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Inspection on 13/08/09 for Valley View Residential Nursing Home

Also see our care home review for Valley View Residential Nursing Home for more information

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

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

The manager and provider were receptive to advice given and are committed to improving the service further. Staff enjoy working at the home and are appreciative of all the training they receive. Residents feel safe and like living at the home. Survey respondents` compliments about the service included "The home attends to my needs"; "The food, cleaning and arranging for doctor and hospital visits are good"; "My relative is very pleased with the care they are receiving"; "Good standard of care and the cleanliness of the home is always commented on by visitors"; "It provides good nursing and a good environment" and "Manager organises lots of training and responds to staff and residents` concerns"; "Recent concerns about nutritional needs were more than adequately met. Family is happy with care service. I`ve always found staff friendly and cooperative, approachable and willing to help with problem solving"; "The home maintains good care plans, provides activities, seeks advice from healthcare professionals as appropriate and follows advice"; "The home maintains good working relationships with all relevant agencies" and "Valley View is a very good home and I love working there".

What has improved since the last inspection?

The new manager`s presence and input has had a positive effect on the running of the home. Staff are receiving regular supervision and feel supported in their roles. New policies and procedures and professional guidance documents have been obtained. This should assist the service in keeping up to date with current legislation and good practice. All staff responsible for supervising staff are trained to do so. Job descriptions have been reviewed and updated, to reflect actual responsibilities. A new induction programme is in place and follows the Skills for Care common induction standards. Garden furniture has been acquired so residents can enjoy sitting outside if they want to. Staff meetings now take place more regularly. Corridors are no longer cluttered up with hoists, providing an environment for residents to move safely around the home. There have been no safeguarding vulnerable adult investigations made since our last visit. Survey respondents` comments included "I would like it noted that there appears to have been a marked improvement in the standard of management, and therefore to the care at Valley View over the past months" and "Valley View is a better place to work".

What the care home could do better:

Accurate resuscitation information should be obtained and recorded, so that residents` wishes are actually carried out. For auditing purposes off duty rotas should clearly identify the supernumerary time of the manager for her administration duties. Where care staff undertake different roles at the home, off duty rotas should clearly define this also. This includes activities and general administration. Risk assessments should be undertaken on any action taken to improve residents` safety but which may curtail their freedom of movement, such as sitting in special chairs. Registered nurses must comply with their professional body regarding amending care records, so that a proper audit trail can be carried out. No requirements have been made but a number of good practice recommendations have been made throughout the body of the report.

