Inspection on 21/04/09 for Avalon Care Home

This inspection was carried out on 21st 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Avalon Care Home 15/09/09

Avalon Care Home 14/10/08

Avalon Care Home 08/05/07

Avalon Care Home 12/06/06

Avalon Care Home 06/12/05

Avalon Care Home 15/06/05

Avalon Care Home 22/02/05

Avalon Care Home 08/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

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: Avalon Care Home 24 Duke Street Southport Merseyside PR8 1LW     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: Claire Lee     Date: 2 1 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Avalon Care Home 24 Duke Street Southport Merseyside PR8 1LW 01704541203 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Avalon Residential Homes Ltd care home 20 Number of places (if applicable): Under 65 Over 65 20 1 3 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 0 0 The registered person may provide the following category of service only: Care home only: Code PC, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP (maximum number of places: 3). Dementia over 65 years of age: Code DE(E) (maximum number of places: 20). Mental disorder, excluding learning disability or dementia over 65 years of age: Code MD(E) (maximum number of places: 1) The maximum number of service users who can be accommodated is: 20. Date of last inspection Brief description of the care home Avalon Residential Care Homes Ltd purchased Avalon care home in July 2004. Avalon is a Residential Care Home, which provides personal care and support for up to twenty elderly residents. Ann Wilson manages the home. The home is a large detached converted house, set in a residential area, within walking distance of all the amenities Care Homes for Older People Page 4 of 29 1 4 1 0 2 0 0 8 Brief description of the care home of the town of Southport. Access to the town can be made via the local transport services where necessary. A lift provides access to all floors of the home. There is a spacious lounge, dining room and quiet room. Steps from the main front door lead to the garden and there is also wheelchair access to the garden from the lower ground floor. Fees for the service are currently charged at 383 pounds per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit to the home was one part of the inspection. It was carried out over one day for a duration of approximately nine hours. Twenty two residents were staying at the home at this time. The term resident is used in this report as this what the people accommodated like to be known as. During the time spent at the home different areas were looked at and a number of care, staff and health and safety records were checked to see what care the residents living there received. Discussion took place with three residents, four staff, two relatives and the manager. During the inspection two residents were case tracked (their care files were looked at and they were asked for their views of the home). Other residents also took part in the inspection and all the key and other standards Care Homes for Older People Page 6 of 29 were assessed during the visit. Reference to them is made in this report. To find out more about the care provided at the home survey forms called Have Your Say About... were distributed to a number of staff prior to the inspection. Resident and relative surveys were given out at the time of the site visit. A number of comments included in this report are taken from surveys received and also interviews which took place. An AQAA (annual quality assurance assessment) was completed by the manager. The AQAA comprises of two self questionnaires that look at the outcomes for people.The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the home, including staff numbers and training. The AQAA lacked information to demonstrate what the service provides and how this is achieved. Advice was given to the manager regarding its completion. The last key inspection took place on 8th May 2007. What the care home does well: What has improved since the last inspection? What they could do better: The resident assessment should record more behavioural information so that staff are Care Homes for Older People Page 8 of 29 aware of the factors that affect behaviour and memory loss. This information should then be transfered to the plan of care to help with determining the level of support needed for the residents dementia and its associated factors. This will help staff when delivering good outcomes for them. Risk assessments should also be completed in more detail as to the level of risk to the resident and how staff will minimise it to help protect them. A more formal complaint log could be introduced to record the outcome of the complaint and to assist with audit complaints received. Staff files seen showed that staff require training in moving and handling, first aid, fire prevention, food hygiene and infection control. This is needed to ensure they have the skills and knowledge to care for residents safely. Staff must also have skills & competencies to meet specific care and management needs of a person with dementia. A training plan should be drawn up to show dates of training and their renewal. This will help the manager with planning courses. Skills for Care Induction Standards should be accessed as these provide a formal induction in health care in accordance with NVQ (National Vocational Qualifications). The staffing rota should evidence the actual date along side the day and month so that records are kept accurate. The AQAA should be completed in sufficient detail to demonstrate what the service does and how this is achieved. