Inspection on 03/11/08 for Ashwood Care Centre

This inspection was carried out on 3rd November 2008.

CSCI 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

Ashwood Care Centre 09/10/08

Ashwood Care Centre 19/05/08

Ashwood Care Centre 06/11/07

Ashwood Care Centre 29/11/06

Ashwood Care Centre 12/07/05

Ashwood Care Centre 25/01/05

Ashwood Care Centre 19/01/05

Ashwood Care Centre 05/07/04

Ashwood Care Centre 30/09/03

Ashwood Care Centre 20/05/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashwood Care Centre 1a Derwent Drive Hayes Middlesex UB4 8DR     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: Clare Henderson-Roe     Date: 0 3 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ashwood Care Centre 1a Derwent Drive Hayes Middlesex UB4 8DR 02085731313 02085731124 ashwood@lifestylecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross (LSC) Ltd Type of registration: Number of places registered: care home 70 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 15 Elderly Personal Care 23 Older people with dementia - personal care. 32 Elderly Frail, of which 24 beds are for nursing and 8 are personal care or nursing Minimum Staffing notice. Date of last inspection Brief description of the care home The home is situated between Uxbridge and Hayes. It is a purpose built home and there are 3 floors accommodating residents, with 2 units on the ground floor and 1 unit on each of the 1st and 2nd floors. The home can accommodate a total of 70 residents. There are 68 single rooms and one double room, all with en suite facilities. There are local shops, bank and post office facilities nearby. The Beck Theatre is near the home, as are local pubs and restaurants. The home can be accessed by bus and main line Care Homes for Older People Page 4 of 27 Over 65 0 70 70 0 Brief description of the care home train services. The home has one GP practice and there are weekly visits to the home, and other healthcare services can be accessed by the home for the residents. A Devotional Meeting is held regularly and religious and clergy visits are arranged as required. The home has a Manager, plus a Deputy Manager who also works as a registered nurse within the home. There is also a Head of Care in charge of the personal care units. The fees range from three hundred and ninety four pounds to seven hundred and eighty seven pounds and 97 pence per week. Care Homes for Older People Page 5 of 27 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 was an unannounced inspection carried out as part of the regulatory process. A total of 20 hours was spent on the inspection process, and was carried out by two Inspectors. We carried out a tour of the home, and service user plans, medication records and management, staff rosters, staff records, financial and administration records and maintenance and servicing records were viewed. 12 residents, 15 staff, 1 visitor and 3 healthcare professionals were spoken with as part of the inspection process. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents, staff and health and social care professionals have also been used to inform this report. It must be acknowledged that it is not always possible to ascertain the views of residents living with the experience of dementia. Care Homes for Older People Page 6 of 27 Two Random Visit Inspections had been undertaken in July 2008 and October 2008 in relation to 2 Statutory Enforcement Notices which had been issued in June 2008. The home was found to have complied. The last Key Unannounced Inspection took place in May 2008. What the care home does well: What has improved since the last inspection? There has been a significant improvement in the formulation and completion of the service user plans. Where residents had experienced a fall the risk assessment for falls and other documentation had been thoroughly completed. Assessments in relation to skin, continence, nutrition and moving and handling were up to date and being regularly reviewed. Since the last inspection the home has purchased some new pressure relieving equipment to meet the needs of the residents. Bedrail assessments had been completed with consent for their use being obtained. We found that residents were being weighed regularly and where input from a dietician was required this had been actioned promptly. Wound care documentation was being well completed and their was input from the tissue viability nurse specialist. We found improvements in the information relating to the wishes of residents and their representatives in respect of end of life care. Staff had also received training in this area. Individual information regarding residents interests and hobbies was available and activities provision in the home had much improved. Staff care for residents in a gentle, caring and professional manner, respecting their privacy and dignity. Staff were heard speaking with residents using their preferred term of address. A good rapport was observed between staff and residents. Changes have been made to the menu and residents individual choices and preferences are met. We found that any unexplained injuries were being recorded, reported and appropriately investigated. The redecoration and refurbishment plan is being implemented and their have been several areas of redecoration in the home. No storage issues were identified at this inspection. We were informed that all equipment in the home was in working order. Whilst their has been an improvement in the management of maldours, further work is required in this area on the residential dementia unit. We found that the home was clean and that laundry was being completed in a timely fashion. No issues were noted with the cutlery and crockery provision and we were informed that all cutlery and crockery is washed using the Care Homes for Older People Page 8 of 27 dishwasher. Staff had been receiving training in topics relevant to the resident group, health and safety and further training is planned. Systems are in place for effectively reviewing the quality of care provided and for reviewing all aspects of the home for quality assurance purposes. We found that staff were receiving regular supervision and this had helped them develop their confidence and knowledge. There has been a significant improvement in the management of all residents records and these improvements must be maintained. