Inspection on 27/06/08 for Bracknell Nursing Home

This inspection was carried out on 27th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bracknell Nursing Home 04/06/07

Bracknell Nursing Home 27/07/06

Bracknell Nursing Home 02/08/05

Bracknell Nursing Home 07/04/05

Bracknell Nursing Home 13/07/04

Bracknell Nursing Home 10/06/04

Bracknell Nursing Home 24/04/04

Bracknell Nursing Home 01/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bracknell Nursing Home Crowthorne Road Bracknell Berkshire RG12 7DN     The quality rating for this care home is:   one star adequate 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: Date: 2     7 0 6 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 26 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 26 Information about the care home Name of care home: Address: Bracknell Nursing Home Crowthorne Road Bracknell Berkshire RG12 7DN 01344484584 01344429343 bracknell@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tamaris (RAM) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) The registered provider is responsible for running the service Name of registered manager (if applicable): Name of registered manager (if applicable) Mrs Lydia Dipuo Makuyama Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Only people over the age of 60 years to be admitted. Date of last inspection Brief description of the care home The fees for the home range between £529.91 and £622.91 per week. Service users pay additional charges for chiropody, hairdressing, toiletries, newspapers, trips out and transport. 0 30 Over 65 30 30 Care Homes for Older People Page 4 of 26 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: one star adequate 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 inspection of the service was an unannounced Key Inspection. It was a thorough look at how well the service is doing. We (the commission) received detailed information from the service in the form of an annual quality assurance assessment (AQAA). This provided details of current care provided, as well as plans for the future, details of staff and resident numbers, qualifications and training of staff, and information about the health and safety of the home. A site visit was undertaken by Amanda Longman, regulation inspector, on 27 June 2008 over a period of eight hours. During this site visit we spent significant time observing the care being given. We also toured the home and spoke with residents, staff and visitors to the home. We examined care records and staff records. As part of this inspection process we also reviewed all the information we have received about Braknell Nursing Home since the Care Homes for Older People Page 5 of 26 last inspection, which was undertaken on 4 June 2007. Please note the fees quoted in the brief description above are not accurate. The current fees for the home range from 591 pounds to 682 pounds. The service has in place policies and procedures relating to equality and diversity and there was evidence that they could meet a range of different needs. What the care home does well: What has improved since the last inspection? 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 7 of 26 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 8 of 26 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 benefit from having sufficient information about the home and from having their needs fully assessed. Evidence: The home has an appropriate Statement of Purpose in place. Although it is not recorded on residents records, the manager confirmed these were issued to all residents. In the pre-site visit surveys received, 80 of respondents confirmed they had enough information about the home. We looked at four residents files. All had full needs assessments in place. Care Homes for Older People Page 9 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having their personal and healthcare needs met most of the time. Staffing levels sometimes limit choice and residents would benefit from the homes approach to person centred care being further developed. Medication administration processes need to be adressed to ensure best practice is always followed. Evidence: Outcomes for residents in this area were judged to be good at the previous inspection. Detailed care plans and risk assessments were in place for the four residents whose files we checked. This included details of how each resident wishes their personal care to be delivered and diverse needs associated with this. The residents records also include monthly reviews of their care plans and detailed daily records. Risk assessments were detailed, up to date and regularly reviewed, and include plans to minimise risks. Of those residents who responded to the pre-visit survey 80 said they usually or always get the care and support they need but 20 said only Care Homes for Older People Page 10 of 26 Evidence: sometimes. The home has recently changed the format of its care plans and the manager stated in the AQAA that they were pursuing a person centred approach to delivering care. We discussed the implications of preson centred care with the manager. For example, the assessments undertaken include social needs assessments but these are not currently linked directly in to the care plans to ensure that information picked up in the assessment process about individual needs and choices are automatically reflected in the care plans. For example one persons social assessment stated they had always attended church and would like to receive visits from the local vicar. Although the persons care plan noted the need to meet spirituall needs by the in-home service there was no detail in the care plan of what arrangements had been put in place and whether the resident had in put in to this, and felt it met their needs. The manager agreed to look at methods to ensure this information is fully captured and addressed in individual care plans. The care plans all address the health care needs of residents and are detailed regarding, for example, mobility, eating and drinking and risk of developing pressure sores. 