Inspection on 13/07/09 for Mansion House

This is the latest available inspection report for this service, carried out on 13th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mansion House 16/08/06

Mansion House 27/01/06

Mansion House 08/09/05

Mansion House 24/03/05

Mansion House 06/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mansion House Burnham Road Althorne Maldon Essex CM3 6DR     The quality rating for this care home is:   three star excellent 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: Diana Green     Date: 1 3 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 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: Mansion House Burnham Road Althorne Maldon Essex CM3 6DR 01621742269 F/P01621742269 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) : Mr Francis George Kirk care home 36 Number of places (if applicable): Under 65 Over 65 36 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is:36 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 with any other category - Code OP Date of last inspection Brief description of the care home Mansion House is a fully detached period property with the original building reported by the provider as being around 600 years old. Its location is on the eastern edge of the village of Althorne, which is approximately two miles from the nearest town of Burnham on Crouch. The original building has been considerably extended, and is registered to provide accommodation for thirty six elderly people (over the age of 65) in twenty eight single and four shared rooms. Accommodation is provided on two floors. There are four communal lounges and two communal dining rooms, all on the ground floor. Access between floors is provided by a passenger shaft lift. Mansion House is set in attractive & spacious enclosed grounds, which are accessible to Care Homes for Older People Page 4 of 29 Brief description of the care home residents. Ample visitor car parking is available to the front of the property. Public transport links include a bus service along the main road directly in front of the home and rail services approximately one mile away in Althorne Village. Information regarding fees is available from the home. Past inspection reports are available from the home, and from the CSCI internet website. 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: three star excellent 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 3 star. This means that people who use this service experience excellent quality outcomes. This unannounced inspection took place on 13th July 2009. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service, is a self assessment that focuses on how well outcomes are being met for people using the service. This was completed by the registered provider and returned to us prior to the visit to the home. Information received in the AQAA Care Homes for Older People Page 6 of 29 provided us with some detail to assist us in understanding how the registered persons understand the services strengths and weaknesses and how they will address them. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures.Time was spent talking to residents, staff and the manager. The manager and staff were welcoming and helpful throughout the inspection. What the care home does well: What has improved since the last inspection? The number of staff with an NVQ level 2 qualification has increased and some staff have level 3 and 4. The standard of care planning documentation has been reviewed and a person centred approach has been introduced. An activities coordinator has been employed and is working with residents to offer a flexible programme to meet their needs. In addition to the established staff training programme, training has taken place in a number of conditions associated with older people ( Parkinsons, stroke awareness, dementia, infection control etc.) as well as person centred care planning, nutrition and well being, equality and diversity and deprivation of liberty. The home are developing best practice in end of life care and have worked with the End of Life Care Facilitator to introduce the Preferred Place of Care (PPC) document to enable people living at Mansion House to choose where they would like to be cared for at the end of their lives. Care Homes for Older People Page 8 of 29 Decoration and refurbishment of some residents rooms has taken place and an ongoing programme of maintenance has continued. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 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 10 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. People planning to live at Mansion House can be assured they will receive information about the service, have an opportunity to view the home and be assessed prior to admission to ensure their needs can be met. Evidence: The home had a statement of purpose and service user guide that were combined documents and had been reviewed on 1st April 2009. A copy was provided during the visit to the service. The statement of purpose did not include the name and address of the registered provider and therefore did not meet regulatory requirements. The information also needed further development to include details of other accommodation in the home such as communal rooms and service users views of the home. The admission procedures were discussed with the manager of the home. Referrals Care Homes for Older People Page 11 of 29 Evidence: were accepted by telephone and information on care needs obtained. Prospective residents and /or their relatives were encouraged to visit the home and view the accommodation. People interested were encouraged to come for coffee or stay for lunch and take part in activities arranged at the home. This enabled them to meet with other residents and to have an opportunity to experience life at the home. We were informed that assessments were undertaken either in the persons home or hospital. A pre-admission assessment was undertaken using a pre-assessment form as a prompt to discuss care needs. Information was used following admission to complete a full assessment within forty eight hours. Two residents care plans were viewed during the visit to the service. Both included a pre-admission assessment detailing information that had been obtained prior to admission to the home. The home does not provide intermediate care. Care Homes for Older People Page 12 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. People living at Mansion House can expect to have their individual health and personal care needs met and to receive their medication as prescribed. Evidence: Three residents care records were viewed during the site visit. All three contained a pre-admission assessment detailing the residents care needs. This was used to develop care plans enabling care staff to provide appropriate care to meet residents needs. We were informed that person centred care planning had been introduced