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from a more detailed behavioural assessment so that staff are aware of the factors that affect behaviour and memory loss. This will help staff to assess the level of support each resident needs for their dementia. Evidence: Information regarding Avalon was recorded in a brochure called a Statement of Purpose. The document is given to residents and their families when they come to visit the home. They are also invited to stay for lunch and have a look round the premises before deciding whether it is suitable for them. The manager completes a care needs assessment prior to the resident taking up residency. The assessment information is gained from the resident where possible, family members and other health professionals. Social services assessments were also seen to help gain as much information as possible regarding the care and support the Care Homes for Older People Page 11 of 29 Evidence: resident needed from outside agencies prior to admission. Relatives said the staff had plenty of questions regarding help needed with areas such as walking, eating, sleeping, memory loss and assistance with bathing. A resident commented, The staff were so kind when I arrived. Two assessments were looked at and these recorded details regarding the health and social care the resident needed. The manager is in the process of introducing a new assessment and this includes more details regarding factors which affect resident behaviour and memory loss. It is recommended that this be implemented as this forms an important part of of the care provided by the staff. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents at Avalon have their care needs met and their care is provided in a manner that respects their privacy and dignity. Evidence: Residents had an individual care file with details of the support and care they needed. Case tracking took place for two new residents to review their care documents. The residents had a plan of care and this recorded their care needs and how staff would provide the necessary support. This was seen for areas such as, walking, eating, communication, washing and dressing. A new system for documenting care is being gradually introduced for all residents. This was seen at the time of the inspection and also reported in the AQAA. Staff said, We have new care plans in place which allow us to record all general information in full and to write daily reports and We have new care plans in place that give us information in an easier way to document daily living requirements. The new care plan format will enable staff to record more details regarding changes to residents behaviour, communication and factors associated with memory loss. It is recommended that staff do record more specific details with regard Care Homes for Older People Page 13 of 29 Evidence: to this to enable them to fully understand and respond appropriately to the residents symptoms of dementia. The care plans seen had been reviewed to ensure the information recorded was accurate and also relatives had been approached so that they were aware of how the staff would care for their family member. Care staff had also completed a number of care records to support the resident. This included family information, daily written reports by the staff, medical appointments and risks to the resident. Risk assessments were seen for assisting residents who were unsteady on their feet. Again these could be recorded in more detail for managing falls to determine how staff minimise them with compromising the residents independence. Residents were weighed to ensure they were receiving a good diet and the manager is seeking help from a practice nurse to complete a nutritional assessment. The district nurse service was providing clinical advice and treatment to residents, as the staff are not qualified nurses. They work with the care staff and records seen and staff interviews conducted showed that their advice was followed. One residents care needs had increased and it was evident that the staff were attentive and regular checks were carried out to ensure the residents comfort. A health care professional said, The staff are good and respond well to the advice we give. Residents and relatives interviewed said they were pleased with the care and that the staff made sure this standard was maintained. A local GP attends the home and is responsible for overseeing the majority of the residents accommodated. This provides good continuity of care and the care files seen had written records by the GP when asked to attend a resident. Relatives interviewed said the staff were quick to phone the GP for advice when needed. A chiropodist visits regularly and referrals are made to the CPN (community psychiatric nurse) and memory clinic when needed. A resident said, I keep well but I know I can see my doctor. The manager is liaising with a CPN regarding providing care to a resident who needs help with making decisions. This will help to protect them. The manager has a contract with a local pharmacist for supplying medicines to the home each month. The local pharmacist has recently completed a review of the medicines given out and staff confirmed that he provides advice when needed. Staff records also confirmed that formal medicine training is accessed for them and the manager had completed an assessment of their knowledge to ensure medicines were given out safely. Medicine charts seen showed that medicines had been given by the staff according to the prescription. Good recording systems were evident and staff are now signing for external preparations, for example, creams to be applied. This was a requirement at the