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Inspection on 06/04/09 for Holmlea Care Home

Also see our care home review for Holmlea Care Home for more information

This is the latest available inspection report for this service, carried out on 6th April 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a stable care staff team, who know the residents and their needs well. 86% of care staff hold the NVQ 2 Care qualification. People spoke highly of the staff. Comments included "the managers and staff go to great lengths to make Holmlea a home from home", and "staff do anything to help". There was a choice at every meal time and staff would offer other alternatives to try to tempt people to eat if they had a poor appetite. Comments about the food included, "I can have what I want to eat" and "the cook is very good, you can`t fault the food". Everyone is offered a trial visit before making a decision about whether to remain at the home. The majority of residents have visited the home for several periods of respite care or day care in advance of admission. As a result they know the home and staff before making a choice to accept the placement. People`s health care needs are well met. A comments from health professional in our surveys included, "staff have the healthcare needs of patients as their main concern". A nurse spoken with said that they bring things to her attention if they have any concerns. The home is clean and well maintained. A group of people spoken with said that they liked the four separate wings as this made it feel more homely. Staff recruitment practices are safe. There is an activities co-ordinator for 15 hours per week. Activities are normally done in a group. There are also regular trips out. One person said in our survey "I like the bingo" and another person spoken with said, " the activities person is very good, with lots of patience, it is needed because we are slow".

What has improved since the last inspection?

There has been new carpets and furniture in several areas of the home. Additional equipment has been purchased for people with poor mobility. Recording systems have improved and are now clearer and more accessible for care staff. Records are now secure. Communication between staff and managers have improved and there are now regular staff meetings. There has been significant improvements in the way that the home manage medication, and this is now being done using good practice guidelines. Additional staffing hours have been agreed. This includes a worker for the laundry, which will give care staff more time with the residents.

What the care home could do better:

Although the training is excellent for new staff, training updates are not always provided in a timely way. Few residents were offered a bath more than once per week. One person spoken with said that they would like a bath twice a week. This will hopefully improve when the additional care staff are in place. The furniture in the conservatory area needs replacing as it is worn and difficult for people with poor mobility to get in and out of. Some chairs in bedrooms were not suitable for people with poor mobility. Not all complaints had been recorded appropriately. To ensure equality of opportunity there should be additional staff available to assist when a trip is organised for people that need a wheelchair. One person wrote in our survey, "a shortage of staff sometimes means that wheelchair bound residents cannot be accommodated on outings unless a relative is available".

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holmlea Care Home Waverley Street Tibshelf Derbyshire DE55 5PS     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: Jill Wells     Date: 0 6 0 4 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 29 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 29 Information about the care home Name of care home: Address: Holmlea Care Home Waverley Street Tibshelf Derbyshire DE55 5PS 01773720815 01773728605 pat.rhodes@derbyshire.gov.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) : Derbyshire County Council care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Holmlea is situated near to the centre of the village of Tibshelf and is next to the local medical centre and pharmacy. The home provides 24 hour personal care and accommodation for 40 older people. They have 2 beds for intermediate care, with a view to supporting people to return home. The home is a purpose built, single storey building and all residents have single rooms. The design of the home is four separate wings. The home has pleasant garden and patio areas fully accessible to residents. Derbyshire County Council owns the home. Fees are £404.06 per week for permanent residents, but people staying for short term care are individually assessed up t a maximum of £344.82. Additional charges, e.g. hairdressing, chiropody, are clearly identified in the homes Statement of Purpose and Service User Guide. Copies of inspection reports are available in the foyer. Care Homes for Older People Page 4 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: 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: The quality rating for the service is two star. This means the people who use the service experience good quality outcomes. The inspection visit was unannounced and took place over 8 hours. There were 33 people living at the home on the day of the inspection and 2 people there for respite care. 8 residents, 4 staff, 1 visitor, the manager and deputy manager were spoken with during the visit. We also looked at all the information that we have received, or asked for, since the last key inspection on the 29 April 2008. This included: Care Homes for Older People Page 5 of 29 