Inspection on 05/05/09 for Belle Vue Nursing & Residential Home

This inspection was carried out on 5th May 2009.

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

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

Other inspections for this house

Belle Vue Nursing & Residential... 17/05/07

Belle Vue Nursing & Residential... 01/06/06

Belle Vue Nursing & Residential... 12/12/05

Belle Vue Nursing & Residential... 19/05/05

Belle Vue Nursing & Residential... 10/01/05

Belle Vue Nursing & Residential... 22/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Belle Vue Nursing And Residential Home 1 Stanmore Road Heaton Newcastle Upon Tyne Tyne & Wear NE6 5SX     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: Suzanne McKean     Date: 1 4 0 5 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 31 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 31 Information about the care home Name of care home: Address: Belle Vue Nursing And Residential Home 1 Stanmore Road Heaton Newcastle Upon Tyne Tyne & Wear NE6 5SX 01912090300 01912090301 bellevueheaton@hotmail.co.uk 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) : Bawi Homes Limited care home 49 Number of places (if applicable): Under 65 Over 65 49 dementia Additional conditions: 0 One specified person under the age of 65 may be accommodated for as long as they are in residence. The CSCI must be informed at that time so that this condition can be removed. Date of last inspection Brief description of the care home Belle Vue House is a purpose-built two-storey care home of traditional brick build and tiled roof construction. It is situated in the Heaton suburb of Newcastle upon Tyne. The home is well located with ease of access to the nearby Chillingham Road and its variety of public amenities including shops, cafeterias, schools, public houses, parks, churches and regular transport services. The home is registered to provide care with nursing to people over the age of 65 years who have Dementia. The home charges fees of between £454 and £475 per week depending upon the needs and requirements of the individual residents. As the home provides nursing care the free nursing care element of the funding is provided in addition to the costs Care Homes for Older People Page 4 of 31 Brief description of the care home charged to the resident. The home provides information about the service through the service user guide. A copy of the last inspection report from The Commission for Social Care Inspection is available to prospective residents and their families. Care Homes for Older People Page 5 of 31 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken Summary: This is an overview of what the inspector found during the inspection. How the inspection we carried out:- Before the visit we looked at, the information we have received since the last visit on 17th May 2007. How the service dealt with any Care Homes for Older People Page 6 of 31 complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. The visit: An unannounced visit was made on 5th May 2009 and a second visit that was arranged was made on 14th May 2009. The total time time spend in the home was eleven hours. The visits were undertaken by the link inspector for the home. During the visit we: Talked with people who use the service, relatives, staff, the manager and visitors. Looked at information about the people who use the service and how well their needs are met. Looked at the records which must be kept. Checked the staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building and parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the Manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: Two requirements were made as a result of this inspection. These are as follows. To make sure that there are sufficient numbers of staff on duty to meet the needs of the residents taking into account the numbers accommodated and their level of dependency. And to make sure that the home operates thorough recruitment procedures based on equal opportunities and ensuring the protection of service users. The following recommendations were made. Care plans should be improved to make them more person centered and show how the residents or their representatives are involved in their development. Care Homes for Older People Page 8 of 31 There are plans to enrich the environment of the home to give a more stimulating and appropriate living space for the residents taking into account their dementia care needs, this should be pursued. It it recommended that the home further develop the social activities programme and associated records to a sufficient level to make sure that the all residents are living active and fulfilled lifestyles in line with their abilities and choices. The records should more fully show how the residents are spending their leisure time and if they have enjoyed any specific activities so that planning could reflect this. It is recommended that the way that the dining tables are presented are reviewed and that condiments and sauces are made available for the residents in a way that maximises their independence while maintaining their dignity and safety. The home should provide specific design features or signage that would give someone cues to find their way around or help them to maintain their existing skills. This will prevent environmental barriers for people with these specific needs and assist them to make sense of their environment and maintain their quality of life. 