last key inspection and this has now been met. Hand written entries for the medicine charts should be countersigned by two staff to ensure accuracy of the record. A list of staff signatures who are authorised to give out Care Homes for Older People Page 14 of 29 Evidence: medicines should be kept. This will identify staff who can carry out this practice safely. Good interaction between the staff and residents was seen. There was a relaxed atmosphere and staff were seen to spend plenty of time talking with the residents, assisting them with personal care and helping with their meals. Staff were observed to be polite, helpful and patient in their approach. The support given was in a positive, warm manner to ensure residents enjoyed their day. Attention was paid to ensuring clothing was appropriate and ladies were wearing make up and jewelery. A staff member said, We provide a homely atmosphere for our residents with plenty of interaction. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are both well managed and provide daily variation and interest for the residents at Avalon. Evidence: The routine in the home appeared relaxed and residents were comfortable with the staff. Staff interviewed discussed the importance of providing social interests to suit each resident and the benefits of good stimulation. Residents were seen to enjoy contact with the homes pets which include a dog, guinea pig, budgerigar and a parrot. Bingo was played at the time of the inspection and the Salvation Army conducted a church service. Holy Communion is offered to residents so that they can continue with their chosen faith. Residents were able to take part in a number of activities which included, singing, music, gardening, shopping, trips out in the mini bus and reminiscence therapy. Family contact is encouraged and relatives interviewed said that they were always made welcome by the staff. They also commented that they were kept informed of any change to their family members care and social arrangements. A coffee morning was taking place on the weekend and BBQs are being planned for the summer months. A resident said, There are things going on and I can decide whether to join in. The daily activities were on display in a prominent place for the residents to Care Homes for Older People Page 16 of 29 Evidence: see. The new care plans encourage staff to record in more detail social information regarding the residents to help the staff to get to know their preferred interests and their life prior to coming to the home. If residents wish to pursue their own activities this is risk assessed to ensure their safety. A number of residents were seen to be independent when walking, however staff were on hand to help to reduce the risk of falling. The menu was based over two weeks and it offered a good choice of hot and cold meals at different times of the day. The main meal is served at lunch time and there are two sittings. The majority of residents sat at the dining room table. The dining room was warm, airy and the table nicely laid. Lunch was served in an unhurried way by the staff and the residents were given time to enjoy their meal. The cook stated that special diets are catered for and a list was seen of the foods residents prefer. This helps to ensure they receive a good nourishing diet, which they enjoy. The kitchen was found to be well stocked and residents had fresh fruit and vegetables as part of their diet. The menu for the day was displayed in a prominent place and a resident said, The food is fine, I can have my breakfast when I want. Hygiene control records for the kitchen were up to date to ensure satisfactory standards of cleanliness were maintained. Advocacy details were displayed should residents and their families wish to seek independent advice. A relative said, The manager and staff have been very helpful when asking for information on dementia which has been very reassuring. Staff were seen to be polite and caring in their manner. They spoke slowly to the residents, using touch appropriately and allowing sufficient time for the resident to understand and respond. Examples of this were seen at, meal times, meeting visitors and encouragement with participation in social activities. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their families can express their concerns and be listened to. Their rights are protected and they are safeguarded from abuse. Evidence: There is a complaint policy and procedure and the details were made available to residents and their visitors. One complaint has been received by the previous organisation, Commission for Social Care and Inspection and this was investigated by the manager and not upheld. The AQAA recorded that one complaint had been received directly to the home. Following the managers investigation this was upheld. A more formal complaint log should be introduced to record the outcome of the complaint and to assist the manager when reviewing complaints received. The complaint policy should also be udpated with the new care regulators contact details, Care Quality Commission. When discussing how to handle a complaint the staff interviewed said the following, We refer the complaint or concern to the manager and I would record the complaint appropriately and forward it on to the manager as soon as possible. Relatives interviewed said they were pleased with the home and that they had no concerns at this time. A resident said, I think it is all fine. With regards to protecting vulnerable adults the staff have access to policy documents Care Homes for Older People Page 18 of 29 Evidence: and also local guidance on how to report and deal with an alleged incident. Not all staff have received training in the protection of vulnerable adults and this should continue so that their knowledge is up to date and and in accordance with local guidelines. A staff member said, I would have no hesitation in reporting it (incident). Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, well maintained, clean and pleasantly decorated home. Evidence: A tour of the home took place and areas seen were found to be clean and well maintained. A painter and decorator was working in the home as part of the ongoing maintenance. A part time handy person was responsible for keeping the home in a good state of repair and this was seen in relation to records kept and safety checks being done. A resident said the home was looked after and was comfortable. Likewise a staff member said, I feel it is a lovely homely environment. To help the residents to get to know their way around the home, there were visual signs and different colour schemes, for example, blue for bathrooms. With regards to safety, door alarms had been fitted to alert staff when resident are wandering or may get up at night. Hand rails in the corridors help residents with their independence and if a resident requires a special bed and mattress this is obtained from the district nurse service. This was seen at the time of the inspection. There are two lounges, one on the ground floor and a small quiet lounge on the lower floor. Both had comfortable arm chairs and the rooms were bright, warm and airy. The quiet lounge leads to the garden where residents can smoke if they wish. Care Homes for Older People Page 20 of 29 Evidence: Bedrooms seen were pleasantly decorated and had a good standard of furniture. The bedrooms had matching bed linen and designs and colour schemes were according to the residents choice. Personal items had been brought in from home to make the rooms feel special and cosy. A brief social history of the resident was available in their own bedroom with details such as, preferred name and time of getting up. Photographs were also available to help resident recognition. Infection control procedures were in place to minimise the risk of infection and there were plenty for gloves, aprons, liquid soap and paper towels for staff use. Domestic staff were employed to ensure a good standard of cleanliness. The hot water was being tested so that it was delivered at a safe temperature and the emergency lighting subject to visual checks as part of monitoring the fire prevention equipment. These all help to make make sure the accommodation is safe for the residents. The garden is landscaped and there is also a patio area for the resident to sit out in. BBQs are held in during the warmer months and the guinea pigs have a hutch here. CCTV cameras viewed external areas only and these help with keeping resident safe, The manager stated that a security lock is being placed on the main gate. Residents had access to a call bell when they needed assistance from the staff. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have not received uo to date training and this is required to enable them to care for the residents safely. Evidence: Sufficient numbers of staff were on duty to provide care and support to the residents. This was confirmed by looking at the staffing rota and talking with residents,staff and relatives. The staffing rota should record dates to ensure the accuracy of the record. Relatives interviewed said they were pleased with the way in which the staff looked after their family member. Likewise a resident reported, They cant do any better. The manager works supernumerary hours and is supported by a deputy manager. There is always a senior on duty with two care staff. At night the manager or deputy manager are on call to assist when needed. A domestic is employed and standards of cleanliness were found to be good. New staff were being recruited safely and pre employment checks included police clearance an two written references. New staff had received an induction and discussion took place with the manager regarding the Skills for Care Induction Standards. These provide more formal learning and an introduction to NVQ (National Vocational Qualficicatins) in Care. The manager said these would be implemented through an external training company. Staff made the following comments, I was Care Homes for Older People Page 22 of 29 Evidence: given induction training and all policies and procedures were explained to me in full and In the first few weeks of employment I worked along side the manager on the care side. New staff had been given a number of policies and procedures to read so that they were aware of how to work safely. Fire prevention had also been discussed at this time. Training in NVQ is ongoing for the care staff. Staff interviewed said they were supported by the manager and deputy with the learning material. The AQAA reports that approximately 50 staff have an NVQ in care as part of their development. Staff files seen showed that staff require training in moving and handling, first aid, food hygiene and infection control. This is needed to ensure they have the skills and knowledge to care for residents safely. Staff must also have skills & competencies to meet specific care and management needs of a person with dementia There was no evidence of future training dates. The manager was advised to obtain these and ensure staff received training over the next three months. Contact was made with an external trainer at the time of the inspection and once available training dates are to be forwarded to the Care Quality Commission. Study days regarding continence management and care of vulnerable skin have been arranged as part of caring for an older person. A training plan would be beneficial for recording training dates and their renewal. