Inspection on 14/04/09 for Aaron Lodge

This inspection was carried out on 14th April 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Aaron Lodge 09/10/08

Aaron Lodge 24/04/07

Aaron Lodge 25/10/06

Aaron Lodge 17/10/05

Aaron Lodge 24/05/05

Aaron Lodge 05/01/05

Aaron Lodge 20/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Aaron Lodge Marmaduke Street Liverpool Merseyside L7 1PA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paul Kenyon     Date: 1 4 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Aaron Lodge Marmaduke Street Liverpool Merseyside L7 1PA 01512610005 F/P01512610005 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Aaroncare Limited care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: 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: Dementia - Code DE. The maximum number of service users who can be accommodated is: 48 Date of last inspection Brief description of the care home Aaron Lodge is registered to provide personal care to 48 elderly people who have an age related mental health condition. Aaron Lodge is a purpose built home. Each resident has a single bedroom. Bathrooms and toilets are situated on both floors. Each floor has a dining area and a lounge. There is a private enclosed garden to the rear of the home with patio furniture. Parking is also available at the rear of the building. A lift and bathing aids are provided. There is access to a bus service from the home. The home is close to local shops and amenities. The city centre is approximately 10 minutes away by public transport. The range of fees for residing at the home are Care Homes for Older People Page 4 of 30 Over 65 0 48 0 9 1 0 2 0 0 8 Brief description of the care home between 385.00 pounds and 415 pounds per week. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit to Aaron Lodge was unannounced and took place during the morning and afternoon. During this time, we examined records relating to the care provided, spoke to people who use the service and observed the way in which they are supported. We also obtained comments from staff members before the inspection through surveys. The service had submitted an Annual Quality Assurance Assessment ( AQAA) before the inspection within the time we asked them to. The information they gave us helped us to make a judgment on the care the service provides and the services assessment of their performance is included in this summary. The nature of the needs of individuals who live in Aaron Lodge is such that it is not always possible to gain their direct views about their experiences of the care they are provided. Observation of care practice was used to form judgements about the service Care Homes for Older People Page 6 of 30 and observations are included within this report. What the care home does well: What has improved since the last inspection? The needs of people are now met given that all people who use the service have their needs outlined in a plan of care. The health and safety of individuals is now promoted by the practices of the service and the devising of manual handling assessments for all. The service now records any complaints it receives in a coherent manner. Individuals are protected from abuse by the way in which the service liaises with the Local Authority Safeguarding Unit and training provided to staff. The Annual Quality Assurance assessment written by the service states: We have managed the home is an open and transparent manner utilising the experience and skills of other agencies. We have developed communication with other agencies to ensure a single approach to planning care for each resident. We are now Care Homes for Older People Page 8 of 30 operating as part of a team of agencies supplying a joint service. 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those who come to live at Aaron Lodge do not have their needs consistently identified and as a result not all have their needs met. Evidence: We looked at ten files relating to individuals who had come to live in Aaron Lodge since our last visit in October 2008. In some cases, individuals had been assessed by both their the authority that pays for the persons care and the service itself. The services assessment in these cases included reference to the needs of the person in relation to their personal hygiene, their spiritual needs, their ability to communication and other issues relating to their they need. In two cases, people had come to live there as a result of an emergency. The service had identified their needs but had not obtained an assessment from the local authority who pays for their care. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those who use the service benefit from having their needs reviewed on a regular basis but individuals and their families and not given the opportunity to agree with the care that is provided. The health of people is promoted. The people who live at Aaron Lodge are supported in a dignified and respectful manner which takes their privacy into account. Evidence: We looked at ten care plans of those people who had come to live at Aaron Lodge since our last visit in October 2008. All individuals had a care plan. No individual or relative had signed the care plan to confirm that they agreed with the support that was being provided. This is raised as a requirement in this report. All care plans have been reviewed on a monthly basis. This showed that the service seeks to ensure that when needs change, the right support can be provided each person in order to meet their needs. The content of care plans and their review is backed up by the recording made by staff Care Homes for Older People Page 12 of 30 Evidence: on daily records. One care plan had been altered to reflect a health need that one person had had but no information on this had been recorded in the daily records. As a result