since the previous key inspection. This was confirmed from one person centred care plan viewed that included a personal history of the resident named my story. Care plans were held in residents rooms. This allowed care staff to have easy access ensuring they were able to provide appropriate care to meet residents needs. Care plans were seen for personal care, emotional health and well being, sexuality, continence, eating and drinking and mobility. Nutritional risk assessments were undertaken on admission and reviewed with weight monitoring also undertaken monthly. Risk assessments were seen for risks associated with manual handling, risk of falls, pressure sores, smoking Care Homes for Older People Page 13 of 29 Evidence: and confusion. General risk assessments were recorded for risks from layout of the room, fire safety etc. All had been regularly reviewed. We were informed that management arrangements had been reviewed to ensure there was management support at weekends so that reviews could be undertaken where relatives were unable to visit during weekdays. A group of residents were spoken with during the visit to the service and all said they were satisfied with the care at the home. We were informed that the home aimed to provide best practice on end of life care enabling residents to choose where they were cared for at the end of their lives. The home had therefore worked with the End of Life Care Facilitator to introduce the Preferred Priorities for Care (PPC) document, giving residents the opportunity to discuss their preferences on where they would liked to be cared for. Residents access to healthcare services was discussed with the manager. Residents from the local area were able to keep their own GP. All other residents were registered with the local GP practice who attended regularly on request. One residents care records viewed during the visit to the home confirmed they had received visits from their GP, district nurse and had received regular chiropody and annual eye tests. Another residents care record also confirmed they had received a visit from an NHS dentist. The manager said that a local optician was also available to visit residents at the home on request. The medication systems were discussed with the manager and a senior care assistant. Medication was supplied from the local prescribing GP practice in individual containers and given senior care staff employed at the home who had received medication training and confirmed from the records viewed. A list of staff signatures and initials was held to enable appropriate follow up in the event of an adverse incident. The home had a medication policy and procedures for staff guidance that were kept under review. Medication was supplied from the local prescribing GP practice in individual containers and stored in two locked trolleys that were secured to the wall, one in the staff office and one located on the first floor of the home. Appropriate procedures were in place for the receipt and disposal that were seen to be well adhered to. However room temperatures were not recorded and monitored to ensure medicines were stored within safe recommended levels (maximum 25 degrees centigrade) and there was no monitoring of drug refrigerator temperatures.The medication storage and medicines administration records for three residents were examined. All medication was available as prescribed.There was a cupboard for CD storage that met requirements and a CD register that was recorded accurately and in full with entries of the name and address made on receipt of CD drugs on discharge/disposal. Staff were observed to be friendly but respectful to residents during the visit to the home and to be courteous in their conversations with them. Residents spoken with Care Homes for Older People Page 14 of 29 Evidence: confirmed that personal care was provided in private and from observation it was evident that efforts were made to maintain privacy. Rooms included personal items of furniture and lockable facilities for storage of valuable and medication in the event that a resident chose to self medicate. Care Homes for Older People Page 15 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. People living at Mansion House can expect to have a nutritional diet and be supported to maintain contact with their family and friends and to have an independent lifestyle that satisfies their cultural expectations, needs and choices. Evidence: The home had a large activities room that was used for group activities such as card games, board games, dominoes, quizzes, puzzles, watching videos and weekly film evenings. The room was comfortably furnished and overlooked a pavilion and bowling green that was available for residents use. There was also a pathway surrounding the green for residents to walk or to mobilise with the assistance of staff. We were informed that a library regularly visited the home and large printed books were also seen on display in the entrance lounge of the home. The home employed an activities coordinator who provided activities on four days per week. An activities programme was seen on display and detailed activities such as board and card games, art and craft sessions, film evenings and keep fit but was flexible to suit residents choices. The statement of purpose informed us that residents birthdays were celebrated with a tea party and cakes. This was confirmed from discussion with a resident and a cook who also showed us home baked cakes ready prepared for residents tea that day. We Care Homes for Older People Page 16 of 29 Evidence: spoke with one resident who was waiting in the activities lounge to play a game of dominoes who told us Its alright here. I havent been on many outings but I do like to take part in some of the activities. The records were viewed and each residents file was seen to include either a social care history or in the recently introduced person centred plans, a profile named my story. This gave staff key information of the residents life and activities they enjoyed doing. During the site visit to the home, residents were engaged in conversation with each other and staff and some exchanged light hearted banter with the inspector which was good to hear and gave some indication of how comfortable they were in their surroundings. Some residents were reading, listening to music and relaxing in one of the lounges or just spending time alone in their rooms. The social activities were discussed with the manager who informed us that entertainment was provided each month. The home had minibus that was used to take residents on outings to local areas such as Paper Mill Lock for a trip on long boat and a trip to Burnham. A strawberry fair had also been arranged to which friends and relatives were invited and events during the festive season were also organised (coffee mornings, entertainment etc). A resident also confirmed that that outings were arranged every month