Inspection on 11/05/10 for Heathlands

This is the latest available inspection report for this service, carried out on 11th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heathlands 10/11/09

Heathlands 06/10/09

Heathlands 05/05/09

Heathlands 22/08/07

Heathlands 06/06/06

Heathlands 28/12/05

Heathlands 16/08/05

Heathlands 04/01/05

Heathlands 09/06/04

Heathlands 09/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for older people Name: Address: Heathlands Station Road Pershore Worcs WR10 1NG     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: Sandra Bromige     Date: 1 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Heathlands Station Road Pershore Worcs WR10 1NG 01386562220 01386550409 heathlands@heart-of-england.co.uk www.heart-of-england.co.uk Heart of England Housing and Care Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 60 Dementia (DE) 60 Physical Disability (PD) 60 Date of last inspection Brief description of the care home Heathlands is a purpose built home situated close to the town centre of Pershore. It is located within walking distance of the town centre where there are shops, restaurants, public houses, churches and good pubic transport. Care Homes for Older People Page 4 of 29 Over 65 0 60 0 60 0 60 1 0 1 1 2 0 0 9 Brief description of the care home The home is built on two floors with a passenger lift to each floor and is arranged in units. All bedrooms are single and with en-suite toilets and showers. Adapted bathrooms are available on each floor and each unit has a communal lounge, dining and kitchenette facilities. The home is registered to provide a residential care and respite service for up to sixty older people who may have physical disabilities and/or mental health needs. A separate eight-bedded unit provides a service to older people with dementia type illnesses. A separate day care unit provides a service five days each week to older people living in the community The registered providers are Heart of England Housing and Care Ltd. Their is currently no registered manager in post for this service. Information regarding the home is available in their Statement of Purpose and Service Users Guide. Copies of these and the inspection reports are available in the homes reception and on request. Alternative formats can also be provided. The current fees are available upon request from the home. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We, the commission completed the last inspection of this service on 22nd August 2007. This was an unannounced inspection. One inspector and a pharmacist inspector spent time at the home, talking to people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for two people. This included observing the care they receive, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The manager of the service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. We also Care Homes for Older People Page 6 of 29 received completed survey forms from people who use the service, and staff working at the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. Some of the comments from the surveys have been included within this inspection report. Since April 2009 there have been three complaints and six safeguarding investigations relating to this service. The complaints were about staffing levels, staff competencies and staff morale and how these were impacting on the people who use the service. We asked the Provider to investigate these complaints and the outcome was two were proven and one was inconclusive. Due to the concerns received, safeguarding information and referrals and outcomes of random inspection visits to the home, we met with two representatives of the organisation in December 2009 to highlight the concerns we had about the management of the service. The organisation produced an action plan and we have monitored their progress against their action plan. We have not received any further complaints since January 2010. The service have cooperated fully with us and the safeguarding team to make the improvements needed to the management of the service to improve the standards for the people who use the service. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed prior to admission to ensure the home are able to meet their individual care needs. The service does not offer dedicated intermediate care facilities. Evidence: We saw that pre-admission assessments had been carried out by the home for the two people we case tracked. There was sufficient information in these assessments to formulate a care plan prior to admission. The staff are listing the medication people are taking, but they are not recording the dose and frequency it is being taken. This information needs to be recorded on the assessment form. People who use the service told us in surveys they completed that they received enough information to help them decide if the home was the right place for them, before they moved in. Care Homes for Older People Page 10 of 29 Evidence: One person told us they visited the home before they moved in and chose the room they wanted. The AQAA completed by the manager prior to the inspection told us, there is an assessment that takes place prior to the placement been agreed. We would also recommend a day visit/short stay before any placement is confirmed. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need to be updated and reviewed as peoples needs change to ensure people can be sure their needs will be met. Further improvement is needed to the aspects of management of medication to ensure people are not placed at risk of harm. Peoples privacy and dignity is respected. Evidence: We looked in-depth at the care of two people who use the service. We found good outcomes of care for both of these people. We saw they had care records which had been prepared on the day of admission from the information gathered at the preadmission assessment carried out by the home. Overall, the quality of the information in the care records was good, there is a person centred approach and staff had a good knowledge of their individual care needs. One person had agreed to their care plan, but one person had not seen their care plan and had not been given the opportunity to discuss and agree to the content. The care plans had been reviewed, but there were some areas where changes or incidents had taken place and the care plan and risk assessment had not been Care Homes for Older People Page 12 of 29 Evidence: reviewed. For example, a medical practitioner had visited both of these people and prescribed treatment for their skin problem but this had