Inspection on 02/07/09 for Kidsley Grange

This is the latest available inspection report for this service, carried out on 2nd July 2009.

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

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

Other inspections for this house

Kidsley Grange 17/07/06

Kidsley Grange 30/01/06

Kidsley Grange 28/09/05

Kidsley Grange 12/11/04

Kidsley Grange 20/05/04

Similar services:

Carlton Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kidsley Grange 160 Heanor Road Ilkeston Derby DE7 6DY     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: Susan Richards     Date: 0 2 0 7 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 30 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 30 Information about the care home Name of care home: Address: Kidsley Grange 160 Heanor Road Ilkeston Derby DE7 6DY 01773769807 F/P01773769807 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Gerald Poxton,Mrs Sandra R Poxton,Mrs Ann Theresa Poxton,Dr Michael G Poxton,Ashmere Care Group,M care home 26 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 26 old age, not falling within any other category Additional conditions: 0 Ashmere Care Group is registered to provide personal care with nursing at Kidsley Grange for service users of both sexes whose primary needs fall within the following categories:- Old age, not falling within any other category (OP) (26) The maximum number of service users to be accommodated at Kidsley Grange is 26. Date of last inspection Brief description of the care home This Care home is situated in the village of Smalley. The home is a converted building on two floors. There are two lounges one incorporating a conservatory and an open plan dining room. There is provision for nursing care to a maximum of 26 service users. The home is located on an acute bend on the A608 road. The access to the car park and the main entrance is via a right turn off Adale road. Care Homes for Older People Page 4 of 30 Brief description of the care home Information about the service is provided through the Statement of purpose and Service user guide, both of which are made available to residents and their families and includes reference on how to access the previous inspection report. The current fees for the home per week are 395.82 to 770 pounds. Fees are dependant on individuals assessed needs and may include contributions from the local or primary care trust authorities for those eligible or a top of fee of £30 to be made by the service user. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire, AQAA. We ask the home to complete this on an annual basis in order to provide us with key information about the service. We also received some survey returns from advocates of people who use the service and staff. At this inspection there were twenty one people accommodated. We used case tracking in our methodology, where we looked more closely at the care and services that three Care Homes for Older People Page 6 of 30 people receive. This included discussions with them and with staff who provider their care and support, looking at their written care plans and other health and associated records and looking at their private and communal accommodation. We spoke with staff about the arrangements for their supervision and support and their recruitment, induction, training, deployment and supervision. And we examined related records. We were also assisted by the nurse in charge and the external area manager regarding the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian religion. What the care home does well: What has improved since the last inspection? What they could do better: Continue to develop a person centred approach to care and regularly consult with people about their preferred daily living routines and lifestyle preferences so as to best promote these. Ensure that staff adopt best practise when offering assistance in eating for people so as Care Homes for Older People Page 8 of 30 to always provide such support in a discreet and senstive manner. Continue to develop leisure and social activities for people and in consultation with them. Continue with the programme of redecoration and renewal and the monitoring and eradication of any malodours in the home. Meet with the matters arising from their recent infection control audit undertaken by the infection control nurse from the local primary care trust. So as to promote best infection control practise Use a validated staffing tool, such as the Department of Healths Residential Staffing Forum in order to calculate required care staffing levels. So as to determine staffing levels that are based on peoples individual dependency needs rather than purely occupancy levels. Review staff uptake of NVQ training, with a view to ensuring that staff employed, and to be employed are committed to undertake such training. Ensure clarity as to lines of management accountability in the home. Publish the results of satisfaction surveys and make these available to current and prospective service users, their representatives and other interested parties, including the Commission. 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 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are suitably informed and supported throughout their admission to the home and their needs reasonably well accounted for. Evidence: At our last key inspection here we found that people were well supported and assisted in choosing the home and their needs fully assessed before moving there. We made a requirement there that clear information be provided for people about fees charged and what they cover. We also made a recommendation that peoples preadmission assessment records should always be signed and dated by the person completing them. At this inspection we found these to be met. In our annual quality assurance questionnaire completed by the home, they told us that they continue to ensure an effective admission process for people. And that their Care Homes for Older People Page 11 of 30 Evidence: needs are always fully assessed before they are admitted there to ensure