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 31 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 31 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. The residents needs are clearly identified during a comprehensive pre admission assessment, and they are given the necessary information to help them make up their mind. Evidence: The care plans showed that residents have a full needs assessment carried out by care managers before being admitted to the home. The home manager or senior nurse also carries out a full assessment of need before anyone is admitted to the home. Potential residents are encouraged to visit the home before admission. They are able to visit for part of a day and have a meal with other residents and join in any activity or event that is happening in the home. They are provided with good information on which they can base their decision to move into the home. Care Homes for Older People Page 11 of 31 Evidence: All residents have a trial period after which a multi disciplinary review is held with the resident and their representative. Following the review the decision to stay in the home is then made. Care Homes for Older People Page 12 of 31 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. People living in the home have their health and personal care needs met in a planned way and the care is delivered in a respectful but friendly manner. Evidence: Each resident has an individual care plan which contains an full assessment of their needs and a plan of how the care will be given. They are generally up to date and have the necessary information to make sure that the people living in the home have their needs and abilities taken into account when the care is planned. There were some gaps in the the monthly reviews where the named nurse has been on holiday and the Manager has now put in place a system to ensuring that these are picked up by other staff. Relevant risk assessments are completed for, prevention of falls, wound care, moving and assisting, and continence promotion, these were up to date and detailed. There is an assessment to look at residents food and fluid intake. If a resident has any unplanned weight loss a plan is drawn up to address this. In one care plan this Care Homes for Older People Page 13 of 31 Evidence: included getting advice from a dietitian and speech therapist and in another speaking the residents General Practitioner. The care plans could be further improved by making them more person centered in the way they are written. They do not currently contain evidence of how the resident or their representative have been involved in there development, although relatives spoken to were happy with the involvement in decision making. Residents have their personal and healthcare needs met by the staff in the home. They have descriptions of how the personal and health care needs of the residents are being met. There are plans to enrich the environment of the home to give a more stimulating and appropriate living space for the residents taking into account their dementia care needs, this should be pursued. Residents access NHS services and facilities as necessary. The care plans showed that specialist advisors are used for individual residents if necessary. A visiting relative said that she was very happy with the care and another that the staff were lovely The care being given during the visits showed that the residents are having their personal and health care needs met. Medicines management was in line with guidance. The staff record the medicines correctly when they are ordered. The prescriptions are then checked when they are received in the home from the General Practitioners and are then sent to the Chemist for dispensing. The medicines received from the pharmacy are checked against the record of what was ordered and prescribed so that any errors can be picked up. Medicines no longer required are disposed of safely. No resident manages his or her own medication. There has been a recent change in the way medication is being managed. For a period care staff, who had received medication training were administering medication to both residential and nursing care residents. This has been suspended while the home consider the evidence they have in place to show that the staff are safe to do this and making the judgment as to if this is in the best interest of the people living in the home. Care Homes for Older People Page 14 of 31 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 living in the home are supported to live active lives but this could be developed further to ensure they have fulfilled lives in line with their choices, abilities and previous lifestyles. The food being served is particularly good. Evidence: Residents spoken to who were able to respond to the question said that they are encouraged to make choices in their daily routines in simple but important ways including the time they get up, what and when they eat and how they spend their time. The home has a policy to ensure that residents can choose the gender of staff for personal care. A weekly activities programme for residents was seen and showed a range of events taking place, although this is dependent on the daily preferences and changing needs of the residents. There is no activities co-ordinator employed in the home as they have recently left, and currently no staff member has responsibility for developing this area of care. Residents were seen spending their time mainly watching television and spending time together. The high level of dependency of the some of the residents presents a challenge to providing social activities and result in some of the opportunities needing to be provided on a one to one basis and specifically targeted to the residents stage in their illness. However, this has not been developed Care Homes for Older People Page 15 of 31 Evidence: to a sufficient level to make sure that the residents are living active and fulfilled lifestyles. The records in the care plans do not fully describe how the residents are spending their leisure time or if they have enjoyed any specific activities. A relatives survey suggested that they felt that there could be more opportunities for interaction with residents who are not mobile or have little speech. The Manager agreed that this could be developed further and has plans to do so. The residents were dressed for the activities