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Avalon is well managed and people who use it can contribute to its development. Evidence: The manager has many years in caring for older people and she has completed the Registered Managers Award in NVQ and is currently undertaking further NVQ management studies. Feedback from residents, relatives and staff confirmed that the home was well run and that the manager makes time to meet with people and review the service given. This helps to ensure good outcomes for everyone. Comments included, The home is good to work in, Everything is good and This home is run to a very high standard. The main priority is the residents and that they are all well looked after. The quality of the service is reviewed to ensure it is managed in the best interests of the residents. This included satisfaction surveys, which had been completed for an external quality award and also informal meetings with relatives. A coffee morning was Care Homes for Older People Page 24 of 29 Evidence: taking place this month to enable relatives to meet other family members and to raise any points they have. Staff meeting had been held and staff were receiving supervision of their job role so that they could discuss care practices and their learning development. A staff member said, We get regular supervision and an appraisal. Documents seen confirmed this. The need for staff training has been recorded under the section Staffing and the manager must ensure this is provided so that staff work safely. Financial records held on behalf of residents were up to date and they included two staff signatures for the written entries. This helps to keep records accurate. A resident said that the staff were willing to do shopping for them and there was no concerns over handling money. An AQAA was completed by the manager and this did not record sufficient detail regarding the home. An AQAA is the main way that the manager will let people know how well the service is delivering good outcomes for the people using it. It should contain sufficient information to evidence this. Advice was given regarding its completion. The AQAA stated that equipment and services were subject to safety checks and a spot check of the gas, fire prevention, electric and lift showed this to be correct. New staff had received fire awareness training on their induction and instructions are given to staff on fire prevention when fire alarms are tested. The manager is arranging fire training for all staff over the next three months. Dates of these should also be forwarded to the Care Quality Commission. The manager had completed formal records regarding incidents in the home relating to resident falls and had communicated with the Care Quality Commission regarding these. The incidents had also been reported to the relevant health and safety agency. The new care plans will enable staff to complete more detailed risk assessments, which will benefit the staff when identifying potential risks and their management. The accident book also showed details of incidents that affected residents health and well being. Staff had recorded episodes of agitation that affected a resident and how they managed the situation. This shows an awareness and understanding of dementia. Equality and diversity is identified through the resident care plans. For example, chosen faith, preferred routine and social contact. This information helps them to provide care and support according to need and personal wishes. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 18 Staff require training in moving and handling, first aid, food hygiene and infection control. This will ensure they have the skills and knowledge to provide care and support to residents safely. 21/07/2009 2 26 18 Staff require dementia care training This will ensure they have the skills and knowledge to provide care for dementia and its associated illnesses. 21/07/2009 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 3 The manager should complete a more detailed behavioural assessment so that staff are aware of the factors that affect behaviour and memory loss. This will help staff to assess the level of support each resident needs for their dementia. Care Homes for Older People Page 27 of 29 2 7 The residents plan of care should record more specific detail relating to their dementia. The residents plan of care should record in more detail the management of falls to determine how staff minimise them with compromising the residents independence. 3 9 Handwritten entires on the medicine charts should be signed by two members of staff to ensure accuracy of the record. A list should be kept of staff signatures for those who are authorise to administer medicines. A more formal complaint log should be kept to record the outcome of a complaint and to to help the manager to review comlaints received. Staff should have received training in the protection of vulnerable adults and this should continue so that their knowledge is up to date and and in accordance with local guidelines. The staffing rota should evidence the actual date along side the month so that that records are kept accurate. Skills for Care Induction Standards should be accessed as these provide a formal induction in health care in accordance with NVQ (National Vocational Qualifications). The AQAA should be completed in sufficient detail to demonstrate what the service does and how this is achieved. 4 16 5 18 6 7 26 26 8 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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