when a coach took them to local places of interest. The AQAA informed us that visitors are encouraged throughout the day and evening. We want our residents to behave as they would when they lived at home. Maintaining outside contact is key to providing continuity. The homes visitors book also confirmed that visitors were able to come during the day, evenings and at weekends. One resident told us My x visits regularly and phones me every day to see I am ok....and Ive made one or two friends since being here. During the visit to the home several residents were also seen to go out with family. During the visit to the home residents were observed to have a choice of where they ate their meals and how they spent their day. One resident told us I can go to the lounge when I want to or I can stay in my room if I wish. Residents rooms were seen to be personalised with their own belongings (photos, pictures,ornaments etc.) Information on advocacy services was seen on display in the home and the statement of purpose contained details of advocacy services that could be arranged on behalf of residents. The kitchen was viewed during the visit to the home and was seen to be domestic in size, clean and well organised. Residents were observed enjoying the lunchtime meal which comprised roast chicken, roast potatoes and green beans with a choice of salad or prawns followed by a desert of trifle and ice cream. Residents records viewed confirmed that a nutritional risk assessment was undertaken on admission to the home Care Homes for Older People Page 17 of 29 Evidence: and weights monitored with nutritional supplements provided as needed ensuring that residents did not lose weight unduly. The AQAA informed us that specialist diets were catered for and advice obtained from a dietitian where needed. A resident told us we get plenty to eat and drink and the food is pretty good here and another said its top notch here. The staff training records also confirmed that care staff had received training on nutrition, enabling them to understand the importance of good nutrition and the importance of meal times for people living at Mansion House. Care Homes for Older People Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Mansion House can expect to have their concerns and complaints listened to and acted upon and to be safeguarded by robust policies, procedures and staff practices that are well adhered to. Evidence: The home had a complaints procedure that was included in the statement of purpose and service user guide. No complaints had been received either by the home or the Commission since the previous key inspection.The AQAA informed us that residents are provided with a copy of the procedure and encouraged to raised any concerns they have. The manager said that residents were able to voice any issues at residents meetings and the cook was also in attendance to discuss their food preferences. One resident told us I have no complaints and another said it is OK here. they look after you well. The home had safeguarding procedures in place and the records confirmed that all staff had received updated training in safeguarding adults since the previous key inspection. The manager confirmed that the Essex safeguarding procedures were available for staff guidance in the event of needing to refer an allegation. A whistle blowing policy was also available to support staff should they witness an allegation of abuse. The AQAA informed us that institutional abuse is discussed during staff supervision and is not tolerated.There had been no allegations made since the Care Homes for Older People Page 19 of 29 Evidence: previous inspection.The homes recruitment procedures were inspected and were confirmed to protect residents by ensuring all relevant checks were undertaken prior to appointment. Care Homes for Older People Page 20 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 living at Mansion House can expect to live in a clean, comfortable and homely environment that is well maintained and appropriate for their needs Evidence: A tour of the premises was made during the visit to the home. The home was secure with a door entry system in place. Several residents rooms, communal rooms, bathrooms, a shower room, the kitchen and laundry were viewed. All accommodation was pleasantly decorated in keeping with the status of the home, clean well maintained with no odorous smells. The home had a programme of maintenance and decoration in place. The gardens were attractive, accessible to residents and wheelchairs users and were well maintained. The AQAA informed us that carpets and flooring had been replaced and a sun awning and garden benches and furniture had been purchased to enhance the external environment of the home. The manager informed us that a review of furniture had been undertaken and there were plans to upgrade furniture in residents rooms. Records viewed during the visit to the home confirmed that systems were in place to ensure the building complied with the requirements of the local fire and environmental health department. The home had stairs and a passenger lift to enable access to the first floor of the premises. There were grab rails and aids in bathrooms and toilets to meet the mobility Care Homes for Older People Page 21 of 29 Evidence: needs of residents. Call systems were provided throughout communal and individual rooms to enable residents and staff to call for assistance and records confirmed these were well maintained. A range of specialist pressure relief equipment was available to meet the needs of individual residents. This included individual slings for hoists to be used for residents with mobility needs. The home was clean with no malodorous smells evident. Systems were in place to ensure staff had personal protective clothing for use when providing personal care. Hand washing facilities (liquid soap and paper towels) were provided throughout to ensure care staff had appropriate equipment to safely provide personal care. The laundry room was viewed and was clean and well organised with shelving, individual boxes and hanging rails to enable staff to organise the sorting and return of residents laundry to the rightful owner. There were two washing machines fitted and two driers all in working order. Both washing machines had sluice facilities (able to wash at 65 degrees centigrade for a minimum of 10 minutes) to minimise the risk of infection. Residents spoken with during the visit to the home confirmed they were satisfied with the standard of laundry. One resident who had an allergic condition told us that efforts had been made to ensure their personal laundry and bedding was laundered to minimise the risk of exacerbating their condition. Care Homes for Older People Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Mansion House can expect to be cared for by staff who are robustly recruited, well trained and well supervised. Evidence: There