they were undertaking and looked smart and tidy. The residents who were able to speak to me were positive about the care being given. Comments made included the staff are lovely. The food being served on the visit was well received by the residents on the day. A second alternative is offered which residents can choose from prior to the mealtime. Alternatives were offered for both the main mean and the pudding/sweet. The residents were complementary about the food during the mealtime and appeared to enjoy it. This was also supported by relatives views suggesting that the home provides well cooked, nutritious food and that the home makes a genuine attempt to provide for everyones needs. Although the meals were of a very good standard the way that the dining areas were presented did not give a pleasant atmosphere to encourage residents to enjoy the experience. On the first visit it was difficult to asses the meal times as the usual dining areas were being redecorated. The second visit was quite well organised, however there were no table cloths, table ware or condiments on the tables and there was no evidence that sauces would be available for specific meals being served, although they were available in the home. Staff said that the residents could have these if they asked but this is not satisfactory as there are very few of them who would be able to articulate the request and would need to be prompted. There was a discussion with staff as to the way that the dining areas are organised and this is to be looked as as part of the redecoration programme. The cooks have a good understanding of the dietary needs of the residents, and how to increase the calories in the food being served for those at risk of weight loss. Fresh fruit is served in a variety of ways. The morning tea trolley offered a varied selection of drinks. There was tea, coffee, or cold drinks of either juice or milk. There were biscuits provided. The catering staff have worked hard to meet the dietary needs of a resident who has very specific cultural dietary requirements. This is to be commended as it shows how flexible the home can be in relation to individual needs. The bedrooms are nicely personalised according to the taste of the resident and where possible they choose their own decoration. Two residents said they were happy with Care Homes for Older People Page 16 of 31 Evidence: their rooms and that they had a lot their own personal items around them. Residents have visitors at any time and are able to use their own rooms, or the lounges to see them. Three relatives said that they are welcomed into the home and one said that they felt that the it was very welcoming, friendly, with families. Care Homes for Older People Page 17 of 31 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. There are good policies and procedures in place which are followed by the staff to make sure that complaints are dealt with effectively and that residents are safeguarded from harm. Evidence: The complaints procedure is available in the service users guide and a copy is displayed in the home. There were four complaints recorded in 2008 and two in 2009, one of which is being investigated at the moment. One complaint was given to the home from a relative who contact the Commission for Social Care Inspection (now Care Quality Commission) this was investigated but the final response to the complaint was not sent to the complainant in the homes timescale as the Manager dealing with it had left his post. This was then dealt with by a Senior Manager to the satisfaction of the complainant. The record of complaints since the return of the manager were detailed and showed her intention to investigate fully. Two relatives who were visiting the home were aware of the complaints procedure but had not needed to use it. They said I have not had to make a complaint but if there is anything I am worried about the staff listen and sort it out for me. Care Homes for Older People Page 18 of 31 Evidence: Since the last inspection the home has been involved in two Vulnerable Adults investigations. This is a process led by Social Services and is used to ensure that there is involvement of professionals from outside of the home in considering any event which has effected the welfare of a resident or residents living in the home. The manager worked well within this process and showed a willingness to consider the process as a way of improving practice. Staff are given protection of vulnerable adults training both as part of the in-house training package, the Manager has secured a place on the in depth Local Authority Safeguarding adults training course in May 2009. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well decorated, pleasantly furnished and clean and only lacks the specific design features for the specialist client group to help them to maintain their skills and maximise their independence. Evidence: The environment is pleasant and well decorated. There is a programme in place to ensure it remains in good repair although the wear and tear in the home is an ongoing challenge. The home was odour free on both of the visits although pockets of odour were present when individual residents were having their personal care needs met, these were only temporary. There are sufficient numbers of communal areas for service users to choose from. These include a range of lounges, dining rooms, and communal spaces that service users can use. Some areas have been recently redecorated others were being redecorated during the first visit. Although the residents had moved back into them by the second visit there were not fully completed and needed pictures and some furnishings put back in place. It was appropriately judged that it would be less disruptive for the the residents who had been spending time in lounges they were not Care Homes for Older People Page 20 of 31 Evidence: as familiar with during the process. Two relatives on