that these can be met by the home. They told us about some improvements they have made, including to provide people with better information about the service. There is now a corporate brochure in place, which gives people better information about how to choose a home, including an independant scoring assessment that people can use and financial information and advice. Further information can also be obtained about the homes services from the their website detailed at the front of this report. They also told us about improvements they aim to make in the coming months, which include developing their needs assessment record format to ensure that it is consistent with the Mental Capacity Act Code of Practise guidelines. This work was still to be undertaken at our inspection visit. However, the information given to us by the home, tells us that they know what they need to do to effect this. At this inspection people told us they were provided with the information they needed about the home to decide to live there and that they were well supported in their admission to the home. We saw that overall, peoples individual needs were reasonably well recorded and accounted for in their individual care files. And we saw that a revised and more comprehensive approach to assessing peoples personal handling and falls risks was being introduced. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their health and personal care needs will be suitably accounted for and met. Evidence: At our last key inspection we judged that the planning and delivery of care ensured that peoples health and personal care needs were fully met. We made two requirements then. One to develop written care plans for people that are person centred and clearly state interventions required as necessary for staff to meet that persons needs. And the other related to medicines records. At this inspection we found that peoples preferred daily living routines that they told us about, were not always reflected in their written care plans. And we saw that peoples agreement, or otherwise with their care plans was not recorded. When we looked at medicines arrangements, which we have referred to in the main, in this section below. We saw records of administration were well kept, although on one Care Homes for Older People Page 13 of 30 Evidence: particular shift, one persons medicines were not signed as given or a coded reason for their non administration recorded. We discussed this with the person assisting us there. People told us that they are offered baths on a rota every four days. One person said they were used to taking a daily shower before moving into the home, which they prefer, but had not been asked about this. Staff said that they would try to accommodate peoples personal bathing requests where made. This tells us that staff may need to be more proactive in consulting with people to establish their preferences and choices. Otherwise, care plans were formulated in accordance with peoples risk assessed needs and did include some information relating to their personal choices and wishes and likes and dislikes. They were reflective of recognised clinical guidance concerned with the care of older people and had regularly recorded reviews and quality assurance checks. People told us that that they felt their needs were mostly well met, including their medical needs and that staff treat them with respect and ensure their privacy and dignity. With the exception of that stated above, we found the arrangements for the ordering, receipt, storage, admininstration and disposal of peoples medicines to be satisfactory and in accordance with good practise. And we saw that the medicines systems and arrangements are quality assured on a monthly basis by the manager. This indicates that any omissions of recording on the medicines administration record sheets for any person, would potentially be found and acted on. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a lifestyle at the home, which mostly accords with their known choices. And they receive nutritious food in accordance with their risk assessed needs. Evidence: At our last key inspection we found people were able to access social, cultural and recreational activities that met with their expectations and that they were satisfied with meals provided. In our annual quality assurance questionaire that we asked the home to complete. They told us that they provide people with a variety of activities, planned with them and including seasonal and calendar events. However, they said they could improve by further development of activities and that had employed an activities coordinator for this purpose. They also told us that they engage more outside entertainers into the home. At this inspection we saw that information about activities provision for people is openly displayed in the home, including regular trips out and regular church services held at the home by a visiting minister and including for communion. Recent trips Care Homes for Older People Page 15 of 30 Evidence: included to garden centres, parks, a canal trip, pub lunches, shopping to the Westfield Centre in Derby. We saw from speaking with staff and examining recorded minutes of recent staff meetings that the need to ensure an action plan for the review and development of activities arrangements for people is identified, although with no clear action plan to date as to how this is to be achieved Some people told us that they particularly enjoy the frequent trips out and visiting entertainers who come in the home on a regular basis. All said that activities are sometimes organised in the home in an afternoon. We did not observe any specific activities being organised at our visit. Although we were informed that an existing staff member employed as the cook, is recently provided with additional dedicated hours for the planning and organisation of afternoon activities for people. Information displayed on the noticeboard advises that bingo, arts and crafts and music and movement are offered. Leaflet information is also openly displayed to inform people about local advocacy