not been updated in the care plans. There had been some incidents of challenging behaviour with one person and the risk assessment for this had not been reviewed. We received 10 completed surveys from people who use the service prior to the inspection. We asked people what the service does well and they told us, I receive care and support when required. Yes, I would recommend this home. It makes me feel at home, comfortable and respected. Nothing is too much trouble. Caring on the whole. The carers are marvellous. Staff told us they look after the residents. Ensure they are happy. A visiting professional told us the staff are caring and hardworking. They communicate well with our District Nursing team. The information in the AQAA told us, there is a keyworker System in place and it has improved since the set floors have been implemented. We saw the people we case tracked had allocated key workers. One person told us they had a key worker and this person ensured they received an assisted bath when requested. We looked at the medication administration record (MAR) charts and overall found that they were documented with a signature for administration or a reason was recorded if medication was not given. We saw that the times of administering medicines were clearly highlighted on the MAR charts. However, we saw that some medicine records were not always clear, in particular for the application of peoples creams and ointments. For example, we saw that one person had recently been prescribed two new skin preparations by the GP. We saw that the medicine records had not been accurately documented for the application of two prescribed external applications. One medicine was prescribed for application to the scalp one to two times a week. There was no record of this being applied although we saw that the bottle had been opened. The second medicine was prescribed to be applied to the persons face for ten days. The application was received into the home six days before the inspection. We saw two records for the application, however they had not been signed on the correct dates. The records did not document that the person had their cream applied daily as prescribed. Overall, the medicine records did document that medicines were being given to people as prescribed, however the records were not always correctly documented for people who were prescribed creams and ointments and were at risk of not having their condition treated. New air conditioning units had been installed in the nurses station where the medicine Care Homes for Older People Page 13 of 29 Evidence: trolleys were stored. We found that the temperature records for storage of medicines were documented daily and all medication was stored within the recommended manufacturers guidelines. Personal care plans were not always kept kept up to date with information relating to peoples medication. We looked at three peoples care plans with regard to medication and found that two care plans contained up to date medicine information and one care plan did not. The first care plan documented information about a medicine prescribed to help with agitation and anxiety on a when required or as needed basis. We saw written information that described under what circumstances the medicine should be given to the person. This means that their health and welfare was protected with up to date medicine information. The second care plan documented information about a person who was looking after their own medicines in their bedroom. We saw a risk assessment which was completed every month to ensure the safety and the independence of the person was safeguarded. The third care plan we saw was for a person who was prescribed a medicine which required careful monitoring. There was no information documented to inform staff how this medicine should be given. There was no information documented to inform staff what to do if a dose was missed and what side effects to expect. There was no information about the need for regular blood tests and the importance of informing a GP if the person was ill. The care plan was not up to date and it was not clear how the medicine was being administered to the person, which increases the risk to their health and welfare. Surveys told us the staff respect peoples privacy and dignity at all times. People told us the staff knock on the door and wait to be invited in before entering their bedroom. We saw that people had a key to their room and this gave them the choice to lock their door when out and about in the home. One person told us they choose to lock their door at night and the staff do not disturb them at night. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home intend to make improvements to the social care provision to enable a wider range of activities to be available for the people who use the service. A healthy and balance diet is provided to ensure they provide a choice of menu and are able to meet the nutritional care needs of the people who use the service. Evidence: The information in the AQAA told us there is a structured activity programme in place and activities are planned a month in advance. There are two activity coordinators in post. There is a residents committee in place, and regular residents meetings. There are varied entertainers come into the home. We looked at the provision of social care for the people whose care we tracked. We saw their hobbies and interests had been recorded in their care plan. It was evident from speaking to one person that staff had not spoken to them in detail about their life history to enable the home to capture this information to support the provision of a person centred care plan. For example, there was no information about the persons occupation. The person told us they wished to attend a religious service for their denomination but was unsure where about in the local community this was available. We spoke to staff and they were not sure of the religious beliefs for this person and Care Homes for Older People Page 15 of 29 Evidence: had not taken any steps to support this persons religious care needs. People told us the activity programme is put on the notice board in the home. We saw this and an example of the activities offered were;hairdressing, one to one, arts and crafts, music, manicures, sing-a-long, board games, cards & dominoes, shopping trips, bingo, videos, reminiscence, cooking and Holy Communion. We asked people who use the service about the suitability of the activities provided by the service and we received a mixed response. People told us, there could be more done on it. Would