there is the potential for important information not to be recorded. The record writing in daily records as a result should be reviewed. We received six staff surveys. These commented on the care plans that were used by the service. Comments included: Relevant information on residents is always available everything is always up to date everyone is always up to date with every resident We looked at the health records for ten people. Records suggested that District Nurses are involved in the support of many people. the Manager has monthly meetings with the Community Matron in order to discuss the progress of individuals as well as resolving any issues that may occur. This is viewed as an improvement since our last visit. Personal files showed evidence that the health needs of individuals are taken into consideration. Information such as continence assessments, the monitoring of weight, manual handling assessments, risk of falls and assessments relating to pressure sores all demonstrated that the main health needs of individuals are taken into account. Information was present to suggest that the nutritional needs of people had been assessed and there were records of when health care professionals had visited individuals when needed. The weight of individuals are monitored at least on a monthly basis. The service had identified that weights taken in February 2009 may not be accurate. In those cases, steps had been taken to ensure that the weights were measured more often so that any pattern of weight loss or gain could be more accurately identified. This involved designated staff being identified to do this. Two people had seemingly lost weight from February to March 2009 and had since had their weights more frequently monitored to ensure that this was addressed. There was evidence for another person that weight loss had been identified as an issue when they had been admitted through the services own assessment. This person had only just come to live at Aaron Lodge and this had been identified as an issue on their care plan. As part of the inspection a pharmacist inspector visited on 29th April 2009 to check how medicines were being handled. We found medicines stock and records to be well organised and securely stored. Our checks of the records and current stock showed that medicines contained in the special packaging system (this makes giving medicines easier to do) were being given and recorded correctly. A clear system of stock control was in place that helped make Care Homes for Older People Page 13 of 30 Evidence: sure medicines did not run out of stock and made sure they could be fully accounted for. When we checked a sample of liquid medicines, packets of medicines, inhalers and creams we found some did not add up showing they had either been missed completely, had been given at the wrong dose or an incorrect record had been made. The manager agreed with our findings and took immediate action to help prevent these mistakes happening again. We checked how controlled drugs (medicines that can be misused) were handled. The cupboard used for storage were secure and a special register was used for record keeping. Stock levels were correct and all entries were properly witnessed. Secure storage and detailed records help prevent mishandling and misuse. We looked at the times medicines were given and found the records did not always state the correct time to take medicines in relation to food intake. This means that some medicines might not always be given at the right time in relation to mealtimes, particularly those that need to be given before food and this was confirmed by the manager who then took immediate action to put this right. Medicines must be given to people at the right time and dose to help make sure their health and wellbeing is maintained. We looked at a sample of peoples care plans and found some good information about their medicines. We gave some advice to the manager about how to make this information more accessible to staff by having some of the information kept with the medicines records and the manager took immediate action to help improve this. Having detailed information about medicines helps make sure people have their medicines given to them correctly. Medicines were regularly audited (checked) and detailed records of this were made, however, these audits had not found the types of mistakes that we had found so we gave some advice to the manager on how to make the necessary improvements. The manager said all staff had been booked on a safe handling of medicines course to take place over the following 12 weeks. Although staff received regular training there were no formal procedures for assessing their competence when giving and recording medicines. We gave some advice to the manager about how to include competency as part of staff supervision because the mistakes we had found had been due to staff not following the correct procedures. Regular checks on medicines, formal training and regular competency checks help make sure staff have the necessary skills to handle medicines safely. Care Homes for Older People Page 14 of 30 Evidence: The service has a residents charter on display in the building. This outlines that the service seeks to maintain the personal dignity and independence of individuals. We observed care practice during the visit. This noted that there were examples of staff members knocking on peoples bedroom doors before they entered and of families being provided with the opportunity to visit their relations in the privacy of their own bedroom. One person commented that he had always found staff to be polite. Staff interacted with individuals in an informal yet supportive manner. The preferred terms of address for people are outlined in care plans and these were used by the staff team. Staff were noted to explain to individuals what they were going to do if the individual needed assistance with being transferred. One care plan noted that two people lived at Aron Lodge who were married. Information in their care plan stressed that the privacy of each person needed to be taken into account at all times. Clothing was noted be marked in a discreet manner. The Manager had provided information to visitors to ensure that any clothing was marked appropriately. This had been the source of some complaints yet ensured that the right clothing could be worn by the right person. During the visit it was noted that some bedroom doors were open. The doors are fitted with a device which ensure that the door automatically closes if a fire is detected. Notices are in place for some people that they preferred to keep their doors open during the day and this was to be extended to all others. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Aaron Lodge are provided with the opportunity to be involved in activities. They are able to maintain contact with their families and friends and are encouraged to be as independent as possible. Their have their dietary needs and preferences taken into account by the service. Evidence: We looked at care files for ten people. It was noted that the interests of individuals are recorded. Life histories of individual are not consistently recorded although there was evidence through relatives meetings that the manager has requested these from the relations of each person. An activity co-coordinator is employed and an activity plan is on display indicating events through the week. There did not appear to be an organised activity on the day of the visit although there was evidence that there had been events over the recent Easter period. Those who use the service are kept up to date with events through the issuing of a monthly newsletter. There was evidence that where individuals shared interests staff encouraged this and this was observed during the visit. There was a notice indicating the preferences of one person to rise at a certain time. The Manager is currently devising this for all individuals to recognise their preferences. Care Homes for Older People Page 16 of 30 Evidence: The visitors book indicated that visitors come during the day and visitors were seen visiting their relations during our time there. One person confirmed that they have contact with their family on a weekly basis and the same person received a visit from their wife during the inspection. The persons wife commented that she thought that the care was good The visitors had the opportunity to meet with their relative in the privacy of his bedroom. It was also noted that visitors are offered a cup of tea on their arrival. Information is provided to relations through a monthly newsletter and meetings are also held between them and the Manager. In addition to this the Manager has an open door surgery for relatives to meet with her during the week. These invitations are on display on a notice in the hallway. The service is not involved in the financial affairs of any individual. This is left for families or other advocates to deal with through court of protection. The service does not act as appointee for any individual. No individual uses an advocate at present although it was reported that one person did use an advocate last year. A number of people rely on walking aids to mobilise around the building. It was observed that staff gave people the time to mobilise and to do this on their own rather than intervene. A tour of building noted that personal possessions of individuals enable them to personalise their bedrooms as much as possible. Menus suggest that three meals are offered each day. A three week menu is available and this is placed on tables or is written on a notice board close to each of the two main dining areas. There is also evidence that alternatives are provided if needed. Hot drinks were noted to be made available to individuals through the day. Some individuals are assisted with feeding. In these situations, staff remain with them to assist and this is done on a one to one basis. The kitchen area is well equipped and organised with sufficient food stocks available. Information is in place for kitchen staff in relation to the dietary needs of individuals. This suggested that some have diabetic diets, some require food supplements and those who are on softer diets. All personal files sampled included a nutritional assessment. Two dining areas are available these are pleasant areas with sufficient seating. One is located on the upper floor and the other on the lower floor. One person had been out and was late for lunch but was offered a meal as soon as they returned. Out of those personal records sampled, there was no indication that they had any religious or cultural beliefs that influenced their diet. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service and their families have the information they need to make a complaint and as a result can influence the standard of care provided by the service. Individuals are protected from abuse by the policies and procedures used by the service. Evidence: A requirement at our last visit inspection noted that there was an incoherent approach to recording complaints. A new system has since been introduced which separates records into concerns complaints and safeguarding issues. Twelve instances have been recorded since January 2009. Four of these were in respect of missing clothes. There was evidence that the manager had identified this issue as clothes being brought into the home by relatives which had been unmarked and then lost. A notice for relatives is on display asking clothing to be marked. All concerns included a record of what action had been taken. Where safeguarding issues are raised, there was evidence of these being referred to the local authority safeguarding