were twenty-nine residents at the home. We were informed that in addition to the manager and deputy manager, administrator and a senior care assistant, staffing levels comprised four care staff increasing to five care assistants at peak times. Care staff assisted with laundry duties and an activities person worked three days per week. A cook, assistant cook and maintenance person were also employed. The duty rota was seen and confirmed the staffing levels were as discussed and appeared to meet residents needs. During the visit to the home, residents were observed to be well cared for indicating that staffing levels were appropriate for their needs. The manager informed us that some staff who had been employed for some time had been unwilling to undertake NVQ training. However recently employed care staff were enrolled on NVQ courses. We were informed that the home employed a total of thirtyfive care staff of which seventeen had an NVQ level 2 qualification or above. This is marginally lower then the 50 needed to meet the recommended standard but should easily be met with recently appointed staff already enrolled on NVQ level courses. Care Homes for Older People Page 23 of 29 Evidence: The recruitment files for three recently employed staff were viewed. All files included evidence that the relevant checks (CRB, two satisfactory references, identification etc.) were undertaken prior to appointment. We were informed that a copy of the General Social Care Council (GSCC) Code of Practice was given to all new staff on appointment to ensure they were aware of their responsibilities as a care worker. This was also confirmed in discussion with staff. The files also included staff contract/terms and conditions detailing their legal rights of employment. The home had an extensive training programme that included statutory training (health and safety, manual handling, fire safety, first aid etc) and a comprehensive range of training to meet residents and staffs individual needs, for example dementia, Parkinsons disease, managing challenging behaviour, person centred care, stroke awareness, palliative care, deprivation of liberty, bereavement, effective hand hygiene, role of the key worker. The training records for the same three staff were viewed and confirmed that since appointment they had received training in manual handling, safeguarding adults, medication, pressure area care, supervision, role of the key worker, effective communication, managing challenging behaviour, fire safety, first aid and had completed the common induction standards. Care Homes for Older People Page 24 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. People living at Mansion House can expect to live in a well managed home with good health and safety standards that protect them and staff. Evidence: Discussions were held with the manager for the home who informed us that she had managed the home for thirteen years. She stated that she had completed NVQ level 4 in Care and Management and was currently undertaking a degree in business and management. The records viewed also provided evidence of updated training having been undertaken since the previous key inspection. There were also two deputy managers who provided cover for each other over a seven day period. This ensured that clerical duties could be covered and a manager was also available during weekends. During the visit to the home it was clear that the manager was well known to all the residents. From observation and an inspection of records, the home appeared to be well managed. Care Homes for Older People Page 25 of 29 Evidence: The homes quality assurance policy and procedures were discussed with the manager. Questionnaires with an anonymous response were forwarded annually to residents and their representatives, general practitioners and other health professionals (district nurses, chiropodists, social workers etc.). Information obtained was used to develop an action plan to address any issues raised. The AQAA informed us that the home had a comprehensive range of policies and procedures in place for staff guidance that had been regularly reviewed ensuring they met with up to date legislation and best practice guidance. The AQAA did however lack detail and did not fully describe the the current good practice that was evident during the visit to the service nor the plans for future improvement of the service. The arrangements for handling residents monies were discussed with the manager. Neither the manager nor representative were appointee for any resident. All residents had a relative or representative to manage their finances on their behalf. Personal allowances were held in secure facilities on their behalf. The personal allowances and records were inspected for three residents. The amounts of money were present and correct for two residents with records of transactions made and receipts held as evidence. However there was £3.00 excess held for the third resident. The procedures that required two people to check all transactions had clearly not been followed in this instance. The manager said that supervision was undertaken for all staff at two monthly intervals to discuss care practice and performance. Handover was provided between shifts to ensure staff were aware of residents changing needs. The records for three staff members were viewed and confirmed these arrangements were in operation. The home had a health and safety policy and procedures in place for staff guidance that had recently been reviewed. The records confirmed that staff had attended health and safety training following appointment. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g.checks on fire equipment, fire alarms and emergency lighting etc.). However during the site visit clinical waste bins stored externally were noted to be unlocked, posing a risk of access by animals and vermin and therefore to people. Care Homes for Older People Page 26 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 27 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 38 13 Clinical waste bins stored externally must be kept locked. This will ensure that animals and vermin are unable to access the waste and the risk to people is minimised. 31/08/2009 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 The statement of purpose and service user guide should be reviewed to include all information laid down in the regulations and schedule. To ensure medication is stored within safe recommended temperatures and does not deteriorate, room and refrigerator temperatures should be monitored, recorded and appropriate action taken as needed. To ensure residents personal finances are appropriately safeguarded procedures that require two people to confirm transactions should be adhered to. 2 9 3 35 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. 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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