty during the waking day, with support from catering and housekeeping staff. There are two staff on duty overnight, one awake and one sleeping in. The service was not fully occupied at the time of the inspection and the numbers on duty appeared to provide sufficient time for staff to spend with people living at the home. This was confirmed by discussions with people at the inspection and in all five residents surveys returned prior to the inspection. People said that they always received the care and support they needed and one survey stated They (staff) help me all the time, one big happy home and I am well cared for and looked after. The manager was not on duty on the day of inspection but staff spoken with outlined the daily routine of the home and identified periods within their shifts where there was time allowed to spend time with people in activities either in or outside the home. They felt they had sufficient staff cover to meet their needs without rushing. All staff spoken with on the day of inspection highlighted the need for the homes occupancy to Care Homes for Older People Page 21 of 27 Evidence: increase now that the home was registered for dementia. It is felt that the home is able to provide a lot more and is currently only operating at under 50 percent occupancy. This has had a knock on effect with staff hours being reduced to ensure financial viability of the home and is causing staff to worry about their positions. A discussion was held with the manager at the homes last inspection regarding the dementia category application and the need to increase staff in line with dependencies and occupancy, however not much progress seems to have been made with new placements since the last inspection. The homes AQAA also does not make reference to there being any problems, however a discussion with the proprietor on the day of inspection indicated their agreement that more could be done to increase occupancy. The staff training programme and matrix demonstrated that staff undertook a variety of courses pertinent to their work including skin care, medication, dementia, Safeguarding, falls prevention, infection control, fire safety, food hygiene, first aid, moving and handling and funeral awareness. Other areas covered included advanced dementia, care planning and deprivation of liberty workshops. All other courses are planned for this year. Staff spoken with demonstarated a good sense of knowledge within these areas indicating a positive outcome for residents and impact on practice. Additionally the majoriy of staff have either completed or are undertaking their (National Vocational Qualification) NVQ level 2 or above. This maintains the service to over 50 per cent compliance with the standard relating to a national qualification for its care staff. Staff files were examined to determine how the service carried out its recruitment process. The documents on the files seen demonstrated a robust approach with checks made on the persons Criminal Records check prior to employment and the Department of Health Safeguarding list, as well as two written references, and proof of the persons identity. These with the completed application form assist the service to determine whether the person is of a suitable background to work with vulnerable people. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. The management team at Dunedin generally ensure the home is run in the best interests of the residents but some improvements in health and safety need to be made so residents can be confident they are safe and that staff are appropriately supervised. Evidence: The home has a registered manager and they have been working at the home for a number of years and know the service and the people living there well. The manager was not on duty on the day of inspection. The proprietor reported that a specialist company had been contracted to carry out quality assurance training and implement a quality assurance model to help the service to move forward. This had not been achieved at the time of the last inspection or this one and there is still no any formal quality assurance system in place. Staff supervision was discussed with the proprietor and staff records examined in staff files. Although staff were clear that they received Care Homes for Older People Page 23 of 27 Evidence: supervision outlining the agenda these followed, it was not consistently evidenced in the staff records reviewed. In addition to this we were informed by the proprietor that the manager does not receive supervision and this was discussed with the proprietor on the day of inspection. A number of staff spoken with on the day of inspection raised concerns regarding the manager having a somewhat detached role and felt more support was required to enable a more cohesive and united approach to running the home was achieved. The proprietor when spoken to seemed unaware of the low staff morale currently affecting staff, and in light of this agreed to speak to the manager and commence regular supervision to ensure the team, including the manager worked together to ensure positive outcomes for residents. The completion of the AQAA was also still noted to be brief and non specific in areas. Although it showed an understanding of the home a much more detailed completion is required and would have clarified the homes development and progress. The proprietor and manager are reminded that there is an expectation that the AQAA be an up to date audit tool for the home required by law, and should identify how the home plans to develop and ensure positive outcomes for residents. Records required for the protection of service users and for the efficient and effective running of the care home were inspected and reviewed during this inspection. We were informed that all the homes policies and procedures have been renewed in January 2009 and upon review these were noted to be appropriate and up to date. There are systems in place to maintain the health and safety of the home, and a clear policy statement of the arrangements to maintain health and safety in the home, including employer and employee responsibilities. Staff training records showed that staff had received training in relevant health and safety topics, including the moving and handling of people. The home maintains records to show that equipment and utilities are regularly serviced, and that appropriate internal checks are carried out. Records relating to the fire safety checks were in place and regular fire drills and checks on equipment were recorded. Care Homes for Older People Page 24 of 27 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 25 of 27 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 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 3 People moving into the service should have all their needs, strengths and aspirations documented. This will ensure that the service is fully aware of these and how they will support them before they agree to the admission. The home should formalise quality assurance systems within the home to ensure they are providing a service which is suited to their current service user group so that individual choices and needs can be met. The home should have a consistent supervision and appraisal stucture for all staff including the manager and ensure appropriate records are kept. This will ensure service users know they are cared for by staff with the specific skills required. The quality of information provided to the Commission in the Annual Quality Assurance Assessment should support the understanding of how the service is complying with their responsibilities under the Care Standards Act 2000 and what steps they are taking in order to improve the outcomes for people living at the service. 2 33 3 36 4 37 Care Homes for Older People Page 26 of 27 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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