Inspection on 12/06/09 for The Firs Specialist Residential Home

This is the latest available inspection report for this service, carried out on 12th June 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

The Firs Specialist Residential... 29/08/07

The Firs Specialist Residential... 16/08/06

The Firs Specialist Residential... 04/01/06

The Firs Specialist Residential... 12/09/05

The Firs Specialist Residential... 12/10/04

The Firs Specialist Residential... 28/04/04

The Firs Specialist Residential... 24/06/02

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

Key inspection report Care homes for older people Name: Address: The Firs Specialist Residential Home Old Forewood Lane Crowhurst East Sussex TN33 9AE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Melanie Freeman     Date: 1 2 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: The Firs Specialist Residential Home Old Forewood Lane Crowhurst East Sussex TN33 9AE 01424830591 01424830346 thefirs.crowhurst@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miyano Care Services Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 30 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Date of last inspection Brief description of the care home The Firs at Crowhurst is a detached extended and adapted building, situated in the village of Crowhurst. Both the towns of Battle and Hastings with their shops and access to bus and rail services are approximately three miles away. Accommodation is provided on two floors in six double and eighteen single rooms. A stair lift is fitted to assist those residents who have mobility problems to access first floor accommodation. The home is registered to accommodate 30 older people who have a dementia type illness. The registered provider is Miyano Care Services Ltd. The home provides personal care and support to residents who are both privately funded and those who are funded by Social Services. The homes fees as from 01 April 2009 range from what is funded by the placing authority, and 460 pounds per person per week for those funded privately. Additional costs are charged for hairdressing, chiropody at 12 Care Homes for Older People Page 4 of 29 30 Over 65 0 Brief description of the care home pounds, newspapers, toiletries and activities charged at 12 pounds and 6 pounds per month. 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: 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at The Firs at Crowhurst care home will be referred to as residents. This was a key inspection that included an unannounced visit to the home on Friday 12 June 2009. The allocated inspector spent approximately six hours in the home and was able to discuss matters with the manager who received the inspection feedback at the conclusion of the visit. During the assessment visits the inspector was able to spend time meeting with the staff, visitors, residents and observing practice in the home. Residents lifestyles within the care home were also looked at along with measures taken to promote resident s individuality, health and well being. Care Homes for Older People Page 6 of 29 The communal areas of the home were viewed along with a selection of the residents bedrooms, a range of documentation was reviewed including the homes service users guide, pre-admission assessment procedures, the systems in place for handling complaints and protecting residents from harm, staff recruitment files, staff training records, quality assurance systems and some health and safety records. The care documentation pertaining to three residents were reviewed in depth and the inspector ate a midday meal with a group of residents in one of the two dining rooms. The required Annual Quality Assurance Assessment (AQAA) was completed by the manager and returned when requested and was used to inform this inspection report. Four staff and seven residents/ representatives surveys were received by the Commission prior to the inspection, and were used to inform this report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The home has responded positively to the last inspection report and the requirements made within this. The AQAA recorded that the decor in the home has been improved along with the hygiene facilities. It also identifies that practice in the home has improved and is more responsive to residents choices. During the inspection visit it was confirmed that the care documentation records more clearly residents choices and preferences, and in this way gives individual guidelines for staff to follow when caring for each resident. Peoples choices are also now being sourced ensuring that routines and practice in the home are not followed as a matter of routine. A new controlled drugs cupboard has been provided and this along with reviewed procedures ensure all controlled drugs are stored and administered safely. The arrangements for cleaning and the laundering in the home have been changed and is now completed by the care staff. The standard in these areas has improved with the home being clean, and residents having clothes suitable for wearing. Suitable hand washing facilities have now been provided in all communal hand washing areas that include liquid soap and paper towels, to promoted good infection control practice. The manager has established more robust quality monitoring system to ensure residents and their representatives views are taken into account, and demonstrates ongoing review and improvement to the quality of care, and services in the home. Care Homes for Older People Page 8 of 29 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 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. Prospective residents and their representatives are provided with information about the home in order to make an informed choice about whether to live at the home. The admission procedures ensure that all prospective residents are fully assessed by a competent person, before admission, and are assured that their needs can be met by the home. Intermediate care is not provided at The Firs Residential Care Home. Evidence: The home has a combined service users guide and statement of purpose. This is available in the entrance area of the home, and includes a copy of the most recent inspection report. This document had been reviewed and updated since the last key inspection, and records the required information, providing good information to people in the home, and