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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 and their representatives are provided with information about the home, thus allowing them to make an informed choice. Residents are fully assessed prior to admission to the home to ascertain that the home is able to meet their needs. Evidence: The Statement of Purpose and Service User Guides have been updated since the last inspection and provide a good picture of the services offered by the home. These documents were freely available. There have been few admissions since the last inspection. One pre-admission assessment was seen and this had been well completed and provided a good picture of the resident and their needs. A copy of the Social Services assessment was also available. Care Homes for Older People Page 11 of 27 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 service user plans are being well completed, thus providing staff with information about each residents needs and how these are to be met. There is good input from healthcare professionals, thus optimising the residents wellbeing. Medications are now being well managed in the home, thus safeguarding residents. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. End of life care wishes are discussed and documented, ensuring that the wishes of the residents and their families are respected. Evidence: We viewed 5 service user plans from the units throughout the home. Overall these were well completed and gave a clear picture of the needs of each resident and how these are to be met. There was evidence of regular reviews and involvement of residents and their Representatives in the reviews. Documentation had been updated monthly and whenever there was a significant change in a residents condition, for example, when returning to the home following a hospital admission. Risk assessments for falls were in place and these plus any relevant documentation had been completed Care Homes for Older People Page 12 of 27 Evidence: and updated following any falls. Wound care documentation was viewed. Risk assessments for pressure sore risk were in place, and a care plan for each wound had been formulated, along with a record of the ongoing dressing reviews. This documentation recorded the types of dressings to be used and the frequency of the changes. There was evidence of input from the tissue viability nurse and the pressure relieving equipment in use had been identified in the care plans. Several staff have attended training in pressure area care and further training in tissue viability has been booked. The residents on the nursing units are weighed weekly as a matter of routine. Where there was evidence of significant weight loss a referral had been made to the dietician and there was evidence of the dietician visiting the home in a timely manner. Nutritional assessments and, where a problem had been identified, food and fluid records were in place and the information from these documents is also used to inform the dietician. Moving & handling assessments were in place and clearly identified the equipment to be used for each resident. All residents have a moving & handling care plan in place. Continence assessments had been carried out and the regimes and products to be used to assist residents with continence management had been recorded. Risk assessments for the use of bedrails were seen, and where the resident was unable to sign the consent for their use, the GP had done so until the representative was able to attend and sign also. There was evidence of input from healthcare professionals to include GP, psychiatrist for the dementia care unit, speech & language therapist, optician, chiropodist, occupation therapist and the dentist. Healthcare needs are being well met at the home. We carried out 2 random visits in connection with medication management following the last key inspection, and shortfalls identified at that inspection had been addressed. At this inspection we sampled medication management and records on each unit. For each resident there is an individual sheet with a photograph, room number, name, date of birth, GP, allergies and any other relevant information recorded. There were lists of staff signatures and initials in place. The medication administration record (MAR) sheets had all receipts and administration recorded, and when a medication had been omitted, the correct coding and explanation had been recorded. Disposal records were clear and 2 staff had signed for all entries. Fridge and room temperatures were within safe ranges for the storage of medications. Liquid medications, eye drops and inhalers had been dated when opened. Correct lancing devices were in use for carrying out blood sugar monitoring. Any specialist instructions for individual medications had been clearly recorded. A running stock balance is recorded each day for each medication. Controlled drugs were being securely stored