80 of residents who responded to the pre-visit survey said they always get the medical support they need and 20 said usually. One family spoken with gave an example of how pleased they are with the care provided by the home. Their relative had moved to the home from hospital, where they had been immobile and doubly incontinent. Through the homes care plan their continence had greatly improved, they were now mobile again and able to go out. They were much happier. A second family spoken with at the site visit also stated they were very pleased with the standards of care at the home. However both families spoken with and residents spoken with stated staff were often overstretched. Staff are good but usually have too much to do. Staff do not have time to give enough one to one care, were two comments received during the inspection process. (Please see the section on staffing for further comments on this.) Staff spoken with were knowledgable about promoting privacy, dignity and choice. In our observations on the day we witnessed staff speaking respectfully to residents and residents being offerred choice about, for example, what to wear and what to eat. However, we also witnessed staff being too busy to engage in sitting down and chatting with residents when they werent performing a care task to assist them. We also witnessed residents not always being given choice about where they were put to sit in the lounge, whether or not they wanted to watch television, or what they watched. Feedback from residents and visitors also stated staff, although kind, competent and caring, were frequently too busy to chat with residents. We raised with the manager the lack of choice we witnessed and she agreed to deal with this with staff, although stated that this was sometimes because staff knew where someone Care Homes for Older People Page 11 of 26 Evidence: usually liked to sit. Residents are assisted to use the toilet. The dignity of those residents that use incontinence pads is respected in that appropriate pads are stored descreetly in bathrooms and so are not carried along the corridor by staff. We looked at medication records and administration processes. Medication is always administered by an RGN. The records we examined were appropriate and individual records contain a photograph of the resident to ensure medication is dispensed to the correct person. However, certain medications, paracetamol and movocol are preseribed for several residents. We found these were being dispensed from only one or two packets and not from the individually prescribed packets. The manager agreed this is poor practise and can potentially lead to medication errors. The manager agreed to urgently revise this system, with the RGNs, to ensure all medication is dispensed from each individuals prescribed packets. Care Homes for Older People Page 12 of 26 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 range of activities on offer and the homes open door policy for friends and families contribute to positive outcomes for residents. Residents have choice and control over many aspects of their day to day live but there are areas where this can be improved. Residents mainly enjoy their meals and meal times. Evidence: Outcomes for residents in this area were judged to be good at the previous inspection. Information received in the AQAA stated that a range of activities is offered to residents that provide them with the opportunity for mental and physical stimulation. An activities co-ordinator has recently been appointed for 25 hours per week. There is a timetable of some structured activities which include painting, arts and crafts and a film afternoon. We saw evidence of painting and art work completed by residents and spoke with one visitor whose relative had thoroughly enjoyed the opportunity to paint. We also witnessed the activities organiser engaging in one to one conversation and knitting activities with residents. Residents and visitors stated there is much more to do since the current activities organiser was in post. A group of residents went out to a garden centre on the day of the site visit, to which they were looking forward. We Care Homes for Older People Page 13 of 26 Evidence: spoke to some of them on their return and they had enjoyed themselves. 20 of surveys received from residents prior to the site visit stated there were always activities for them to join, 20 stated usually and 60 stated sometimes appropriate activities were available. Comments included Activities have improved a little. Would like to see more music, exercise and games. Hate sitting in the lounge, and Those with no visitors would benefit from one to one activities. The timescale of when these surveys were completed may have been before, or around the time that the new activities co-ordinator was recruited as feedback on the day of the site visit was mainly postitive. In the AQAA the manager stated that residents are encouraged to maintain contact with their family and friends and are able to have visitors at any time. This was confirmed in discussions with residents and visitors on the day of the site visit. One relative spoken with confirmed they can visit whenever they wish. They stated their family were in and out all week at different times and they always found their relative receiving a good quality of care. The home is visited by religious representatives. (Please see care planning section relating to meeting individuals diverse needs). We spoke with a church visitor who comes on a friday to see one catholic resident who stated the staff are very good but always seem to be over stretched. The AQAA stated that service users are assisted to exercise personal autonomy and choice. We discussed this with the manager in relation to person centred care planning (see the second outcome area above). During the visit we witnessed someone being brought in to lounge in a wheelchair and hoisted in to a chair. Hoisting was appropriately done but the person was not asked where they would like to sit nor whether or not they wanted to watch the television. The television was on all the time but few people were really watching it. We raised these issues with the manager who stated people usually sat in the same place so staff may not always ask them. We explained to the manager that there is an issue here regarding choice and control and the manager agreed to address this with the staff. The room is arranged with chairs round the edge and the television in the corner. The manager explained that if someone particularly wants to watch a television programme they will ensure that they can see the television. There is a quiet area for people to talk to guests. One relative explained this was instigated at their request. One view from a resident was that there was not enough freedom of choice because they were not allowed to choose whether to be in the lounge or their room. We discussed with the manager the need for staff to fully support resients choices about how they wish to