those looking at the homes as a potential placement. An assessment of the admission process included a review of the documentation used Care Homes for Older People Page 11 of 29 Evidence: in respect of the last two admissions to the home. This demonstrated that all prospective residents are fully assessed by the manager prior to admission. The assessment is often combined with the prospective resident visiting the home. As identified at the last inspection the assessment documentation should record where the assessment was completed, and who else is present and involved in the process, it should also record clearly the reason for admission. The manager said that these matters would be addressed. Records seen confirmed that prospective residents or their representative are written to confirming that their assessed needs can be met by the home, and confirming all the costs involved, including any additional costs that may be incurred. The AQAA recorded that both the prospective resident and their relatives, are encouraged to visit the home for either a half or a full day, before the admission is progressed. Intermediate or rehabilitative care is not provided at The Firs at Crowhurst Care Home. 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. The home was found to be meeting residents personal and health care needs, although the care documentation needs to take account of any consultation with the resident or their representative. Residents health care needs are met with the advice and support of community health care professionals. The homes practice ensures that residents medicines are stored and administered safely. Care is delivered in such a way that promotes and protects the residents privacy and dignity. Evidence: The care documentation pertaining to three residents were reviewed as part of the inspection process, and each of these residents were met with during the inspection visit to the home. Each resident had a plan of care and this along with the day and night care records, identified the individual care to be provided. These covered the health and personal care needs of residents along with their social and mental health needs, some choices Care Homes for Older People Page 13 of 29 Evidence: and preferences were also recorded. The care plans were found to be current and demonstrated regular review. Further attention to specifics would ensure guidance is provided on the detail of care, for example the hygiene care could record how people want this care completed. On the whole the care documentation was comprehensive and gave a good level of information to care staff. It was however noted that consultation with either the resident or their representative, is not clearly recorded. The manager however said that relatives are sent a copy of the care plan shortly following admission, for discussion if needed. Residents or their representatives need to be included on an ongoing basis with the care provided, and the reviews completed. Ways of recording this consultation need to be established as identified at the last key inspection. Residents preferred names are recorded within the care documentation and during the inspection visit it was noted that these are used. The care documentation is now also recording if people want their rooms locked and why, and if they are unable to have their own toiletries in their room for safety reasons. This ensures residents are given choices rather than blanket routines and practice being applied. Risk assessments are used to inform the care and included those to protect residents skin, and ensure that they are moved safely. It was however noted that although residents are weighed and that this demonstrated that two residents were loosing weight , how this is responded to and monitored was not reflected in the care documentation. This was discussed with the manager for her to address. All verbal feedback about the care provided from residents and visitors and recorded within the returned surveys was positive. Comments received included The care provided is excellent Care for mum very well and see to her needs I believe the best care is given. The Medicine Administration Records (MAR) charts evidenced that medicines are administered in accordance with prescriptions. Staff who administer medicines are suitably trained, and practice seen during the inspection confirmed that medicine administration is completed in a safe way. The individual as required medicines guidelines were seen to be very personalised and to provide clear instruction for staff to follow. A few residents have their medicines crushed and this is clearly recorded, with the necessary consultation with the General Practitioner. A new controlled drug cupboard has been provided and the associated records were found to be accurate. Care Homes for Older People Page 14 of 29 Evidence: Throughout the inspection residents were seen to be spoken to in a positive and inclusive way. Staff spent time with them and this interaction was seen to be enjoyed by the residents. Observation confirmed that any care provided was completed in private, and residents rooms are now not locked routinely, with access to them being available. The visiting community nurse confirmed that staff always assisted her, thus ensuring that when she visits a resident she is able to see them in their own room. All residents have their own toiletries now, and in most cases these are kept in their rooms, unless a risk assessment identifies that this is not appropriate. The home charges 12 pounds a month for toiletries that are normally bought as stock items. The manager did however advise that those residents who have specific needs or preferences, and these are expressed, can have individual items purchased for them. 