services and the Mental Capacity and Deprivation of Liberty Acts implications for care homes and the righs of people living there. Staff told us that activities are regularly organised, including quizzes, bingo, table top and group activities and sometimes potting plants for people who wish to engage in this. They also told us about theme days that are held, giving examples such as St Davids Day, St Patricks and St Georges day. People told us that their daily living choices and routines are usually upheld. Although because of some feedback we received from people, we have made a recommendaton that the home actively consult with people about their preferred bathing routines and choices under the Healthcare section of this report. We also saw that people had individual written care plans providing some information as to their social care needs and how these are to be met, although these may benefit from further development in consultation with people. People told us that the food provided is OK and that they are given an alternative to the main menu. Some told us they had been asked recently by the home as to their opinion about food although were not sure as to the outcome of this. Management confirmed this to be the case, although the results were not made available for people. We have made a recommendation about publishing the results of satisfaction surveys or formal consultation with people under the management section of this report. Care Homes for Older People Page 16 of 30 Evidence: At our visit we observed lunches being served and staff assistance for people. Tables were well set and people ate in a variety of locations, including in the main dining room, their own room and with some in the lounge who were proivided individual tables. We observed varying staff approaches for people who needed assistance to eat and drink, ranging from best practise to lesser standards of practise. However, when we spoke with staff we found that not all have received training and instruction in nutritional assistance. We discussed this with management who agreed to act to ensure best practise at all times. Peoples individual nutritional needs are accounted for by way of recorded nutritional risk assessments and with written care plans where necessary. People told us that for the most part that their daily living choices and routines were upheld, although we have made a recommendation about actively consulting with people about their preferred bathing routines and choices under the Healthcare section of this report. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may be confident that their complaints and concerns will be taken seriously and acted on by the home. And that they will be suitably protected from harm and abuse. Evidence: At our last key inspection here we found that people were able to express their concerns and were safeguarded by the homes procedures. In our annual quality assurance questionnaire completed by the home, they told us that they continue to manage complaints well. And that they have continued to ensure that staff are suitably trained and informed in dealing with complaints and concerns and in safeguarding people from harm and abuse, including whistleblowing procedures. At this inspection staff confirmed that this was the case and were conversant with their role and responsibilities concerned with dealing with complaints and safeguarding people from harm. People who use the service told us that they know who to speak with if unhappy and how to make a complaint. And we saw that written information is provided for people both by public display and within the homes service guide to assist them in making a complaint. Information provided in their service guide also tells us that this can be made available in alternative formats. Care Homes for Older People Page 18 of 30 Evidence: We saw from looking at the homes complaints records that they have received five complaints over the last twelve months. Four of these were relatively minor in nature and were upheld and resolved to the satisfaction of the person raising these. One of these concerned the use of an incorrect method by staff for the moving and handling of a resident. We found from speaking with management and from looking at the homes complaints records, that suitable action was taken to prevent this from happening again and to ensure that staff use the correct moving and handling procedures. We looked at the use of restraint in the home, which is primarily concerned with the use of bed rails and sensor mats for named people. We found this to be in accordance with recognised practise guidance and in the best interests of people whose individual care we looked at where applicable. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people are provided with a clean, safe and comfortable home that for the most part suits their needs. Evidence: At our last key inspection we found that people lived in a safe and comfortable environment, which would benefit from some further areas of renewal and redecoration to make facilities more homely for people. And we made a requirement that the home identify a programme of renewal, including for carpets and bathroom upgrading. We also made some recommendations about replacing any toileting frames that are rusty and monitoring odours, taking action where necessary to reduce and prevent these. We saw at this inspection where areas of progress have been made in respect of these, including for reducing odours, although not wholly. And some redecoration and carpet replacement. The bathroom facilities that we looked at were adequate and we did not observe and rusting toilet frames. In our annual quality assurance questionnaire, the home told us that they provide a safe, clean and comfortable environment for people. And which is suitably equipped to meet peoples needs. However they recognised that there are areas that they could Care Homes for Older People Page 20 of 30 Evidence: improve further, including in respect of maintaining cleanliness and areas of redecoration and renewal. And tell us that they intend to continue with these. At