and the records for viewed were up to date and stock balances were correct. Staff were seen caring for residents in a gentle, caring and professional manner, Care Homes for Older People Page 13 of 27 Evidence: respecting their privacy and dignity. Staff were heard speaking to residents using their preferred term of address. Staff were seen knocking on bedroom doors before entering. Bedrooms were personalised and there was a homely feel on each unit. Training is being arranged entitled My cultural diversity or yours, which looks at understanding the cultural history and needs of the resident group. The home has introduced the Gold Standard Framework for end of life care. Care plans viewed had clear information recorded in respect of the wishes of the residents and their families in the event of health deterioration and care during their final days. The home has developed close links with the Palliative Care Team and training has been implemented for all staff in this area so that they have the skills and knowledge to provide effective end of life care. Care Homes for Older People Page 14 of 27 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 activities provision has improved in order to cater more to individual needs as well as general activities. The home has an open visiting policy, thus encouraging residents to maintain contact with their family and friends. Advocacy arrangements are in place, thus ensuring residents rights and opinions are heard and respected. The food provision at the home is good, offering variety and choice to meet the residents needs. Evidence: The home has a full time activities co-ordinator. Following the last inspection there has been more involvement from the staff on each unit in the implementation of activities, thus improving the activities provision throughout the home. A Life Story is completed for each resident, thus providing staff with information regarding each residents past and their interests and hobbies, so that although there are several activities that are more general in order to engage a wider group of residents, consideration is also given to activities which aim at the interests of individuals, for example, gardening and 1:1 visits for residents who are more frail. Outings have been arranged and there is a qualified MIDAS driver on the staff, so that the local community bus can be used. In addition the Manager has found out about Taxicard scheme and the suitability of it for residents, plus getting residents registered with Care Homes for Older People Page 15 of 27 Evidence: Dial-a-Ride. Residents pay towards the cost of the outings they go on. The smoking room was formerly the activities room, and work has been done to identify a more suitable room for smokers so that the activities room can be reinstated. At the time of the inspection the home was decorated for Halloween, and these were about to be replaced with Bonfire Night ideas and then Armistice Day celebrations. Training entitled valuing memories and life story work is to be undertaken in th near future and rolled out to all staff. We discussed the possibility of having an additional person allocated to activities and within this, to consider a 7 day week provision. This is to be looked into once the home has increased the number of residents accommodated therein again. The home has an open visiting policy and visiting is encouraged. Comments received indicate that visitors are made welcome at the home and representatives are kept up to date with their relatives condition. Visitors are encouraged to attend activities, for example, the Garden Fete and the Fireworks Display. The home has a variety of information on display in the foyer for several advocacy groups, to include Rethink, Age Concern, Care Aware and the Hillingdon residents and relatives group. Contact details for each organisation are contained within the information. We viewed the kitchen and the area was clean and tidy. The home has attained a 5 star rating in the Scores on the Doors scheme from the Food Standards Agency. There was a good supply of fresh, frozen, tinned and dried produce and all items viewed were in date. Since the last inspection the NUTMEG system has been introduced, which is a nutritionally based process of calculating then menus. Examples of improved food provision include fruit platters mid-morning, home baking for the majority of the afternoon tea cakes, fortified milkshakes and build up drinks for residents with low weights, improvements in the provision of foods to meet specific needs, for example, finger foods for residents who wander and do not easily sit down to complete a meal. On the first floor they have introduced 2 sittings at mealtimes so that attention can be given both to those who need assistance with their meals and also to those who need supervision only. The home has also introduced protected mealtime when telephone calls are not put through to the units between 12 and 1pm, so that all staff focus on the lunchtime meal. There are drinks and snacks available throughout the 24 hour period. Care Homes for Older People Page 16 of 27 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 home has clear complaints and safeguarding adults procedures in place and these are adhered to, thus protecting residents. Evidence: The home has a clear complaints procedure and this is on display throughout the home. Since the last inspection the home has received 2 complaints and there was evidence that these had been fully investigated and responded to. The Manager operates and open door policy and encourages residents, visitors and staff to raise any issues they may have so that they can be dealt with promptly, and comments received confirmed this. Southern Cross has safeguarding adults procedures and also the home has a copy of the Hillingdon Safeguarding Adults documentation. There is evidence that any issues identified under the safeguarding adults protocols have been reported and investigated appropriately. 