The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection report. Completed surveys from people living at the home, staff, relatives and professionals that visit. Case tracking was used during the inspection visit to look at the quality of care received by people living at the home. 4 people were selected and the quality of the care they received was assessed by speaking to them, observation, reading their records, and talking to staff. What the care home does well: What has improved since the last inspection? What they could do better: Although the training is excellent for new staff, training updates are not always provided in a timely way. Few residents were offered a bath more than once per week. One person spoken with said that they would like a bath twice a week. This will hopefully improve when the additional care staff are in place. The furniture in the conservatory area needs replacing as it is worn and difficult for people with poor mobility to get in and out of. Some chairs in bedrooms were not suitable for people with poor mobility. Not all complaints had been recorded appropriately. To ensure equality of opportunity there should be additional staff available to assist when a trip is organised for people that need a wheelchair. One person wrote in our survey, a shortage of staff sometimes means that wheelchair bound residents cannot be accommodated on outings unless a relative is available. Care Homes for Older People Page 7 of 29 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 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 adequate 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 with trial visits or respite care to ensure that the home can meet their needs, although the written assessment is not always easily accessible. Evidence: There was a service user guide about the home. At the last inspection visit it was highlighted that this needed to be revised. The manager was in the process of revising this document. Two people spoken with could not recall receiving the service user guide. The manager was spoken with about this. She said that these documents were kept in bedrooms, but people may have taken them home. There was no record kept of service user guides being given to individuals. Four peoples records were seen. There were no completed assessments in their files. The manager explained that these were on the computer system, but had not been printed out and placed on files. One person was admitted as an emergency four days Care Homes for Older People Page 10 of 29 Evidence: previously. The home had not received an assessment for this person from the Social Services care manager. However the computer system showed up-to-date information about this person from a recent review of their care at home. One person commented in our survey, I received correspondence for admission to Holmlea stating financial arrangements. Information provided in the annual quality assurance assessment was that a letter was issued to individuals confirming the arrangements for care. The majority of residents visit the home for several periods of respite or day care in advance of admission. As a result they know the home and have made a positive choice to accept the placement. Several people were spoken with and they confirmed that they had stayed for respite care before deciding to make it their own home. Two people spoken with had been to other homes, but had requested that they be moved to Holmlea. There are two assessment beds available. GPs and district nurses can request the use of these beds to avoid a hospital stay. The intermediate care team support these individuals to gain their independence with a review to returning home. A worker spoken with confirmed that the majority of people successfully return home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met with support from relevant health professionals. Evidence: Four peoples records were seen. Each person had a personal service plan completed by staff at the home. The plan was in detail and described the action which needed to be taken by care staff to ensure that each persons needs were met. The plan was signed by the individual where possible. Care staff completed a monthly review, highlighting any changes to their needs. Two staff spoken with confirmed that new residents care plans were made available for them to read so that they had accurate information about each persons needs and wishes. Two surveys were received from health professionals. One persons commented that, staff have the healthcare needs of patients as their main concern, they report any healthcare needs to the district nurse team. Another comment was, staff will often Do the extra mile in helping people to stay within the home when they are on the Care Homes for Older People Page 12 of 29 Evidence: borderline for nursing care They also commented on the close working relationship between staff and visiting health professionals. One resident commented in our survey that, staff ensure that medical support is available when needed. There was no one with pressure sores at the time of the inspection visit. One person had a tissue viability tool risk assessment that assessed them as at high risk. This was last reviewed seven weeks previously and did not mention any equipment made available to this person to minimise the risk. This was discussed with the manager who confirmed that the person had a specialist mattress. The district nurse had not been requested to complete an assessment as the tool recommended, as the persons skin was in very good condition. One person spoken with the said that they would prefer a bath more often than once a week. On checking records, for most people, a weekly bath is all that was offered. This was discussed with the manager. She said that