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. Residents are encouraged to keep in contact with their family and friends. The meals at the home are satisfactory offering variety and choice and catering for dietary needs if required. There are opportunities for stimulation through leisure and recreational activities for residents although residents would benefit from further specialist input to provide individual meaningful activity. Evidence: Residents during the inspection visit were mostly in one of the two sitting rooms. With some residents walking around the home as they wished. The visiting hairdresser was working in the home and residents were seen to be enjoying the interaction that this provided. During the visit staff were seen to be very kind and responsive to residents, spending time chatting with them. There are some planned activities and these include a motivational entertainer, and a musical entertainer who each visit fortnightly. These activities are well attended and enjoyed by residents. A fee of 6 pounds is charged to each resident to finance any external entertainment sourced. The manager also Care Homes for Older People Page 16 of 29 Evidence: confirmed that the local church representative visits each week. The AQAA recorded that further attention had been given to assessing residents individual social needs and that further investment in activities, would be progressed as the budget allows. Consideration should be given to providing a dedicated trained activities person within the home, to promote meaningful activity for each resident. The Firs has an attractive garden area that is well used in the summer months and some social events like a summer BBQ are held. Visiting is encouraged and the two visitors spoken with said that they felt comfortable when they visit, and were welcomed by staff. They had brought in food to share with their relative, along with the family pet dog. A survey received from a relative recorded that the home was always very welcoming and provided refreshments. Peoples choices are being explored and documented within the care documentation. The manager confirmed although many of the residents are up early this is in response to them wanting to get up, and those residents spoken with said that they got up and went to bed when they wanted to. The meal eaten with residents was satisfactory although it was found to be a rather cold. Three residents commented on this during the mealtime. This was identified to staff who did offer to reheat the food but this offer was declined. Further attention needs to be given to ensuring the food is given to residents hot enough to eat safely. It was clear from observation that residents were given choices in relation to their food, and these were responded to. The manager explained that systems in the kitchen had been reorganised and now allowed for the food to be purchased in conjunction with menu planning. This ensured food was fresher and tailored to the needs and preferences of residents. The manager confirmed that what residents had to eat was recorded but said further attention to the amount would be recorded. She also confirmed that all staff working in the kitchen were appropriately trained. There are two dining rooms and staff were available in these areas to assist as required. The dining activity was a social one where residents chatted with each other and staff. It was noted that residents were asked if they wanted an apron to wear, in order to protect their clothing. The feedback about the food within the returned surveys was positive. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that any complaint would be listened to, and responded to appropriately. Staff training and information in the home ensures that any Safeguarding Vulnerable Adult issue would be responded to appropriately when identified. Evidence: The home has a clear complaints procedure and this is available to interested parties within the service users guide. One complaint was raised with the home over the past year, this was reviewed by Social Services in conjunction with the home, and has been resolved. The home has recently started a quality monitoring system that the home has been using to record complaints within. The systems for recording complaints was discussed with the manager along with need to maintain the confidentiality of any complaint received. The manager agreed to ensure all complaints are kept confidential and to only reflect the number of complaints, and outcomes within the the audit tool. There have not been any safeguarding issues within the home since the last key inspection, and ways of recording safeguarding alerts were again discussed with the manager to ensure confidentiality. Feedback from people spoken with said that they Care Homes for Older People Page 18 of 29 Evidence: would be comfortable and confident in raising any concern with the homes manager, who they felt would deal with any issue effectively. The home has policies and procedures on Safeguarding Vulnerable Adults along with a whistle blowing procedure, and the most recent local policies and procedures were available in the home. Staff training is provided on a rolling programme and the manager confirmed that she and other staff have completed some training on the Mental Capacity Act and deprivation of living. She acknowledged the need to provide relevant policies and procedures on these subjects, to guide the practice in the home. Staff recruitment files confirmed that staff have a Protection of Vulnerable Adults (POVA) check completed along with a Criminal Records Bureau check (CRB). Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical environment is suitable to meet the needs of the residents, and a general refurbishment and redecoration programme is being progressed. The home was found to be clean and fresh. Evidence: The Firs at Crowhurst is a large detached building, set in its own grounds in a rural location. The outside of the home presents an attractive environment and location with good car parking facilities. There is a door entry system in operation, to enable staff to be aware when people are entering or leaving the building for security reasons. The home has accommodation on two floors and is not designated to provide a service to people with physical disabilities, as the stairs and other access arrangements would make it unsuitable for residents with a permanent restricted mobility. There are various communal areas that provide flexible facilities and can provide an area for residents to be seen in private. All communal areas were seen along with some bedrooms and all the communal toilet and bathing areas. The home was found to have a good standard of cleanliness throughout. The home has been subject to a programme of redecoration and refurbishment that Care Homes for Older People Page 20 of 29 Evidence: has provided a separate hairdressing facility and bedrooms being decorated to a high standard. The visiting hairdresser commented on how the new area was like a modern salon and that residents enjoyed