94 of the permanent staff have undertaken safeguarding adults training, and those spoken to were very clear to report any concerns and also understood Whistle Blowing procedures. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been improvements in the environment and overall the home now provides a clean and safe place for residents to live in. Shortfalls identified are the need to replace the corridor carpet and review the lighting on the second floor. The home is clean and are systems in place for infection control, thus safeguarding residents. Evidence: We carried out a tour of the home. There was evidence of several areas of redecoration and refurbishment following the last inspection. The maintenance man has a list of all areas of redecoration and when this was carried out. Several bedroom carpets have been replaced with appropriate flooring for the needs of the residents. The corridor carpet on the second floor needs replacing with flooring suitable to meet the residents needs, as there are still issues with malodours. This needs to be done as a matter of priority. A full audit of the home was carried out last in November 2007 and this is due to be updated. There was evidence on the budget for the years expenditure that further refurbishment has been planned for. The fire risk assessment was last done on July 2008 and the shortfalls identified on the action plan from this assessment had been addressed. The garden is being maintained and there are plans for a sensory garden to be planted. The home has a recurring damp problem with one kitchen wall and this has in turn affected the flooring. This is in the process of being addressed to ensure the cause of the damp is fully eliminated prior to the flooring Care Homes for Older People Page 18 of 27 Evidence: being replaced. It is acknowledged that work has already taken place to address this, but unfortunately this was unsuccessful. Since the last inspection the home has purchased weighing scales for use with the hoist, for ease of weighing residents who are non-weightbearing. All the beds on the nursing units are now profiling beds with integrated bedrails. At the time of inspection all the equipment in the home was in working order and each unit had moving & handling equipment to meet the needs of the residents. There were no storage issues identified at this inspection. There is a call bell system in place throughout the home and each unit is checked monthly. The home was pleasantly warm throughout. There are window restrictors in place to ensure windows are opened a safe distance only. It was noted that the lighting in the second floor corridors was relatively dim and action must be taken to ensure the lighting meets the Lux 150 standard. The laundry room was clean and tidy. There are 3 washing machines and 2 dryers, all of industrial standard and the washers have sluice programmes for infection control Copies of the infection control procedures were available. Laundry was being done in a timely fashion and all items viewed were identified to the individual or their room number. The home has appointed a Housekeeper and clear records for cleaning to include washing of curtains in each area were available. The home was clean, and with the exception of the second floor, it smelled fresh throughout. There was evidence of protective clothing to include gloves and aprons, and these were being used appropriately. The Housekeeper also said that a system of ordering name labels for each resident for whom they are needed has been introduced, so that clothing can be clearly yet discreetly labelled for each resident. Care Homes for Older People Page 19 of 27 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 home is appropriately staffed, thus ensuring the needs of the residents and the home overall are met. Staff undergo training to provide them with the skills and knowledge to care for residents effectively. Recruitment procedures are robust and are followed, thus safeguarding residents. Evidence: The home has employed more staff following the last inspection. There is a kitchen assistant working as a bank member of staff, which ensures that sickness and holiday in this area can be easily covered. There has been an increase in domestic staffing levels, and this was evident in the improved cleanliness throughout and efficiency in the laundry management. The bank nursing and care staff have increased. There is also a full time administrator in post. During this inspection we did not receive any comments from staff regarding being short of staff, and from viewing the staff rosters it is clear that action is taken to replace any staff sickness. The AQAA for the home shows that over 50 of the care staff are qualified to NVQ in care level 2 or above, and several care staff are currently undertaking NVQ in care training. 