Key inspection report Care homes for older people Name: Address: Valley View Residential Nursing Home Maidstone Road Rochester Kent ME1 3LT     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: Elizabeth Baker     Date: 1 3 0 8 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 28 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 28 Information about the care home Name of care home: Address: Valley View Residential Nursing Home Maidstone Road Rochester Kent ME1 3LT 01634409797 01634409699 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Prathap Padmanabhan Jana,Mrs Jyothi P Jana care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users that can be accommodate is 33 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: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The home is a purpose built 33 bedded care home providing nursing care. There are 27 single bedrooms and three double bedrooms, all with en suite toilet facilities. The communal lounge and dining area is on the ground floor. A passenger lift serves all floors. There is an enclosed courtyard garden and conservatory. There are gardens at the front and rear. There is a car park. The home is situated in a residential area of Rochester close to local amenities and a bus route. The current range of activities include quizzes, bingo, motivation to music, arts and crafts, mobile library, reminiscence, sing-a-longs, music for health and movie afternoons. External outings Care Homes for Older People Page 4 of 28 Over 65 33 0 0 2 0 3 2 0 0 9 Brief description of the care home include trips to shopping and garden centres. A monthly church service takes place. Current fees range from £531.56 to £650 per week. Additional charges are payable for hairdressing, chiropody and newspapers. Care Homes for Older People Page 5 of 28 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: On the 13 August 2009 we the Commission carried out a key unannounced visit to the service. The visit lasted eight hours. At the time of the visit 23 people requiring nursing care were resident at the home. We walked around the home and talked with some residents and staff. We had conversations with four residents in private. We met with three members of staff. We looked at care records, staff files, policies and procedures, minutes of meetings and the complaints book. At the time of compiling the report, in support of the visit, we received surveys about the service from four residents, two healthcare professionals and seven members of staff. This was in response to surveys sent for 10 residents, 10 social and healthcare professionals and eight members of staff. As required by regulation, the service returned the annual quality assurance assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes Care Homes for Older People Page 6 of 28 are being met for people using the service. It also gives us some numerical information about the service. The assessment gave us most of the information we asked for. We have incorporated some of the information gathered from the above sources into this report. The last visit to the service took place on 2 March 2009. Since the last visit we have not received any complaints about the service. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Accurate resuscitation information should be obtained and recorded, so that residents wishes are actually carried out. For auditing purposes off duty rotas should clearly identify the supernumerary time of the manager for her administration duties. Where care staff undertake different roles at the home, off duty rotas should clearly define this also. This includes activities and general administration. Risk assessments should be undertaken on any action taken to improve residents safety but which may curtail their freedom of movement, such as sitting in special chairs. Registered nurses must comply with their professional body regarding amending care records, so that a proper audit trail can be carried out. No requirements have been made but a number of good practice recommendations Care Homes for Older People Page 8 of 28 have been made throughout the body of the report. 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 28 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 28 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. Residents move into the home knowing their needs can be met. Evidence: For equality purposes all residents no matter how funded are provided with a contract setting our terms and conditions for staying at the home. Since the last visit the service has reviewed and updated its information. This includes the Statement of Purpose, Service User Guide and Brochure. The Service User Guide has been published in larger print for easier reading. However the Statement of Purpose and Brochure are in normal size print. We are informed that these documents would be available in other formats if requested. The Statement of Purpose generally follows our guidance to providers for its content. However, details of the actual bedroom accommodation do not fully comply with our guidance because precise bedroom sizes are not stated. Although the document refers the reader to care standards, not all people may know of the National Minimum Standards and this Care Homes for Older People Page 11 of 28 Evidence: statement may not mean much to them. All surveys returned from residents indicated that they had received enough information about the home and had received terms and conditions about their stay. Where practicably possible the manager or a registered nurse visit prospective residents in their current place of occupation to see whether the home is suitable to meet their individual assessed needs. Some prospective residents are able to visit the home prior to deciding whether to be admitted or not. However where this is not the case their advocates do so on their behalf. Part of the pre admission process includes obtaining information from other professionals involved in the prospective residents care. This is includes sponsors such as local authorities and primary care trusts. Care records inspected contained assessments from these