the new facility. The communal areas have benefited from the removal of excessive furniture and some decorative items, providing a more airy and spacious feel, but retaining a home like environment. All old commodes have also been replaced and suitable washing facilities have been provided in all communal hand washing areas. The use of the communal areas has been changed in response to comments received by residents and relatives and demonstrated that the home was responsive to residents and relatives views. It was also noted that some rooms are personalised, with residents able to bring in furniture and other possessions into the home, if safe to do so. The AQAA and manager confirmed that the the redecoration and upgrading programme is to be continued throughout the home, and is to include the provision of assisted showers. During the inspection it was noted in the laundry that some clean wet washing was spilling out on to the floor and there was not a clear procedure for the cleaning of commode pots. These matters were discussed with the manager who said that she had the Department of Health guidelines on infection control, and would review the practice in the home with regard to these. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers and skill mix provides a well-motivated and trained staff team that meets residents health and personal care needs. Residents are protected by the recruitment practice followed. Evidence: At the time of this inspection visit there was 20 residents living in the home and the staffing arrangements provided five carers in the morning, three carers in the afternoon, with two waking carers at night. The manager is addittional to these carers, as is a daily chef. The care staff now also complete all the cleaning, laundry and some catering duties as designated each day. The manager advised that the current staffing levels are appropriate to meet the health, personal and social care needs of residents. The manager is aware that the staffing arrangments need to be flexible and responsive to any changing residents dependency or increase in occupancy. The staff had an understanding of their differing roles, and it was noted that they wore separate protective clothing appropriately to ensure good infection control practice. Feedback received about staff working in the home was very positive and comments included the staff are lovely the staff are always happy and cheerful. One relative appreciated the stability of the staff team and how this provided continuity of care and less confusion to residents and a friendly atmospere. Care Homes for Older People Page 22 of 29 Evidence: Staff surveys received also reflected a stable team, and that staff enjoyed working as a team and felt they worked well together. Staff also indicated that the furnishing and decor of the home needs ongoing improvement. The manager confirmed that over 50 of care staff have attained a National Vocational Qualification in care at level 2 or above. Staff training is well organised and the manager uses a matrix to organise, and record the training provided and planed. The staff training is supplied and organised with a training consortium, that provides all the mandatory training. The recruitment files pertaining to three staff were reviewed as part of the inspection process and records held demonstrated comprehensive recruitment practice is followed. This included an application form, evidence of two references and the required Criminal Records Bureau (CRB) and POVA checks on all staff. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was found to be managed in an open and friendly manner that takes into account residents and their representatives views. Residents financial interests are safeguarded. The health, safety and welfare of residents and staff are generally promoted and protected. Evidence: The manager is well qualified and has completed relevant care and management qualifications. She has the registered managers award and a National Vocational Qualification in care at level 4, and provides a good level of supervision and support to the staff working in the home. The managers approach is open and encourages residents, relatives and staff to be involved in developing the services offered at the home. Since the last inspection she and Mr Detheridge the responsible individual for the registered Company, have worked together and made a committed response to not only improving the environment of the home, but the culture. This focus has moved the home away from routine practices, to a far more person centered approach Care Homes for Older People Page 24 of 29 Evidence: to care, that enables residents to maintain the maximum possible level of independence, choice and control over their lives. Observation and discussion with residents confirmed that the manager is well known to all of them, and has a close positive relationship with them, and visitors to the home. The home has established a quality review system that audits areas in the home including complaints, accidents and the environment. The manager also takes into account residents and their representatives views, which are collected through surveys and meetings. There was evidence to confirm that views shared have been responded to. Staff meetings are also held regularly and these have been used to involve staff in the changing environment, and ethos of the home. The manager confirmed that the home does not have any involvement with residents monies. The AQAA confirmed that all the health and safety checks are completed and there was evidence that the hot water is checked for safety, along with routine environmental risk assessments being completed. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans must be 01/09/2009 composed and reviewed with input from the resident and or their advocate, unless the offer is declined. This will ensure that the resident is in agreement to the proposed plan of care to be provided. 2 7 12 The registered person must 01/09/2009 make proper provision for the health and welfare of residents and this should include the monitoring of residents nutritional status, and responding to these nutritional needs. This will ensure that residents are given suitable care in response to identified need, including appropriate food and nutrition. Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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