spend their time. The AQAA stated that the home provides a varied and nutritious menu designed to Care Homes for Older People Page 14 of 26 Evidence: meet the needs of residents. During the previous twelve monthe the home has introduced a new Food Safety Management System Policy and the chef attended a workshop in London on Safer Food, Better Bussiness. Of the residents who completed the pre-visit questionnaires 20 said they always enjoyed the meals, 60 siad usually and 20 said sometimes. Some comments included: Fresh fruit available all day would be a benefit, The chef is a visible member of staff,which is great, and I am sick of mashed potato! We spoke with the chef and the kitchen assistant during the site visit. The chef starts at 7.00am and does cooked breakfasts. This was confirmed by residents. People choose their lunch option the day before, todays choices were fish and chips or salad. We saw that changes in mind are readily accomodated or additionnal choices can be provided, for example an omelette. This was confirmed by residents and relatives. There is also a warm evening meal, for example yesterdays was cauliflour cheese or there is always a choice of soup and sandwiches. All kitchen satff have up to date food hygeine training. Lunch is normally served at a set time but this can be flexible, for example on the day of the site visit four people had lunch early as they were going out. We ate lunch with the residents who said the food was always good. Staff were seen to assist residents appropriately and were at ease chatting with them whilst doing so. Fresh fruit and snacks are visibly available. Care Homes for Older People Page 15 of 26 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. Whilst there have been safeguarding issues at the home since the last inspection, the manager has taken effective steps to deal with them. People who currently live at the home are safeguarded from abuse and their complaints are taken seriuosly and acted upon. Evidence: Outcomes for residents in this area were judged as good at the previous inspection. The home has an apropriate complaints procedure in place which is provided to residents or their representatives and is on display in the home. We looked at the complaints records since the previous inspection and saw that complaints had been dealt with appropriately. We spoke with three lots of relatives on the day of the site visit, all of whom were happy with the care provided by the home and one of whom stated that the home had dealt appropriately with anything they had raised. Surveys received from residents prior to the site visit indicated that 60 always knew who to speak to if they were not happy and 40 usually did. 80 knew how to make a complaint. The home has a safeguarding vulnerable adults procedure which is in line with local multi agency procedures and the home provides training in safeguarding vulnerable adults to its staff. However, since the previous inspection we have been made aware of one complaint and two potential /safeguarding matters, one of which led to the Care Homes for Older People Page 16 of 26 Evidence: dismissal of the previous deputy manager. Bracknell Forest Bourough Council has been involved with the home in resolving these matters and monitoring how these matters affected the welfare of individual residents they had placed in the home. The manager followed appropriate procedures in these matters and kept the Commission fully informed at all times. The manager has introduced additional training for staff relating to safeguarding vulnerable adults. On the day of the site visit we spoke with several residents who confirmed they knew who to speak to if they were not happy and staff we spoke with were familiar with adult protection procedures and whistleblowing. Care Homes for Older People Page 17 of 26 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 environment of the home is fresh and clean, which contributes to positive outcomes for the people who live there. Evidence: At the previous inspection this outcome area was judged to be adequate. Two recommendations were made: not to hang jumpers in sluice room to air because of the risk of cross infection; and to decrease clutter in the home. Both these recommendations have been actioned. During our site visit we saw that jumpers and cardigans are now hung in the laundry and their was no evidence of clutter within the home. The AQAA stated that the home is always kept clean and odour free and that the environment is maintained at high standard at all times. The AQAA showed that maintenance and safety checks are undertaken on gas, electrical and other equipment in line with the manufactueres recommendations. The maintenance persons hours have been increased to 30 per week. The home was recently without one of its hoists which restricted some residents ability to be moved and therefore affected their quality of life. The manager notified us about this and rectified the situation as quickly as possible. Care Homes for Older People Page 18 of 26 Evidence: During our site visit we toured the home and found it to be clean and tidy. There was a faint odour in one area of the home. The manager said this was because not everyone was up and washed yet and cleaning had not been finished. The odour had gone later in the morning. The home currently has 26 residents all in individual rooms. There are four double rooms if people wish to share but these all currently have single occupancy. The home is purpose built and the rooms are comfortably furnished. All have ensuite toilet facilities. There is an assisted bathroom on each floor which were clean and hygeinic but sparsely decorated and not decorated in a homely style. We raised this with the manager who agreed to see how the bathrooms could be decorated in a more homely manner. The home has a large day room which has a dining area, a sitting area arranged in a square with the television in one corner, and a quiet sitting area. The garden has been cleared and landscaping is well under way, which will include raised flower beds for residents to access easily. During the site visit residents and relatives commented positively on the improvements to the garden. Of those people who returned surveys prior to the site visit 80 said the home is always fresh and clean and 20 said sometimes. One comment was that the home has a warm and friendly atmosphere. The home has infection control policies and procedures in place and all staff have received infection control training. The laundry has suitable