discussion with them confirmed that they were happy with the standards of decoration and cleanliness in the home. A number of bedrooms were examined and these were decorated and furnished in a pleasant and homely way. Access into and within the home is good and meets the needs of those service users who have mobility difficulties or have use of walking aids such Zimmer frames or wheelchairs. There are specialist bathing facilities so that residents can be supported to bath safely. All the bedrooms and toilets have suitable lock on the doors to ensure privacy. This provides the opportunity for service users to remain independent and to enjoy good levels of privacy. There were bins in the communal toilet and showers, which means that the disposable paper towels could be thrown away safely. The staff were seen following control of infection practices and knew about their responsibilities. The home is registered to provide specialist care for people who have dementia, but does not have specific design features or signage that would give someone cues to find their way around or help them to maintain existing skills. This may create environmental barriers for people with these specific needs to make sense of their environment and could impact on their quality of life. The manager has plans to improve the way the home is organised and is looking at best practice advice to do this. Care Homes for Older People Page 21 of 31 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. Suitable numbers of well trained staff are employed by the home and the manager is increasing the numbers on duty to make sure that the residents are being cared for safely. Good employment policies and procedures have not always been followed in the past which could have put residents at risk but action taken by the manager has addressed this. Evidence: The home is registered to provide nursing care as so always has a qualified nurse on duty, this was confirmed by the staff rotas. The manager has recently returned to the home following a planned absence and has worked very hard to review the way the the staffing is organised. The staffing rotas show that in the recent past there has been less care staff being scheduled to work than was usual at the time of the last inspection. At that time the number was being maintained at the levels that were set down prior to the change to the CSCI without reduction when a staffing notice was in place. At times the Manager was staffing at a higher level by having an additional carer at times when the resident needed additional support. This was commended as it showed that shows that she was aware of the particularly high level of dependency of some of the residents in the home and prepared to ensure that there are enough staff to care for them well. Care Homes for Older People Page 22 of 31 Evidence: On the first visit which was unannounced there was one nurse, the manager who was working as the second nurse, and six care staff ranging from team leader, senior carer and carer. There was also a carer who was on her induction programme so was supernumerary. At the time of the second visit there was two nurses and six care staff, again with one carer on induction. The manager confirmed that she was planning to increase the staffing numbers to seven carers once she the new staff had completed their induction period. Although the residents were safe and were having their needs met the reduction in the staffing numbers by one carer results in them having less time to spend with residents either when delivering care or as part of the day to day social interaction. This is particularly important when there is no activities coordinator employed. Relatives spoken to said you cant fault the staff for their kindness however this felt that they were run ragged. There was an administrator on duty on both of the visits. Sufficient domestic and catering staff were on duty to make sure that the home could be kept clean and the food prepared safely and effectively. When sickness and staff holidays occur they are usually covered staff picking up extra shifts. When this is not possible agency staff are being used, late reporting does occasionally result in fewer staff being on duty for short periods. Four staff records were looked at and three were complete including application forms, references, records of interviews and CRB checks. However one record showed that the Criminal Bureau Check had returned with information that should have been explored further with the staff member. The records did not show any evidence of this having happened. This was prior to the return of the manager and she is aware of the issue and has put in place an action plan to address it. The homes policy was not followed in this instance. The manager confirmed that the decision to employ is now made after a period of initial induction and that all offers of employment are subject to CRB checks and references prior to beginning employment, in line with the homes policies and procedures. The manager has arranged a number of training sessions on a variety of subjects as well as statutory training. The staff confirmed that they are being encouraged and supported to attend. The training record for four staff was examined, there is evidence of a lot of training being provided and confirmed that all staff had received statutory training. Fourteen out of the eighteen care staff have achieved NVQ level 2 and all of the other staff have been enrolled in the course. Care Homes for Older People Page 23 of 31 Care Homes for Older People Page 24 of 31 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 ensures that she has systems in place to make sure that the home is managed effectively and safely taking into account the needs and wishes of the residents. Evidence: The Manager Mrs Kaur is a registered nurse and was worked in the home for some time. She was previously the deputy manager and knows the residents and