additional bathing would be possible when the extra staff hours have been provided. There were records of GP and other health professional visits. A resident spoken with said that staff would call a doctor for them when they requested it. A nurse was visiting the home during the inspection visit. She was observed re-dressing a residents leg in the lounge area. This was discussed with the nurse. She said that the resident was difficult to move. It was then discussed with the manager, who said that the resident would have been happy for this treatment to take place in a public area. It was however of concern that other residents were sitting close by and may not have been happy for this to have occurred. Staff were observed treating people with respect and good relationships were evident between staff and residents. Care and sensitivity was used by staff when assisting people. The medication systems were checked. They were in good order. Records were clear, accurate and up-to-date. Medication was safely stored. A deputy manager was observed administering medication using good practice guidelines. There was information available to support managers, including an up-to-date medication reference book and a Derbyshire County Council medicines code. There was a signature list of all staff that were trained and able to administer medication. One person living at the home at the time of the inspection visit held their own medication. There was a risk assessment in place concerning this. This person was spoken with. They confirmed that they kept their medication in a locked drawer in their bedroom. Care Homes for Older People Page 13 of 29 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 range of activities and standard of meals offered was good, which met the needs and wishes of people living at the home. Evidence: The information in the annual quality assurance assessment said that residents choose how they wish to spend their time, including use of their rooms. Staff encourage residents to take an active part in planning their daily life and social activities.Visitors and people from the local community are encouraged to visit the home. An independent advocacy service is available for residents. Several people commented in our surveys about activities. Comments included, activities are planned, but a shortage of staff sometimes means that wheelchairbound residents cannot be accommodated on outings unless a relative is available and, I like the bingo, and a little more time with activities would be useful. The activities co-ordinator was spoken with. She confirmed that she worked 15 hours per week Monday-Friday every morning. Activities organised included bingo, keep fit, knitting, games, arts and crafts and nail care. She tried to arrange an outing on a Care Homes for Older People Page 15 of 29 Evidence: monthly basis, however several had to be cancelled. She could take no more than four people as people either needed a wheelchair, or support when walking. She had to rely on volunteers. This often meant that some people that wanted to go on every trip could not do so. The manager was spoken with about this. She confirmed that staffing was due to be increased and this would allow a paid member of staff to support the activities co-ordinator during outings. A record was kept of activities that had taken place. There were many residents that did not take part in the planned activities. The manager agreed to look into this to see if there were other things that these people wanted to do. She confirmed that the additional staffing planned would allow more one-to-one time with staff and residents. One resident said, the activities person is very good, with lots of patience. It is needed because we are slow. There was a Church of England church service monthly at the home. There was also regular entertainment at the home. One person spoken with said that they enjoyed the last singer that visited. During the inspection visit a group of people were making an Easter cake with the activities co-ordinator. A resident spoken with showed a picture frame that they had painted and decorated. They said that they very much enjoyed doing this. The residents meeting minutes showed consultation concerning the planned entertainment. They had been asked what they wanted to do over the Easter period and had requested a buffet tea and bingo. Several people had requested a gardening activity. The activities co-ordinator said that she was planning to support people with pots for the entrance and hanging baskets. Several people were asked how they were helped to exercise choice. One person said, I can get up and go to bed when I want . Another person said, I can come and go as I please, and I didnt think Id be able to when I first came. Everyone spoke positively about the food. Comments included, you cant fault the food and another person said the food is marvellous, there is always a choice. The relief cook was spoken with. She confirmed that each person was asked their choice of food at every meal time. One person was ill on the day of the inspection visit and did not feel like eating. It was evident from observations that staff were prepared to provide anything for the person if it would encourage them to eat. One person new to the home was concerned that they were not receiving snacks between meals to help manage their diabetes. This was discussed with the manager, who agreed to ensure that this occurred. Care Homes for Older People Page 16 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. People who use the service are able to express their concerns and are protected from abuse. Evidence: There was a complaints procedure displayed in the entrance hall. The complaints record kept at the home showed that there had