2 kitchen staff are undertaking Hospital Industry Training, which covers all aspects of catering relevant to a care home environment. Care Homes for Older People Page 20 of 27 Evidence: We viewed 3 sets of staff employment records and these contained all the information required under Schedule 2 of the Care Homes Regulations 2001. Southern Cross has a induction programme that meets the Skills for Care common induction standards. The induction training for all care and nursing staff has been extended and the Manager explained that she and the Clinical Lead work with new staff to ensure they understand the induction programme and can work through it effectively. New registered nurses have a 2 week induction period, to provide them with practical and theory experience. Staff have also received training in topics relevant to the diagnoses and needs of the residents, with further training to include dementia care training planned. Care Homes for Older People Page 21 of 27 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 Manager and Deputy Manager has the qualifications and experience to manage the home effectively and does so in an open and inclusive manner to ensure good outcomes for the residents living at the home. The home is using the quality assurance programmes effectively to raise standards and review practice, thus improving the outcomes for the residents living there. There are systems in place for management of residents monies and these are followed, thus safeguarding their interests. Staff receive regular supervision, thus providing a forum for development and review of good practice and knowledge. The home has good systems in place for health & safety, thus safeguarding residents, staff and visitors. Evidence: The Manager and Deputy Manager are currently both employed in an acting up capacity. Both have the skills and experience to manage the home effectively and this is evident from the marked improvements made throughout all areas of the home since the last inspection. Staff and residents spoken with said that the management Care Homes for Older People Page 22 of 27 Evidence: are approachable and helpful, and provide the information and support to enable staff to carry out their jobs effectively. The Manager has the relevant management qualifications for her role, plus many years of management experience. She has good leadership skills and has developed an open and inclusive environment for staff, residents and visitors. The Deputy Manager is a registered nurse and it was clear that she has been very influential in the in the improvements made on to the nursing units. The home has a system in place for quality assurance, and this has been used effectively. Audits are carried out for various areas of care to include medications, care planning, catering and a monthly Home Managers Audit, which covers all aspects of the home. It is evident in the improvements made in the home that the auditing process had been being used effectively. Regulation 26 visits are carried out and reports made available. Regular staff meetings take place for all staff, the health & safety team and heads of department. Residents and relatives meetings also take place. Minutes were available from all these meetings. The home has a computerised system for the management of any monies held on behalf of residents. We viewed samples of the records to include income and expenditure, plus interest is allocated to each resident. Receipts for all income and expenditure were available and detail of expenditure is recorded. Monies are securely stored in the home. The Manager has introduced a system for staff supervision. This includes both individual and group supervisions, and these are recorded. Staff spoken with confirmed that they receive supervision and this had been positive and constructive in developing them professionally. Since the last inspection the completion of residents records has markedly improved, as reflected throughout this report. We sampled maintenance and servicing records and these were up to date. Generic risk assessments are in place for equipment and safe working practices, dated 2006. The Manager said that she was downloading the updated versions from the Southern Cross intranet. In the kitchen the cook had carried out annual reviews on risk assessments in place specific to the kitchen. Systems are in place to ensure staff read and sign any directives issued by the Manager. Fire drills had been taking place frequently in order to ensure all staff had attended, and only a very few bank staff were still to take part in a fire drill. There had been a big improvement in the health & safety training and there are 3 in-house trainers for moving & handling. The Manager explained that in addition to the routine moving & handling training sessions, further practical sessions are undertaken on the units to ensure that staff maintain good Care Homes for Older People Page 23 of 27 Evidence: current practices. Where some of the bank staff are not evidenced as having carried out all the health & safety updates, it was explained that they have carried out the training in their full-time employment and that certificates are not always available to view. Staff spoken with confirmed that there has been a good improvement in the amount of training provided. Care Homes for Older People Page 24 of 27 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 25 of 27 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 19 23 The lighting on the second floor must be reviewed to ensure it meets the Lux 150 standard. To ensure that residents live in a safe environment. 01/12/2008 2 25 16 The corridor carpet must be replaced on the second floor with suitable flooring to meet the needs of the residents. To provide a pleasant and odour free environment for residents to live in. 31/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 That the home strongly consider additional hours to be allocated to the provision of activities in order to provide activities throughout the 7 day week. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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