this inspection people told us that the home is mostly kept fresh and clean although we found a masked but stale odour on entering there. However, this was not noted througout the home. People also said they were satisfied with their own rooms and that they were able to bring in their own personal possessions from home as they chose. Overall the home was clean, tidy and comforable. We saw that peoples own rooms were personalised and suitably furnished and equipped in accordance with their risk assessed needs. Picture signs are also used to assist people who would benefit from this for their orientation. The laundry was also clean, tidy and equipped. We saw that incorrect type waste bins were placed some areas, that may not best promote good infection control. We also saw that the home had received an infection control audit from the local primary care trust in February 2009. Scoring a total of seventy three percent and with an action plan in place to address matters raised within that audit, including for staff training, which was planned to be carried out. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 met from staff that is suitably recruited, inducted and trained. Although staff NVQ training status and staff deployment arrangements during the afternoon may not always be in residents best interests. Evidence: At our last key inspection we found that people benefitted from support received by a competent and stable staff team. Although shortfalls in recruitment and deployment of staff could potentially place people at risk. We made two requirements at that inspection, relating to staff deployment arrangements, which is almost met at this inspection. And relating to staff recruitment records, which is fully met at this inspection. We also recommended then that at least fifty percent of care staff achieve NVQ level 2 or above in care. This is found to be almost met at this inspection, with five out of eleven care staff meeting this, including three who have achieved at level 3. However, we found that whilst the home offer all staff NVQ training, a number of people have declined to undertake this, which may not be in residents best interests. At this inspection people told us that staff is usually available when they need them Care Homes for Older People Page 22 of 30 Evidence: and listen and act on what they say. And we received many positive comments about staff approaches to peoples care and support and their kindness. However, discussions that we held with people, told us that staff are usually very busy providing personal and nursing care and support, and that they felt this impacted on time afforded for activities and leisure and also their preferred bathing routines. There was also confusion amongst staff as to how staffing levels are determined. On the day of our inspection, for the twenty one residents accommodated, one nurse and three carers were provided during the morning, with one nurse and two carers during the afternoon. Information provided about peoples dependencies told us that fifteen people require at least two staff to assist them in their moving and handling needs. Most staff felt that staffing levels were usually sufficient to enable them to perform their role, but some said that they did not always manage to get their breaks. Although we were advised that active recruitment of additional bank staff was being sought. Discussions held with residents and staff told us that peoples bathing needs were met by way of a bathing rota, conducted during the morning shift, which may not always account for peoples preferenced bathing times. We also saw a company staffing level guide on the office noticeboard, which calculated staffing levels based on occupancy only. This detailed that for up to twenty residents there should be one registered nurse and three care staff on duty throughout the day. This did not match staffing numbers on duty on the day of our visit, as detailed above. Management advised that this was out of date and said that additional staff could be provided as necessary. In all other respects we found the arrangements for staff recruitment, induction and training to be satisfactory. All staff said that training arrangements are very good and organised via a rolling plan and individual staff records that we looked at were reflective of this. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is overall well managed and run and in peoples best interests. Although recent changes to lines of management accountability were not clear. Evidence: At our last key inspection we found the home to be well managed with peoples health, safety and welfare promoted. We made a requirement there for then acting manager to submit an application for registration with the Commission, which was complied with following that inspection. In our annual quality assurance questionnaire completed by the home, they told us that they continue to ensure that the home runs smoothly and that they ensure regular safety checks and monitor staffs adherence to the homes policies and procedures. They told us they could improve in their communication and consultation with people Care Homes for Older People Page 24 of 30 Evidence: who live at the home and who have an interest there. Although they did not provide any measurable information or stated action as to how they were going to do this. Their stated improvement aims are to continue to build good relationships with those people indicated above and to ensure all paperwork is kept to to date. They also gave us some other information that we asked for in the AQAA return, including as to their arrangements for the servicing and maintenance of eqiupment at the home. Although there were some areas where dates given for certificates of maintenance were out of date, we were provided with up to date copies of these at our visit, which tells us that servicing and maintenance work for these is satisfactory. The provider has recently told us verbally that a new manager is appointed for the home. Although, who in the short term is providing full time management support at another home within