been one complaint. This had been dealt with appropriately. However, minutes of a recent staff meeting showed that another complaint had been discussed with staff. This had not been recorded in the complaints record. This was discussed with the manager during the inspection visit, who agreed that it should have been recorded. She confirmed that the complaint was dealt with and the person has since returned to the home for further periods of respite care. One person wrote in our survey that, I would talk to any of the staff if I had a complaint. A relative commented that, we have nothing to complain about Another person spoken with said that they felt sure were that they would be listened to if they had any concerns. The manager confirmed in the annual quality assurance assessment that all residents are registered to vote and are supported with postal votes. The home applies the Derbyshire County Council adult protection policy that is available at the home, which provides a framework for the protection of vulnerable adults. She stated that staff received training within their induction and also updated Care Homes for Older People Page 17 of 29 Evidence: training. Training record showed that some but not all staff had received training in safeguarding adults. One staff member spoken with was aware of how to respond to an allegation of abuse. Care Homes for Older People Page 18 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. People live in a safe, clean, well-maintained and comfortable environment, which meets their needs. Evidence: Information in the annual quality assurance assessment completed by the manager said that since the last inspection visit carpets in the main entrance have been replaced as well as new curtains. Chairs that raise and recline have been provided for residents with mobility problems. A stand aid has been obtained to assist a person with their mobility.The manager also confirmed that carpets have been replaced on each wing, and new furniture was planned for this financial year. A health and safety audit of the building had been completed by the manager There was no outstanding requirements from this audit. Staff had commented at a recent staff meeting that raised flooring in some areas may be a trip hazard for residents. The manager confirmed that this flooring was due to be replaced as a result of this. Two bedrooms were seen when talking to individuals. One person described their bedroom as small and basic, but all I need. Another person described their bedroom as adequate but always clean and fresh. Two people were asked if they had been offered a key to their room, but neither person had. One person said that they would have liked this. Bedroom doors could be locked from the inside, without a key but not Care Homes for Older People Page 19 of 29 Evidence: from the outside. The manager said that they should have been offered a key. Time was spent sitting in the conservatory area with residents. People were having some difficulty getting up from the furniture. On inspection some chairs had a worn base, making the cushions sag, and two chairs had ripped cushion covers. Two chairs that were seen in peoples bedrooms were also low and difficult to get out of for someone with mobility problems. The individuals said that this furniture belonged to the home, and sometimes its a struggle to get out of my chair. All other furniture in the home was of good quality and suitable for older people. A group of people spoken with said that they liked the four separate wings as this made it feel more homely. Care Homes for Older People Page 20 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. The recruitment practices are safe and there were sufficient numbers of staff to support the people who use the service. Evidence: The information provided in the annual quality assurance assessment completed by the manager said that there was a stable care team, who knew the residents and their needs well. Staff turnover is low, and several staff have worked at the home for a number of years.There was a comprehensive induction programme for new staff. 86 of care staff have achieved the NVQ 2 Care award. This should be commended. Staff rotas showed and staff spoken with confirmed that there were usually 4 care staff on duty, apart from the afternoon shift at weekends and when there were short shifts. The manager explained that they had recently had an increase of 40 care staff hours and 25 hours laundry time. This meant that any short shifts could be extended, and care staff could focus more on residents rather than laundry. She was also hoping that this would create more one-to-one time and as stated previously, more time for the offer of additional bathing. Information concerning recruitment practices were requested. All recruitment checks were taking place, including two written references and a criminal record bureau Care Homes for Older People Page 21 of 29 Evidence: check. Training records were seen.They showed that although everyone received the mandatory training when they started at the home, updates were not always provided in a timely way. The service manager present during the inspection visit showed the manager how to access more up to date training information that would help her to audit staff training. A staff member spoken with said that the training programme for new staff was excellent. There was no evidence during the inspection visit to show that the lack of training updates had any negative impact on the care provided. Several staff commented on how much they enjoyed their work. One worker said, I like it here, I love to come to work. Another worker said, the extra hours and the laundry hours will mean we have more time for residents. Everyone spoken with