unit. There was evidence of the response from this authority being retained. Staff surveys were returned to us. These provided an indication of what staff would do if they received a complaint such as Care Homes for Older People Page 18 of 30 Evidence: I would inform the manager and fill in incident book I would know what to do I would inform the manager right away I would always follow policy and procedure if there are any concerns. The Manager is always available to advise The service has a copy of the Local Authority safeguarding procedure and is practiced at referring any areas of concern. A requirement at our last visit raised the need for the service to improve its communication with the Local Authority in respect of safeguarding issues and this has been done. This visit demonstrated that they fully inform relevant agencies of any areas of concern regardless if it relates to practice within the service or elsewhere. Correspondence in respect of referrals is maintained and the Manager seeks to refer any issues which constitute safeguarding to the safeguarding authorities. All safeguarding referrals are made known to us as well as the safeguarding team and the service have improved their record keeping in this regard. Training records suggested that staff had recently received training in the protection of vulnerable adults and some staff have attended training in the deprivation of liberty. Policies in respect of the involvement of staff in the financial affairs of individuals are available and are included within the induction process for new staff. A whistle blowing procedure is available for staff. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those who live at Aaron Lodge live in a pleasant, well maintained and hygienic environment. Evidence: A tour of building was undertaken. The front door is secure and operated by a coded Lock as well as Close circuit television cameras monitoring the outside of the home both front and back. A garden is available to the side of the building and access is possible for all to this area. The rear garden area is secure and not overlooked giving privacy to the people who live there. Grounds are well maintained and offer seating areas and offer access to sunlight. Maintenance staff are available to the service. Any repairs or redecoration are identified and recorded through monthly health and safety audits. The tour of the building noted a slight odour in one corridor area. Discussions with the Manager confirmed that this had been identified as an issue with following and that steps were being taken to address this. The building was found to be clean and tidy. Ancillary staff are on duty and were noted to be working through the building on cleaning tasks. Protective equipment is available to staff and soap/towels available in hand wash areas with bacterial hand wash available in some areas. The laundry is separate from food preparation and storage areas. Industrial appliances are included within the laundry and all equipment was said by the laundry assistant to be working Care Homes for Older People Page 20 of 30 Evidence: satisfactorily at present. Hand wash facilities are available and laundry has an impermeable floor in place. The laundry is organised. A clinical waste system is in place with clinical waste bins located in each area and bins located externally for removal. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Aaron Lodge receive support from staff who are sufficient in number to meet the needs of individuals. Staff are also qualified and trained to meet the needs of individuals. The recruitment process protects individuals form abuse. Evidence: Staff rotas are available. These include a mix of managerial, care and ancillary staff on duty during throughout the day and night. Rotas include the designation of staff. There was evidence of each persons file that their dependency levels and the assistance they need from staff in each daily living task are assessed on a monthly basis. A scoring system is used for this and out of the ten files sampled, these indicated that generally these individuals have low dependency. The Manager considers that current staffing levels meet the needs of individuals. We received staff surveys before our visit. Comments included: Extra staff will be called in if because the morning is very busy The manager always ensures that all shifts are covered and staffed appropriately There is always enough staff In respect of qualifications, training records suggest that over fifty percent of care staff have at least a National Vocational Qualification at Level 2. Records also suggested that some have attained Level 3. This is above the standard we expected from the service. Care Homes for Older People Page 22 of 30 Evidence: One recruitment file was examined given that only one member of staff has been recruited to the home since our last visit. The file related to the new post of deputy manager created to assist the Manager. Application form available as well a police check, a check carried out by the service to ensure the person has not been included on a list barring individuals from working in the care industry, two references, proof of identity and information confirming the persons status to work. Staff surveys were received by us before the visit. Comments included: All checks were done and on my induction I was brought in before my first shift and shadowed staff I could not start until my police check and references were all received I was trained on all relevant topics for my job My induction showed me the different needs of each resident and the way the shift is set out Training records were available. Records confirmed that staff have received health and safety training and that this is ongoing. Training includes infection control, food hygiene, fire training, manual handling, the