like more entertainment that uses their brain. Entertainment is good. In the 10 surveys we received people told us there are always or usually activities provided that they can take part in. The information in the AQAA told us the home are of the opinion they need to make improvements in this area, as they told us more trips out of the home will be beneficial and they plan to improve through an increase in the activity hours within the home. Allard unit is an eight person unit. The care staff told us they provide all the activities on this unit as part of the holistic care for the people they care for. On the morning of the inspection we saw staff playing a giant floor version of snakes and ladders with a group of people. We looked at the provision of meals in the home. They have a four week rolling menu. We looked at the menu choice for week number four. This shows that breakfast is continental, which includes porridge, fruit juice and grapefruit. A cooked breakfast is available twice a week. Lunch is a choice of two main meals of the day, and an alternative menu offering salad of the day, vegetarian option of the day, soup or sandwiches. There is a dessert of the day or a choice of ice cream, yoghurt or fresh fruit. Supper is a choice of two snack meals, although four days per week the second choice is sandwiches. People told us they are quite happy with the food. They have a choice of meals. Biscuits and cake between meals, and a bedtime drink. People told us in surveys they always or usually like the meals at the home. Comments included, meals are very good. The standard of food is good. My family feel welcome when they arrive. Staff told us the catering is excellent. We observed the service of lunch on the unit for people who have dementia. We saw Care Homes for Older People Page 16 of 29 Evidence: seven people sitting at the table having lunch. One of the care staff was serving the meals from the hot trolley. Meals are individually portioned. Lunch was fish or chicken and mushroom pie with mashed potato, swede, carrots and green beans, with a dessert of apple crumble and custard. We heard people ask for small portions of food which the staff gave them, but they also told the people there was more available if required. We saw staff assisting and prompting people to eat their meal in a very discreet and sensitive manner. All had a drink available with their meal. One person did not eat their meal as they told the carer they did not like it, so we saw the carer plate them a different meal choice. We saw visitors coming into the home and spending time with their relatives in the home. People brought dogs into visit people. We saw these people were made welcome in the home by the staff. One person told us if they have a visitor they ask staff for a drink and biscuits and they provide this. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concern with their care, they or people close to them know how to complain. These concerns are looked into and action taken to put things right. People who use the service are safeguarded from abuse. Evidence: Since April 2009 there have been three complaints and six safeguarding investigations relating to this service. The complaints were about staffing levels, staff competencies and staff morale and how these were impacting on the people who use the service. We asked the Provider to investigate these complaints and the outcome was two were proven and one was inconclusive. Due to the concerns received, safeguarding information and referrals and outcomes of random inspection visits to the home, we met with two representatives of the organisation in December 2009 to highlight the concerns we had about the management of the service. The organisation produced an action plan and we have monitored their progress against their action plan. We have not received any further complaints since January 2010. The service have cooperated fully with us and the safeguarding team to make the improvements needed to the management of the service to improve the standards for the people who use the service. People told us in surveys they know how to complain if they have any concerns. We looked at the homes complaints records and these show they have received two Care Homes for Older People Page 18 of 29 Evidence: complaints since January 2010. Both were proven and resolved to the satisfcation of the complainants. We saw there have been many compliments recorded about the home. One person told us they feel quite comfortable about raising any grumbles with the staff and they feel safe living at the home. Staff spoken with were aware of the homes complaints procedures and the action they should take if someone complained. Staff requested our identification when we arrived at the home. This is good practice. Staff told us they had received safeguarding training updates in the last 12 months and they were clear of the action they would take if they suspected any abuse taking place in the home. Staff told us they have not received any training about the Mental Capacity Act(MCA) or the Deprivation of Liberty safeguards(DoLs). The manager confirmed this and advised the training will be arranged. We looked at two staff files and saw that robust recruitment checks had been carried out before people started work at the home to ensure only suitable people are employed. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained providing a safe environment for the people who use the service. Systems for the management of infection control are in place to ensure the safety of the people who use the service. Evidence: The information in the AQAA told us there is a regular maintenance programme in place. There are weekly and monthly equipment checks such as call bell system and fire system, reception and secure entry. The numerical data provided in the AQAA told us all the equipment has been serviced in the last 12 months. We looked at the parts of the home used by the people we case tracked. They had single bedrooms, which were nicely decorated and peronalised by the people using the service. Window restrictors were in place in the upstairs bedroom. These are required by health and safety legislation to ensure the safety of the people who use the service. We asked to see the monthly checks of these window restrictors to ensure they are in place. The manager told us they do not do these checks at present, but said she would ensure they are included in the homes monthly maintenance checks. The rooms were clean and tidy, and there were no bad odours in the home. People told us in surveys the home is