praised the staff. One person said, staff are patient and kind and a new person said Staff are very friendly, they made me feel welcome. A relative commented that staff were, at every level so friendly and helpful, and another said, my mother is well looked after and the staff really care for her. Care Homes for Older People Page 22 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. There is an effective quality assurance system, ensuring that people living at the home are listened to. Recording and communication between the management team and staff had improved, to ensure that the staff team are working in the best interests of residents. Evidence: The registered manager is qualified, competent and experienced to run the home. She is supported by a team of deputy managers, most of which have also obtained the managers qualification. Information provided in the annual quality assurance assessment completed by the manager said that every aspect of the home is run to seek and ensure the safety and well-being of residents and staff. A full range of policies and procedures are in place, and staff have access to these. Equal opportunities are promoted for residents and staff. Holmlea has the support of business services team to assist with financial advice Care Homes for Older People Page 23 of 29 Evidence: and management of budgets. Holmlea has access to a handyman scheme to ensure repairs are done in a timely way. The manager said that since the last inspection visit the management team has worked hard to improve communication between managers and staff. There are now regular monthly staff meetings and management team meetings. The communication and recording system has been reviewed and improved. The minutes of the staff meetings that were seen showed that these were used as an opportunity for the manager to inform staff of changes and reminds them of good practice. They were also an opportunity for staff to raise issues of concerns. As a result of comments made by staff, some positive changes have been made to day-to-day practices. A staff member spoken with said, everybody gets to say what they think. Staff spoken with felt that the managers were now more approachable. An annual survey was completed to gauge the views of residents. Workers from Age Concern assisted residents, if required. The results showed that 100 rated cleanliness, food, staff and visiting arrangements as good or excellent. A number of residents rated the decoration and amount and variety of social activities as only fair. Residents made suggestions that more one-to-one time with residents and more physical activities would improve the service. The manager explained that an action plan will now be completed as a result of the outcome of the surveys to see if improvements can be made. The service manager responsible for the service completed regular monthly reports that were detailed and covered all relevant areas. The manager confirmed that the service manager visited as a minimum on a weekly basis, and spent time talking to staff and residents. Two care staffs supervision records were seen. They showed that supervision was taking place and was an opportunity to discuss their work and training needs as well as any concerns that they may have. Personal development plans were also completed for staff. The manager was now assessing individuals dependency levels on a monthly basis, and discussing these with the service manager if they highlighted the need for additional staffing. At the time of the inspection there was no one with high dependency needs. Records were now kept securely and were in good order. Information provided was that all servicing of systems and equipment was up-to-date. There was a fire risk Care Homes for Older People Page 24 of 29 Evidence: assessment in place and all fire records and checks were in good order. 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 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 1 There should be a system in place to ensure that each person has received an up to date service user guide so that they have written information about the home. The full needs assessment completed by the care manager should be available on each persons file, as well as the computer system to ensure that everyone has access to this. Everyone should be offered the opportunity for support with additional bathing if they wish, to promote individual choice. Staff should ensure that visiting health professionals undertake medical examinations and treatment in private areas to ensure that individuals privacy is upheld. All complaints received should be recorded in the complaint record. This is to ensure that the manager is evidencing that she is taking complaints seriously and responding appropriately. All staff should receive regular updates in safeguarding adults procedures. This is so that staff have up-to-date knowledge and information about how to respond to an allegation or suspicion of abuse. Page 27 of 29 2 3 3 7 4 10 5 16 6 18 Care Homes for Older People 7 20 Priority should be given to replacing furniture in the conservatory area to ensure that all furniture at the home meets the needs of older people with mobility difficulties. A review of chairs in peoples bedrooms should take place to ensure that they meet the needs of older people with mobility difficulties. There should be evidence of each resident being offered a key to their bedroom to promote privacy and independence. All staff should receive relevant training updates in a timely way to ensure that they have up-to-date knowledge and guidance about their work. 8 24 9 24 10 30 Care Homes for Older People Page 28 of 29 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. 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