sources. The home is not registered for intermediate care. Standard 6 is not applicable. Care Homes for Older People Page 12 of 28 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 health and personal care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. Evidence: For case tracking purposes we looked at the care records of four residents. The records contained pre admission assessments, admission assessments and assessments from other professional bodies. Care plans were supported by clinical and safety risk assessments covering dependency, nutrition, tissue viability, pain, moving and handling, continence, falls and observations. Care plans gave good descriptions of the care planned and that being delivered. Residents spoken with said they had been asked about their health and other needs on admission. However disappointingly the care plans inspected did not include recorded evidence that the residents had actually been involved in their plans or reviews. A combined consent form for the use of bedrails, flu vaccinations and photographs was seen in all the files inspected and had been signed by the resident or their advocate. However it was established on this visit that although consent is always obtained and Care Homes for Older People Page 13 of 28 Evidence: recorded as soon as possible after admission, the permission is not always relevant because the proposed action may not be pertinent in each individual case. For example consent had been obtained for a resident about the use of bedrails, although bedrails are not in use. It is good practice to obtain consent after an actual risk assessment for the provision of bedrails has been carried out to make sure that this is the right course of action at that particular time. Some residents have been provided with special recliner chairs for pressure relief and prevention purposes. However the style of some of the chairs means that depending on the position of the chair the resident may on occasions be slightly tipped back, preventing easy access from it if they wanted to get up. Risk assessments have not been undertaken on the use of such chairs. As the chairs may curtail the residents freedom of movement, a risk assessment should be undertaken. Medication administration record (MAR) charts were inspected and had generally been completed as is required. Pain assessments are normally used to monitor the effectiveness of treatment plans. However the pain assessments for one resident were blank, despite the resident receiving a controlled drug for pain relief. However during our interview the resident said she is kept pain free. For residents with diabetes, blood sugar reading schedules are appropriately maintained. As is good practice, the home has obtained some crisis medication for a resident receiving palliative care. This is good practice. And as the medicine would need to be administered via a special technique, arrangements are in hand for the registered nurses to receive appropriate training. One of the residents likes to self-administer their inhalers for a breathing condition. However a risk assessment had not been done about this. It is good practice to do so. Residents were suitably dressed for the time of day and season, with attention to detail where this is important to them, including make up, jewellery and hairstyles. A hairdresser visits the home weekly and residents look forward to this. Residents said staff assist them with their personal hygiene needs in way which protects their privacy and dignity. The records also included life histories and some end of life information. However in one case there was contradictory information as to whether the resident wished to be resuscitated or not. For a resident whose spiritual needs are very important to them, there was no information about this or indeed how the need would be meet. However the resident said during our interview that they are receiving this support. Care Homes for Older People Page 14 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals and activities offer both choice and variety. Residents are supported in attaining their lifestyle preferences. Evidence: There is a range of activities for residents to take part in if that is their wish. Activities currently include bingo, puzzles, quizzes, reminensce, arts and crafts, music for health, sherry and newspaper mornings. Some residents were seen enjoying a game of bingo during the afternoon of our visit. The home does not employ a designated activities coordinator but activities are provided by an employee who also works at the home as a healthcare assistant. The employee has recently attended a dementia care course and has developed a new activities programme, which she hopes to implement by the end of the month. This will include changing the actual times when activities take place so they are more person centred to each individual resident. The range of one to one activities is also set to expand. Not all residents like to partake in group activities and this is respected. A number of residents were seen sitting in their rooms watching the TV, listening to the radio or reading. Staff regularly check up on and engage with residents who prefer their own company. Residents anniversaries and birthdays are celebrated with special cakes and Care Homes for Older People Page 15 of 28 Evidence: a greetings card. And families are welcomed to join in the celebrations if they wish to. The home has a room in which residents can meet with their visitors or use for quiet contemplation. Visitors were seen coming and going during the visit and residents said their visitors are offered refreshments when they call. There is a dining room for residents to use if they choose to. Menus provide a daily choice and residents we spoke with said the food is good. Although we did not have a meal with residents, the lunch time meal looked and smelt appetising. Care records contained evidence of residents being regularly weighed. Chair scales are used for this purpose and are calibrated as good practice requires. This is to make sure the readings are accurate and weights appropriately monitored. All survey respondents