their representatives very well. She is not currently registered with the Care Quality Commission but has begun the process to do this. She has experience in management and has worked with older people for some time and maintains her Professional Portfolio according to the NMC (UKCC) requirement for updating to maintain her nursing registration. The home has been through a recent period when there were changes to the management arrangements. This including the deputy acting up as manager and the Care Homes for Older People Page 25 of 31 Evidence: appointment of a temporary manager. As a result it was necessary for Mrs Kaur to spend some time on her return reviewing some of the areas of organisation and bringing some up to date, such as audits and the training programme. She has worked very hard since her return to achieve this. The records to support the Managers confirmation that she ensures safe working practices in relation to first aid, food hygiene and moving and handling are in place and are satisfactory. Formal supervision for care staff is up to date and senior staff are allocated specific staff to supervise, the Manager then overviews the process. The qualified nurses undertake informal supervision of care practice when delivering care. The manager takes the necessary action to ensure the health and safety of the service users. This is supported by the policies and procedures and by discussion with the Manager. The Manager facilitates relative and resident meeting, there give the opportunity for the home to communicate formally with them. During the visits the relatives visiting were chatting in a very positive way with the staff. She has periods when she is available for more informal meetings and she has an open door policy, which gives relatives the opportunity to approach her informally if necessary when she is in the home. The personnel records kept in the home of residents who are receiving assistance to manage their finances are detailed, logical and appropriate. Receipts were in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place. The personal allowance records examined allowed the audit of individual residents moneys to ensure that it is being managed effectively. There are records of the Regulation 26 visits, these reports were very detailed and involved the Manager completing an action plan. The individual responsible for carrying this out is being reviewed. There is regular communication between the proprietor and the home generally. The home is a safe place for the residents who live there and the manager tours the premises to ensure that the staff are following good health and safety practices. Checks of hot water are carried out by the home and these show that hot water did not exceed 43degrees centigrade thus protecting the service from accidental injuries. The home has written policies and procedures relating to safe handling of hazardous Care Homes for Older People Page 26 of 31 Evidence: materials for staff to follow. The manager indicated that staff have had training in health and safety, infection control and food hygiene. The laundry machines have facilities for sluicing and washing foul linen at very high temperature to avoid the spread of infection. The manager and the proprietor are currently strengthening the quality assurance procedures and the manager has begun consulting visiting professionals to ensure that the audit programme is in line with current best practice. There are a number of audits carried out and an action plan is being developed to make sure that any improvements are achieved as part of the annual development plan. Care Homes for Older People Page 27 of 31 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 28 of 31 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 18 There must be sufficient 01/07/2009 numbers of staff on duty to meet the needs of the residents taking into account the numbers accommodated and their level of dependency. To ensure that the residents receive appropriate care, are safe and supported to live active and fulfilled lifestyles. 2 19 The home must operate thorough recruitment procedures based on equal opportunities and ensuring the protection of service users. The process must ensure the welfare of the residents living in the home through good recruitment and selection procedures. 01/07/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 29 of 31 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 7 Care plans should be improved to make them more person centered and show how the residents or their representatives are involved in their development. There are plans to enrich the environment of the home to give a more stimulating and appropriate living space for the residents taking into account their dementia care needs, this should be pursued. It it recommended that the home further develop the social activities programme and associated records to a sufficient level to make sure that the all residents are living active and fulfilled lifestyles in line with their abilities and choices. The records should more fully show how the residents are spending their leisure time and if they have enjoyed any specific activities so that planning could reflect this. It is recommended that the way that the dining tables are presented are reviewed and that condiments and sauces are made available for the residents in a way that maximises their independence while maintaining their dignity and safety. The home should provide specific design features or signage that would give someone cues to find their way around or help them to maintain thier existing skills. This will prevent environmental barriers for people with these specific needs and assist them to make sense of their environment and maintain their quality of life. 2 8 3 12 4 15 5 19 Care Homes for Older People Page 30 of 31 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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