control of substances hazardous to health and first aid. Other training specific to the needs of individuals. This included nutrition, dementia awareness, pressure area care, dental care, eyesight care and diabetes training. Comments were received from staff about training I was given training relevant to my role, this helps me understand the needs of people and keeps me up to date We are continually trained and if any new legislations arise we are trained-we have regular staff meetings to put across our views and anything we do not understand is put across and dealt with Training on various aspects is always provided Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Aaron Lodge receive care from a service that is managed by an experienced and qualified individual. All people connected with the service have the opportunity to influence the care they receive by the way in which the service obtains their views about the quality of care. The financial interests of individuals are safeguarded and their health and safety is promoted through the practices of Aaron Lodge. Evidence: Staff surveys were returned to us. These included comments about the Manager of the service. These stated: the manager is very supportive at all times the manager is always available if you need to talk or discuss anything whether generally or confidentially the manager is very helpful and is there if we need her and shows us things when we need to do it the manager is always there when you need her and is very helpful Care Homes for Older People Page 24 of 30 Evidence: The manager has worked there for a number of years and is registered with the previous regulator. She has an National Vocational Qualification at Level 4 Four. She has adopted a policy of meeting with significant others such as relatives, district nursing staff and staff members. She has an open door policy in respect of meetings with relatives and has adopted several quality assurance schemes since the last inspection to monitor the standard of support provided. The service has adopted a number of ways of monitoring the standard of the service it provides. The Manager has periodic meetings with relatives and those who live at Aaron Lodge. minutes of meetings confirmed these. The next meeting is scheduled for May 2009. In addition to this, the Manager holds an open door meeting with relatives on a weekly basis. A suggestion box is available in the main hallway although it is uncertain whether this is used. The Manager has conducted her own visits to the service during the night to ensure that staff practice meets the needs of individuals. Reports relating to these visits were available on the day of the visit. During our visit we were provided with all the documentation we needed and were able to view all parts of the building as well as observe care practice. All requirements from our last visit in October 2008 have been addressed. The service does not directly deal with the finances of individuals but does have a system of paying for day to day expenses for people and then claim it back from relatives who are responsible for their finances. Records are maintained for this purpose and these are in turn audited periodically. Any monies stored are securely placed in a safe. Training records noted that staff have receive health and safety training and this is ongoing. The service conducts a health and safety audit each month. This provides the opportunity to identify any issues within each area of the building which may need to be repaired or refurbished if it means that the health and safety of someone is compromised. In addition this check covers issues such as fire safety and the monitoring of water temperatures. Records are available to suggest that fire safety is taken into account with the required checks on fire detection equipment being carried out regularly. This is reinforced by training. Information received by us prior to our visit suggested that electrical wiring, gas systems and portable appliances had all been tested. The building is secure and takes the safety of individuals living there into account through the use of coded locks, external close circuit television and window restrictors Care Homes for Older People Page 25 of 30 Evidence: on upper floors. The risks that are faced by individuals living at Aaron Lodge are identified in risk assessments and these include those substances that are hazardous to the health and individuals. The service always informs us of any incidents that could affect the wellbeing of people in line with its legal responsibilities and maintains certificates in relation to its registration as a care home and insurance. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The service must obtain a copy of a Local Authority assessment of individuals needs before they come to live at Aaron Lodge so that their needs can be consistently met 15/05/2009 2 7 13 Medicines must be given to 31/05/2009 people correctly as prescribed. This is important because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. Those who use the service and their Representatives should sign to confirm the contents of their care plan or otherwise so that they are involved and consulted about the care they or their relatives or provided with. 15/05/2009 3 7 15 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The assessment used by the service should be fully completed so that the needs of those who come to live at Aaron Lodge can be fully met Daily records should include all events affecting individuals so that communication for staff can be as effective as possible. Suitable arrangements must be put in place for checking medicines and staff competence, this will help make sure medicines are handled safely and help make sure staff have the necessary skills. 2 7 3 9 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!