indicated there are usually activities can take part in and all responded they always like their meals. A Church of England service takes place at the home every month and representatives from other religions visit specific residents so their individual spiritual needs are met. Care Homes for Older People Page 16 of 28 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. Residents and their advocates can be satisfied their concerns and complaints are listened to and acted upon. Evidence: The providers complaints procedure is displayed in the main entrance and includes our contact details as well as those of Medway Council. Care records inspected contained signed records of residents having been provided with a copy of the procedure. Residents said they knew who to speak to if they were unhappy about anything and feel safe living at the home. Three of the four surveys returned from residents indicated they knew how to make a formal complaint. There have been no further safeguarding vulnerable adult investigations made since our last visit in March 2009. One of the safeguarding vulnerable adult investigations made last year has not yet been concluded and it is anticipated that it could take up to another six months for it to be resolved. The providers are assisting the investigators with the process. We have not received any complaints about the service. Since our last visit the home has reviewed and updated its safeguarding vulnerable adult policies and procedures. Staff interviewed described appropriately the action they would take if they suspected abuse had taken place at the home. The training matrix provided in support of this visit indicates that staff have received safeguarding vulnerable adults training. For ease of reference, the matrix now includes the dates Care Homes for Older People Page 17 of 28 Evidence: when the training took place, as well as the renewal dates. The homes complaints book did not contain details of any niggles or informal complaints. However a review of the staff meeting which took place on 22 May 2009 referred to complaints made by residents. It is good practice to record all types of complaints for quality assurance purposes. So residents can exercise their civil rights, the home makes sure that residents are on the electoral roll. Postal votes are then arranged for residents to vote in elections if they wish to. Care Homes for Older People Page 18 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment creates an excellent place for residents to live in. Evidence: The home was clean, fresh and odour free. All the surveys returned from residents indicated the home is always fresh and clean. Our conversations with residents confirmed this also. The homes environment is kept in good order. Corridors are wide and handrails are fitted. This promotes residents independence. A loop system is available for residents with hearing impairments to use if required. All rooms used by residents are connected to the call system and residents said staff are quick to respond. Residents are encouraged to make their bedrooms more homely and individualise them with personal affects. Bedrooms are lockable. Residents are also provided with lockable facilities within their bedrooms to safely keep small items of importance or value. The facility could also be used to securely keep residents medicines if they self administer their medications. An environmental health inspection was carried out on 4 August 2009 and no requirements or recommendations were made. A fire safety inspection was carried out on 7 July 2009 and no work was required. Because of this we did not inspect the Care Homes for Older People Page 19 of 28 Evidence: kitchen or review the fire safety records on this visit. The home has a laundry which is appropriately equipped. Residents were complimentary of the laundry service and commented that their clothes are quickly returned to them and put away appropriately. For residents safety radiators are protected and hot water thermostatically controlled. Windows have restrictors and residents spoken with understood why these had been fitted, so as to prevent unauthorised access, as well as preventing residents falling or jumping out. All bedrooms have en suite WC facilities and a resident said it is a brilliant facility as it promotes their independence. Care Homes for Older People Page 20 of 28 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. Staff morale is good resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Evidence: Specific staff are employed for caring, cleaning, maintenance and cooking. Some care staff have dual roles and provide administrative support to the manager and provider and activities for residents. However it has not been the homes practice to record these different activities separately on the off duties. For tracking purposes, it is good practice to do so. Survey responses from residents indicated staff are always or usually are available when they need them. Staff were seen interacting and assisting residents in a nonpatronising, re assuring and unhurried manner. The returned AQAA indicates that improvements for the next 12 months include changing shift patterns, in consultation with residents and staff, to make sure there are more staff on duty at peak times and less in the off peak times. This is timely as we interviewed a resident who had been left in bed far longer than they would have liked. The resident said they are usually up earlier. 