always or usually fresh and clean. We looked at the how the home manage foul laundry and communal linen such as towels, sheets and Care Homes for Older People Page 20 of 29 Evidence: flannels. We spoke to staff and they told us the temperatures which they are laundered at. These were high enough to prevent cross infection, which is good practice. There are communal lounge and dining areas on each unit. Allard unit which offers care for eight people with dementia has undergone the most change to its environment. The home and its staff have worked very hard to redecorate this unit. It is now bright and cheerful and the bathroom has been redecorated using a sea theme. There is a well equipped quiet/sensory room and the corridors and lounge area now contain items that people can take interest in and hold, touch, feel or walk around with. This is in line with good dementia care. Peoples bedroom doors have been personalised with photographs and pictures to enable them to recognise their bedrooms. People have access to a secure garden. The manager told us the home are seeking support and funding from a local charity for older people to improve the gardens. They are planning to install a water feature, seating area, a sensory garden and decking to encourage people to go outside in the good weather. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff provided with the skills and competencies to meet the needs of the people who use the service. Thorough recruitment procedures are in place to ensure the safety of the people who use the service. Evidence: On the day of the inspection there were two lead care staff and eight care staff on duty across the home to care for 54 people using the service. In addition, the manager, deputy manager and hotel services manager was on duty, along with administrative, domestic and catering staff. We looked at the staff rotas for a two week period prior to the inspection and these showed the staffing levels provided each day were in line with the staff on duty at the time of the inspection. Surveys received from people who use the service told us that there were always staff available when required. Comments included; I admire and respect all staff. The carers are marvellous. Staff spoken with were able to confirm they had attended a number of training sessions since the last inspection for core mandatory training such as moving and handling. The training matrix provided by the manager showed ongoing training had Care Homes for Older People Page 22 of 29 Evidence: taken place in the last 12 months. We looked at the recruitment files for two staff. All the information to show the home had undertaken a thorough process of recruitment was available. This ensures only suitable people are employed at the home. We saw that staff had undertaken or were in the process of undertaking an induction programme which is in line with the Skills for Care Common Induction Standards. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the way the home is being managed to ensure it is run safely and in the best interests of the people who use the service. Evidence: The registered manager resigned her position in February 2010 following a period of sickness. The deputy manager resigned and the home was also without a hotel services manager. The service is currently being managed by an interim support manager from one of the organisations other homes in the area. The Head of Care (South) and other staff from the organisation have been supporting the interim management arrangements in the home. The service have recruited a deputy manager and hotel services manager who were both in the home on the day of the inspection. The organisation are still trying to recruit a manager with the right skills and competencies to manager the service. There has been considerable change of staff over the past six months and a high Care Homes for Older People Page 24 of 29 Evidence: usage of agency staff to support the home whilst suitable permanent staff have been recruited. Despite this, the home have managed to improve the standard of the service over this period and this has been achieved through strong and open leadership by the interim manager and the hard work, dedication and support of the staff team employed at the home. We asked staff what has improved in the home in the last six months and they told us there is a much happier atmosphere around the home, all management help out on the floor. The manager always makes time to stop and listen to staff. Always come to the unit. Staff meetings are more regular. We looked at how they monitor the quality of the service. The manager told us they have meetings with staff and people who use the service every two months. Management are not present now at the meetings, they attend for part of the meeting if requested by staff or people who use the service. Questionnaires have been sent out recently to people and they are just coming back in. The manager will look at the information and if there are any concerns, create an action plan. Outcomes of the survey are published and made available to the people who use the service. We looked at the management of peoples monies. There is a good system currently in place which acts in the best interest of the people who use the service. We looked at the monthly visits carried out by a representative of the organisation. They are unannounced and they include the review of records, seeking views from the staff and people who use the service and looking at the environment. This ensures the owner is able to closely monitor the standard of the service and create an action plan for any shortfalls and monitor the homes progress in meeting any identified actions to ensure they continue to provide a good standard of service. The home are not carrying out checks of the windows in the home to ensure they are functioning properly to ensure the safety of the people who use the service. The manager agreed to address this immediately. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 13(2) To make arrangements to ensure that all medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. This is to ensure that people get their medicines correctly and that procedures for medicine administration are safe. 14/06/2010 2 9 13 13(2) To make arrangements to ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines. This is to ensure that there are clear directions for care staff in order to ensure people receive their medicines safely. 14/06/2010 Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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