Inspection on 27/05/09 for Emmanuel Nursing Home

This is the latest available inspection report for this service, carried out on 27th May 2009.

CQC found this care home to be providing an Good 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

Emmanuel Nursing Home 08/08/06

Emmanuel Nursing Home 25/04/05

Emmanuel Nursing Home 23/11/04

Emmanuel Nursing Home 27/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Emmanuel Nursing Home 17 Southfield Hessle East Yorkshire HU13 0EL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Eileen Engelmann     Date: 2 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Emmanuel Nursing Home 17 Southfield Hessle East Yorkshire HU13 0EL 01482649749 01482649418 emmanuelnursing@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dove Care Homes Ltd care home 44 Number of places (if applicable): Under 65 Over 65 0 44 0 dementia old age, not falling within any other category physical disability Additional conditions: 44 0 44 The maximum number of service users who can be accommodated is: 44 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admisson to the home are within the following categories: Dementia Code DE; Old Age not falling within any other category - Code OP; Physical disability Code PD Date of last inspection Brief description of the care home Emmanuel Nursing Home is owned by a national company and is situated in a quiet residential area of Hessle on the outskirts of the city of Hull. It is a short walk to the nearest main road for access to public transport. The nearby village of Hessle gives access to shops, the post office, banks, hairdressers and a train station. The home consists of a large traditional house with a modern extension to the rear. There are two passenger lifts and ramps are in place to assist the people in the home in Care Homes for Older People Page 4 of 28 Brief description of the care home accessing all areas of the home and the gardens. There are 7 double and 30 single rooms, with some of the single rooms being large enough to be bed/sitting rooms. There are extensive well-maintained gardens and a small courtyard area. Visitor car parking is provided. The home is registered for 44 people over the age of 65 years, of either sex. People using the service may have a physical disability and/or terminal illness. All personal care needs are provided by the staff within the home and most of the health needs are met by the nursing staff, accessing other professionals as necessary. The range of fees given to us by the manager on 27 May 2009 is from 337.04 to 650.00 GBPs depending on the care needs of the individual, the room chosen and the source of funding. People will have to pay additional charges for such items as hairdressing, toiletries and newspapers. Care Homes for Older People Page 5 of 28 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: Information has been gathered from a number of different sources over the past 23 months since the service had its last key inspection visit (28/6/07), this has been analysed and used with information from this visit to reach the outcomes of this report. We completed an Annual Service Review (ASR) for Emmanuel Nursing Home on 17 June 2008. We only do an annual service review for good or excellent services that have not had a key inspection in the last year. An ASR is part of our regulatory activity and is an assessment of our current knowledge of a service rather than an inspection. The published review is a result of the assessment and does not come from our power to enter and inspect a service. Care Homes for Older People Page 6 of 28 This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and peoples files, and records relating to the service. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was good. We received 6 back from staff (60 ) and 6 from people using the service (60 ). Informal chats with a number of people living in the home took place during this visit and comments from the questionnaires and face to face conversations have been put into this report. The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. We have not received any formal complaints about the service in the 23 months since our last visit. One safeguarding referral has been made in 2009, this was investigated by the East Riding of Yorkshire Council safeguarding team and resolved quickly. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. 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 set out 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 8 of 28 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 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. Evidence: Four peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. These documents give clear information about fees and extra charges, which are reviewed and kept up to date. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The home develops a care plan from the assessments, identifying the individuals problems, needs and abilities using the information gathered from the person and their Care Homes for Older People Page 10 of 28 Evidence: family. We spent some time discussing with the manager how the homes assessment process could be developed to include more information around equality and diversity such as race, age, gender (including gender identity), sexual orientation, disability, religion or belief. Those people living at the home who receive nursing care undergo an assessment by a registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. Discussion with the manager indicated she goes out to assess individuals who have expressed an interest in coming into the home, and each person is given information about the service and life in the home. We spoke to one person who is able to independantly make her wishes and choices about her care known to the staff and the funding authority. We were told by the individual I am well looked after, I have been in hospital recently and could not wait to come back to the home. This persons choices are quite specific and do not always follow best practise guidance around pressure relief. However, the home is able to accommodate this persons needs and with input from other health care professionals is closely monitoring their health and wellbeing. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Information from the peoples surveys showed that they were satisfied with the care they receive and have a good relationship with the staff. One person told us the staff are extremely patient and kind, nothing is too much trouble for them. Information from the Annual Quality Assurance Assessment and discussion with the manager and people living in the home indicates that all of the people using the service are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home is able to offer a limited choice of staff gender to people who express preferences about care delivery, as they employ 3 male care staff. The information about peoples preferences should be recorded onto the care plans. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of people Care Homes for Older People Page 11 of 28 Evidence: using the service. Staff who completed our surveys said that their training was good and that they felt they provided a high quality of care, which promoted peoples rights to individuality, privacy and dignity. The home does not have any intermediate care beds and therefore standard six does not apply to this service Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of the people living in the home are clearly documented and are being met by the service and staff. The medication at the home is well managed promoting good health. Evidence: Information given to us in peoples surveys, and during discussions on this visit with people using the service, indicates that individuals are satisfied with the care they receive and enjoy life in the home. Six people said that staff listen to us and take action when needed, and one person commented that the home ensures that medication is on time, meals are on time, clothes are kept clean and there are lots of activities to take part in. On the whole the care plans detailed the needs and abilities of individuals and set out the actions required by staff to ensure peoples wishes and choices are respected and their care needs met. The plans looked at have been evaluated on a monthly basis and any changes to the care being given is documented and implemented by the staff. Care Homes for Older People Page 13 of 28 Evidence: Information about the persons social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are included within the individuals care plan. People and relatives are able to input to their plan and changes to their care is discussed with the individual where possible. In addition to this information there are risk assessments to cover daily activities of life, behaviour management plans where a risk to the person or others has been identified, and clear information about health and input from professionals and the outcomes for people. People said that they have good access to their GPs, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people using the service indicate they are satisfied with the level of medical support given to them. One person told us that the staff are extremely good at getting the GP out to see you if you are unwell, I cannot fault the service. Entries in the care plans specify where individuals have dietary needs, including PEG feeds, supplement drinks and specialist diets. Staff files show that individuals have attended specialist training to ensure that they can meet the diverse nutritional needs of people living in the home. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. The nurses within the home carry out specialist tasks such as PEG tubes/feeding regimes and wound dressings. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses/beds and seat cushions. There has been a safeguarding of adults from abuse allegation made about the pressure care received by one person using the service. Investigation by the Social Services Safeguarding of Adults team showed that the home was working with the individual to accommodate their personal preferences as well as provide a good level of care. One recommendation from the investigation was that the home should liaise more closely with the tissue viability nurse, and at our visit it was seen that this has been undertaken and their advice around wound care is incorporated into the persons care plan. The medication policy for the home says that individuals can self-medicate if they want to and after a risk assessment has been completed and agreed. All of the people spoken to prefer to have staff administer their medication. Checks of the medication records showed these are up to date and accurate, including those for controlled drugs and refrigerated items. However, we recommend that staff Care Homes for Older People Page 14 of 28 Evidence: should be consistently recording where medication is brought forward from previous MAR charts, which makes auditing stock and checking medication is being administered correctly, much easier. Chats with people revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Two people told us that staff support and encourage us to be as independent as possible, and allow us to make our own choices and decisions about life in the home, even if there is some risk involved. Our checks of the care plans showed that the home completes risk assessments for activities of daily living to ensure people are kept as safe as possible, whilst accommodating their decisions. One lady said the home has purchased me a lifeline device (which links to the nurse call system), which I can take with me when I walk around my room. This means I can call for assistance if I fall and means I can continue to make the most of my independence. Observation of the service showed there is good interaction between the staff and people; with friendly and supportive help being given to assist individuals in their daily lives. Care Homes for Older People Page 15 of 28 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 using the