64 of healthcare assistants are now trained to NVQ level 2 or above in care. A number of ancillary staff have also attained NVQs relevant to their roles, which is good Care Homes for Older People Page 21 of 28 Evidence: practice. Since the last visit the home has acquired the new Skills for Care induction programme and new staff are required to follow the Common Induction Standards. This is good news as the homes previous induction programme did not fully comply in that some of the information was out of date and no longer relevant, which did not equip new staff with all the knowledge they needed. The provider encourages staff to attend courses on various subjects applicable to their roles. Recent training has included person centred care, drug administration, dementia care, food hygiene, Mental Capacity Act awareness, wound thereapy, safeguarding vulnerable adults, moving and handling, first aid and infection control. Some staff will be commencing end of life care and equality and diversity training shortly. We inspected two staff files. As part of the homes vetting process, references are sought and Criminal Record Bureau checks undertaken. This is for residents protection. The home attempts to obtain three references on behalf of each new applicant. Although both files contained at least two references having been received, in one case a reference from the former care employers manager had not been received. The employees first employment was stated as 2004. Prior to that date the employee lived overseas. There was no recorded evidence that details of previous employments had been sought. The referees had responded by completing the homes own reference questionnaire. However the questionnaires did not contain a business stamp nor was there an accompanying compliment slip or letterhead to validate the authenticity of the referees. Care Homes for Older People Page 22 of 28 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. Overall the running of the home improved making it a safer place for residents to live in. Evidence: The new manager has now been in post for about eight months. The manager is a registered nurse and has attained the Registered Managers Award. The manager has just submitted her application to us in order to become the homes registered manager. The manager has worked in care homes for older people with nursing for a number of years, including deputy manager and registered manager posts. So that the manager has a clearly defined job description setting out all her responsibilitie for managing the home, her job description has been reviewed and amended. Residents and staff spoke openly about living and working at the home. The home is now stable and residents and staff spoke of the improvements they have noted recently. Staff comments included the new manager is approachable at any time; We get regular supervision now; My clinical practices and competences are now Care Homes for Older People Page 23 of 28 Evidence: assessed; We get lots more information about residents. The support is very good and managers are always readily available. The manager combines her management responsibilities with care responsibilities. However, the hours are not clearly defined on the off duty rota. It is good practice to do so. To assist in the general administration, a carer has a dual role and provides a number of administration hours. This is not recorded separately on the off duty rota. In addition, the provider also provides some administrative support, which again is not clearly defined on the rota. We are informed that the provider is now reviewing how the administrative support will be provided in the future. This is good news, because although there is a clear improvement in the running of the home since the March 2009 visit, consolidating the administrative support should enhance the service further. Staff interviewed said they now receive regular supervision and some have also received their yearly appraisals. Staff responsible for providing supervisions have now received training for this important role. Staff said they receive records of their supervision sessions. Since the last visit the home has acquired new policies and procedures. Staff spoken with knew where to access them if needed for reference purposes. A current copy of a clinical nurse manual has also been acquired and is available for reference purposes. In order for the home to quickly access up to date good practice information, the home is about to re arrange its offices. So that the manager can quickly access websites, including ours, the computer and internet access is being transferred to the managers office on the ground floor. The home has already obtained some of our good practice documents and publications, which were specifically developed to support home managers and providers. We recommended these at our last site visit to the home. The homes AQAA records the maintenance of the homes equipment has been serviced or tested as recommended by the manufacturer or other regulatory body, as required. The home has developed its own quality assurance programme. This includes annual surveys. The results are analysed and circulated for information purposes. A resident said the home has meetings so they can put forward ideas on how the home could change to improve the service for them. The latest survey was undertaken in July 2009 and records that residents are satisfied with activities, meals and the cleanliness Care Homes for Older People Page 24 of 28 Evidence: of the home. Records for residents and staff are maintained with due regard to confidentiality. However the inspection identified that some registered nurses are not keeping residents care records in accordance with their professional bodys record keeping guidelines. This was because correction fluid is used to amend records. This is not good practice. The home maintains small amounts of cash for each resident which is used for the payment of services provided or items purchased on their behalf. Receipts are kept and the cash balances individually kept. Since the last visit in March 2009 the home has amended the forms used to record residents monies in that the name of the depositor is also recorded. This is good practice. Following the introduction of the Deprivation of Liberty Safeguards in April 2009, the home has attempted to access training for all staff members. Local provision has been oversubscribed but training has now been accessed and arrangements are in hand for the training to take place at the home in September. The home has not yet made any authorisation referrals under these safeguards. Care Homes for Older People Page 25 of 28 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 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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