the group. And with the existing registered manager here continuing in her role in the interim. However, staff at the home told us about the appointment of the new manager, but did not seem to be clear as to the interim management arrangements that we have been told about by the provider. This means that lines of accountability in the home may not be clearly understood. And we have not received any formal written notification to date from the provider advising us of those management arrangements as is requested from them. At this inspection we were assisted mainly by the nurse in charge and the regional manager. Staff spoke enthusiastically about the newly appointed manager and told us that regular staff meetings had recommenced and that individual supervisions were being rolled out. They told us about some changes that the new manager had made, including relating to communication systems and for their support and supervision and said that the home was overall well managed and run with an open door approach. We saw that a formal quality assurance and monitoring system is in place in accordance with company policy. This includes reports of monthly visits to the home, from the provider or their representative, indicating their findings as to their opinion of the quality of care provided there along with other key management and safety matters. For matters arising from these, there are clear action plans in place to address these. This tells us that the provider continuously monitors their own practise and quality of care and services at the home. And we saw that there are development plans in place for some of these. Recent developments resulting from audits conducted via outside authorities include action plans for the development of falls management and infection control systems Care Homes for Older People Page 25 of 30 Evidence: within the home, including further staff training in infection control planned for the early autumn. We found from speaking with staff and examining recorded minutes of recent staff meetings that the need to ensure an action plan for the review and development of activities arrangements for people is identified, although with no clear action plan to date as to how this is to be achieved. We were also informed that satisfaction surveys are regularly undertaken with residents, relatives and visiting professionals, although we were not provided with any information as to the results these. We were advised that these are not routinely published or made available for people completing them or people who may have an interest in the service. We have therefore recommended that this be achieved. We saw that the home provides a quarterly newsletter for people, which could be utilised for this purpose. When we looked at the arrrangements for the management and handling of peoples monies, we found these to be satisfactory. The home offers to safekeep personal monies only on behalf of residents who do not wish to retain these in their own rooms. We saw that many rooms are provided with lockable storage space that may be used for this purpose. People case told us that they were consulted about their chosen individual arrangements for these. Staff told us about satisfactory arrangements for ensuring safe working practises, including in respect of their training, accident and incident procedures and the provision of equipment. Some people told us that an additional stand aid would benefit, however, said they understood that this was soon to be provided. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff must always sign for 06/09/2009 the administration of a persons medicines as prescribed. Or where these have not been administered, the correct code must be recorded to determine the reason why they have not been administered. To ensure that people receive their medicines as prescribed. And to accurately account for these, including in the event that they are not administered for any reason. 2 31 39 Written notification must be provided to the Commission as to the current and any changes in management arrangements for the home. To provide clarity as to those arrangements and inlcuding lines of management accountability. 04/09/2009 Care Homes for Older People Page 28 of 30 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 9 People should be fully and proactively consulted and enabled to make decisions about their preferred bathing routines. Staff who administer peoples medicines should be reminded of their responsibilities in the event of them observing any gaps in recording for the adminstration or otherwise of the previous dose. The home should continue to develop leisure and social activities for people in consultation with them. The home should seek to ensure that staff adopt best practise when offering assistance in eating for people so as to always provide such support in a discreet and senstive manner. The home should continue with its programme of redecoration and renewal and the monitoring and eradication of any malodours therein. The home should ensure they meet with the matters arising from their recent infection control audit undertaken by the infection control nurse from the local primary care trust. So as to promote best infection control practise. Use of a validated staffing tool, such as the Department of Healths Residential Staffing Forum should be used to calculate required care staffing levels. So as to account for peoples individual needs rather than purely occupancy levels. A review of staff uptake of NVQ training should be undertaken, with a view to ensuring that staff employed and to be employed are committed to undertake such training. Staff should be clear as to lines of management accountability in the home. The results of satisfaction surveys should be published and made available to current and prospective service users, their representatives and other interested parties, including the Commission. 2 9 3 4 12 15 5 19 6 26 7 27 8 28 9 10 31 33 Care Homes for Older People Page 29 of 30 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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