equiptment and there is a seperate sluice room. The manager explained some residents are hoisted on to the assisted bathing chair but seperate slings are not used. We raised with the manager the potential infection control issues associated with shared slings for bathroom use. Care Homes for Older People Page 19 of 26 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. Residents are supported by well trained, caring staff. However, positive quality of life outcomes for residents are sometimes limited by the number of staff available. Evidence: This outcome area was rated good at the previous inspection. The home currently has 24 residents. In addition to the manager, one RGN works 8.00am until 8.00pm and one 8.00pm until 8.00am. Five care assistants are on duty from 8.00am until 2.00pm, four from then until 8.00pm and two on from 8.00pm until 8.00am. The manager confirmed she is able to use an extra member of staff at night, for example if someone is very poorly, or in the day if it is particularly busy, for example if two people are being admitted on one day. Staff spoken with confirmed they do not work excessive hours (the maximum quoted was 42 hours per week) and do not do double shifts. The AQAA indicated a high use of agency staff to cover shifts. The manager informed us staff have now been recruited and use of agency or temporary staff is greatly reduced. Comments received in the pre-visit surveys and from speaking with residents and visitors on the day of the site visit indicated staff were often overstretched. Comments included Staff usually have too much to do and Staff do not have time for one to one care. Only 20 of the surveys received from residents prior to the site visit stated that staff were always avaiable when residents needed them. (60 said usually Care Homes for Older People Page 20 of 26 Evidence: and 20 said sometimes). On the day of the site visit staff were observed to be very busy. Staff were attentive and caring whilst assisting residents but did not generally have time between tasks to spend time chatting with residents. We were informed on the day that staff writing up daily care notes will do so in the corner of the day room to ensure a staff presence. Service users spoken with confirmed staff were kind and caring. This was confirmed by relatives who added they were competent and well trained. 47 of care assistants are qualified to NVQ level 2 or above and one member of staff confirmed she is about to commence her NVQ level 2. The manager showed us up to date records of staff training. She is currently compiling a spreadsheet to ensure all mandatory training updates are planned. Staff spoken with confirmed that they had received full induction training and all mandatroy training and updates. They were knowledgable about safeguarding procedures, privacy and dignity and complaints procedures. The home has an appropriate recruitment procedure in place and records showed all appropriate recruitment checks are undertaken prior to staff being appointed. All staff receive regular supervision approximately every two months. Staff who supervise have been on supervision training courses. Staff spoken with confirmed they received regular 1 to 1 supervision and said they felt well supported. Care Homes for Older People Page 21 of 26 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. Residents benefit from living in a home which is well managed, where their interests are protected and health and safety is promoted. Evidence: Following the previous inspection outcomes for service users in this area were judged to be good. The manager is registered with the commission and is a qualified nurse. All staff and people in the home spoken with spoke highly of her skills and committment. The manager is aware of her responsibilities to inform us of serious events and has kept us informed of any such events since the previous inspection. The home has a quality assurance process which is based on Four Seasons Quality Governance Manual. It includes regular audits of all aspects of the home including, for example, kitchen and maintenance, and an annual quality assurance survey which seeks views from residents and visitors. From the audits done the manager draws up remedial action plans as required and told us she plans to meet with her heads of Care Homes for Older People Page 22 of 26 Evidence: departments, for example laundry and kitchen, to take this forward further. The last quality assurance survey was done in April 2008 and produced an overall total quality score of 79 . Individual comments have been followed up by the manager. Residents and relatives are involved in the quality assurance of the home through formal meetings which are minuted and also through informal discussion with the manager. Such informal discussion led to the re-arrangement of the lounge to provide a quiet area and to one resident being involved in interviewing for staff. People spoken with on the day of the site visit were generally very pleased with the quality of care provided but there was a theme of staff being stretched. Service users finances are protected by appropriate procedures. We looked at this in detail and found balances to be accurate and recrods and receipts up to date and accurate. Staff said they felt supported and have regular supervision. Staff spoken with said the home delivers a high quality of care and that the manger is approachable and suportive. All staff who supervise others have been on supervision courses. The home has a health and safety policy which was reviewed in 2007 and the manager stated in the AQAA that health and safety issues are given priority. All staff spoken with confirmed they had received training in health and safety and moving and handling. We observed one member of staff using a hoist appropriately. We reviewed accident recording which was appropriate and cross referenced to residents records of care. The manager reviews the accident report regularly and looks for patterns. For example one resident had several fall in a short period of time so was refferred to the falls clinic. Care Homes for Older People Page 23 of 26 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 24 of 26 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 27 18 To ensure suitable staff are available in sufficient numbers at all times. To ensure the positive quality of live outcomes for service users are not limited by a lack of staffl. 29/09/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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