service are provided with choice and diversity in the activities and meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. Evidence: The home employs an activities co-ordinator who works Tuesdays to Fridays 9am to 6pm most weeks. There is some flexibility in her hours to accommodate trips out, evening events and the occassional weekend activity. At the moment there is a range of group activities and one to one sessions taking place, which reflect the interests of the people living in the home and also their gender. Entertainers are booked each month and they provide people with a range of sessions including singing, slide shows, arts and crafts. The mobile library service visits the home every two months and provides large print and talking books as well as the usual reading material. The six people who answered our survey questionnaires said that they were satisfied with the level of activities on offer and one person commented that staff encourage us to join in sessions that we are interested in. One individual Care Homes for Older People Page 16 of 28 Evidence: who spoke to us said that they enjoyed time in their own room, but also liked to take part in outings and that staff respected their decisions about participation or not. Informaton from the Annual Quality Assurance Assessment (21/4/09) completed by the manager, indicates that people have access to a Church of England service held in the home each month and individuals can attend outside services as wished.The home provides special meals and cakes for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors were seen to take part in the lunch time meal and those who spoke to us said they were always made welcome whenever they came to the home. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. There is some information and advice on advocacy and this is on display in the home. Information from the Annual Quality Assurance Assessment indicates that the home holds regular meetings for relatives and people using the service, but that these are poorly attended. People have told the manager that they are satisfied that they can have any issues dealt with by speaking directly to the manager or other staff within the home. We discussed with the manager the option of having more 1-1 talks with people in the home and recording the things discussed on a daily basis. The staff training matrix given to us on 27 May 2009 shows that some staff have attended training on the Mental Capacity Act, Deprivation of Liberty, Safeguarding of Adults and those doing NVQs have done equality and diversity sessions. This type of training ensures that staff have sufficient knowledge about human rights legislation, so they understand individual rights within the care home and out in the community. Observation of the midday meal showed it to be well prepared and presented, and the kitchen staff had made an effort to provide soft diets in an attractive way. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to people who need help with eating and drinking. People and relatives are pleased with the quality and quantity of the meals served, saying the food is very good and there is always a choice given. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that people feel that their views are listened to and acted upon. Visitors and people using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. Evidence: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. Peoples survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said the manager comes round every day to see us and will discuss any problems at this time. Checks of the complaints record showed that there have been no formal complaints in the past 23 months and that the manager deals with minor niggles/grumles on a daily basis. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults Care Homes for Older People Page 18 of 28 Evidence: procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. The staff training matrix given to us on 27 May 2008 shows there is an ongoing training programme for staff to attend safeguarding of adults awareness training and that 22 members of staff attended this in the past year. There has been one safeguarding of adults allegation made in 2009, this was investigated by the local councils safeguarding team and a recommendation about care practise have been implemented by the home. Care Homes for Older People Page 19 of 28 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. The standard of environment within the home is good, providing people with a comfortable and homely place to live. Evidence: The Emmanuel Nursing Home consists of a large, traditional Victorian house with an extensive modern purpose built extension to the rear. Walking around the home it is clear that the environment is spacious, welcoming and decorated/furnished to a high standard. Two passenger lifts, stairways and ramps ensure that people and visitors have access to all areas of the building. Accommodation is provided in 7 double and 30 single rooms; all but one of the rooms have en-suite facilities. Some of the double rooms are adapted into bed sits and provide people with a spacious and comfortable living area of their own, as well as a bedroom. The home has extensive, well kept gardens and there is an enclosed courtyard where people can sit or walk in a secure area. The courtyard contains bird tables, flower tubs and planted areas making it a pleasant place to spend time in. Doorways to bedrooms, communal space and toilet/bathing facilities are wide enough for wheelchairs, and corridors are spacious and have enough room for people in wheelchairs or with walking frames to pass by comfortably. The home has two parker Care Homes for Older People Page 20 of 28 Evidence: baths and a walk in shower room for people who need assistance with bathing, in addition to standard facilities for those people who are more independent. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of the people using the service and to encourage their independence within the home. In the last 12 months the home has put in a brand new nurse call system which is more efficient and effective for staff and people using the service. Discussions during this visit indicate that people using the service are satisfied with the laundry service provided by the home. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. The staffing matrix supplied to us on 27 May 2009 indicates that infection control training is part of the rolling programme of training and that 40 staff attended this in the last 12 months. We noted that there is a hole in the laundry wall caused by the door handle hitting it as it is opened. This should be repaired and a stopper put in place to prevent further damage. The fire door to the laundry was not shutting properly; the door closer should be adjusted until it operates correctly. Care Homes for Older People Page 21 of 28 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. The staff induction, training and recruitment practices are good, resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. Evidence: Checks of the staffing rotas and observation of the service showed that the home employs eight staff from overseas. Discussion with the manager indicated that the home is an equal opportunities employer and there is a diverse mix in the staffing group. Staff members told us that they work as a team and this includes covering shifts when others are on leave or sick. Staff feel that their induction and training helps them meet the needs of people who use the service. We spoke to two people who use the service during this visit, and they were satisfied with the care they receive and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us that staff are friendly, helpful and supportive. At the time of this visit there were 35 people in the home and the staffing levels were Care Homes for Older People Page 22 of 28 Evidence: as follows, in a morning from 7am to 2pm there are two nurses and six care assistants, in an afternoon from 2pm to 8pm there is one nurse on duty and four care assistants and at night from 8pm to 7am there is one nurse and three care assistants. Information from annual quality assurance assessment about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the service, was used with the Residential Staffing Forum Guidance and showed that the home is exceeding the minimum hours asked for in the recommended guidelines. Over 50 of care staff at the home have an NVQ 2 or above in care and all new starters have to complete an induction which meets Skills for Care criteria. Staff have access to a mandatory training programme, as well as a wide range of specialist subjects which reflect the diverse needs of the people using the service. Three staff files were looked at and they contained evidence of a variety of training events attended over the past year including safeguarding of adults, moving and handling, fire management, infection control, bereavement, mental capacity act, palliative care, diabetes and medication training. Nurses are supported in maintaining their own professional portfolio of practice in order to keep their Personal Identification Number (PIN) from the Nursing and Midwifery Council (NMC) up to date. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of three staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. We recommended that the manager undertakes regular registration audits with the Nursing and Midwifery Council to ensure the nurses who are employed by the home are registered and fit to practice. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: The registered manager is a Registered Mental Health Nurse with an active PIN from the Nursing and Midwifery Council, she is in the process of completing her Registered Managers Award and hopes to have this finished by the end of November 2009. She has extensive experience of looking after elderly people and keeps her skills and knowledge up to date with regular training sessions pertinent to her role. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager and senior staff complete in-house audits of the home and its service on a monthly basis, Care Homes for Older People Page 24 of 28 Evidence: and the registered individual does spot checks and completes the regulation 26 visits. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires, and the manager is aware of the need to produce a development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. The home does not handle peoples personal allowances, instead the individual responsible for the payment of the monthly fees is billed for any additional costs incurred by the person using the service. People we spoke to are satisfied with the financial arrangements in the home and are confident they have access to their monies at all times. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. Care Homes for Older People Page 25 of 28 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 28 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 The manager should consider how the homes assessment process could be developed to include more information around equality and diversity such as race, age, gender (including gender identity), sexual orientation, disability, religion or belief. The manager should ensure that information about peoples preferences regarding staff age and gender for giving personal care, is recorded in the individual care plans. Staff should be consistently recording where medication is brought forward from previous MAR charts, which makes auditing stock and checking medication is being administered correctly, much easier. The manager should ensure the laundry wall is repaired and the laundry fire door is adjusted so it closes correctly. The manager should complete the Registered Managers Award by the end of November 2009 The manager should ensure there is an annual development report created from the quality assurance process, to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. 2 9 3 4 5 19 31 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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