Inspection on 02/04/09 for Broomhills

This inspection was carried out on 2nd April 2009.

CQC found this care home to be providing an Adequate 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

Broomhills 07/04/08

Broomhills 25/04/07

Broomhills 26/09/06

Broomhills 05/01/06

Broomhills 10/08/05

Broomhills 18/03/05

Broomhills 12/10/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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: Broomhills Stambridge Road Rochford Essex SS4 2AQ     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: Diane Roberts     Date: 0 2 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 27 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 27 Information about the care home Name of care home: Address: Broomhills Stambridge Road Rochford Essex SS4 2AQ 01702542630 01702542553 broomhills@runwoodhomes.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) : Runwood Homes Plc care home 47 Number of places (if applicable): Under 65 Over 65 0 47 dementia old age, not falling within any other category Additional conditions: 23 0 No more than 47 persons to be accommodated at any one time. Up to 23 persons of either sex to be accommodated who are over 65 years of age and who have dementia. Up to 47 persons of either sex to be accommodated who are over 65 years of age. Date of last inspection Brief description of the care home Broomhills is registered to provide personal care and accommodation for 47 elderly people, included in this number the home can provide accommodation for up to 23 service users who have dementia. The original house is a 100-year-old building of character. There are thirty seven single and five double rooms, most with en suite facilities. The home is currently using three of the five shared rooms as single accommodation. There is a choice of lounges and a separate dining room. There is an activities room in part of the basement. Accommodation is provided on three floors and all areas can be accessed by the way of two passenger lifts. Broomhills is set in three acres of grounds. Local facilities are a mile and a half away in the town of Rochford. Care Homes for Older People Page 4 of 27 Brief description of the care home The home has a Statement of Purpose and Service Users Guide in place. A copy of the most recent inspection report was available and on display in the home. Current fees at the home were quoted as being from £481.00 for a contracted bed and £525.00 to £650.00 per week for a privately funded bed, depending on the room. Additional charges are made for chiropody, newspapers, toiletries and some transport costs. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We visited the home for a whole day and met with the manager, the operations manager and some of the care staff team. Prior to the visit, we reviewed all the information that we already had on the home. On the day of the inspection we spoke to 5 residents and 3 staff at the home and we also reviewed records and undertook a tour of the home. Care Homes for Older People Page 6 of 27 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.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 7 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be assured that they would be properly assessed to ensure that the home could meet their needs Evidence: An up to date service users guide is available and this was seen around the home and in residents bedrooms. The guide contains all the required information but more work could be done to make it more user friendly for the resident group. This was discussed with the manager. In the reception area a copy of the most recent inspection report was clearly available. The manager undertakes all the pre-admission assessments to the home and completes a set of assessment forms. Two recent assessments were reviewed and found to be completed well and in a person centered way, with potential residents choices and preferences noted. The assessments contained sufficient detail on which to Care Homes for Older People Page 9 of 27 Evidence: base a decision about the suitability of the home for an individual. In addition the manager had available, referral information, from social services where appropriate. On discussion with new residents they said that they had been helped to settled in by the staff made to feel welcome and whilst it was not home it was fine. They also said I like the place, its clean, meals are first class and my bedroom is nice. They said that they had either not seen the service users guide or were unsure if they had seen it. One resident said that if they needed to raise a concern they would be unsure who to discuss it with, whilst the other said they would speak to the person in charge. More work could be done to ensure that all residents have the information they require when moving into the home. Relatives who commented in the homes own internal audit said my relatives admission was set up quickly and we were welcomed to an ad-hoc visit. A booklet outlining the facilities would have been helpful. Care Homes for Older People Page 10 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a generally person led approach to their care but some shortfalls may mean that their independence is not always promoted and that their health needs are not always addressed. Evidence: The manager has a care planning system in place. Three care plans were reviewed and other care plans were used to cross reference. Where possible residents had signed care plans to say that they had seen/agreed with the content. The care plans were seen to be quite detailed and written in a person centered way, outlining residents preferences and needs. However on discussion with residents and staff on the level of help required with personal care and comparing this with the care plan, it showed that staff are not always following the plans and therefore residents independence and the retention of skills is not always promoted. Residents spoken to said that staff came in the mornings and just washed them when the care plan detailed what they could do for themselves. Overall, care plans were seen to be in place for the majority of residents needs. More attention/care planning could be given to residents requiring Care Homes for Older People Page 11 of 27 Evidence: pain relief, so staff recognise this more as a need and how this may affect their overall abilities. Residents with arthritis and on pain relief, did not have this referred to in their care plans. More detail is also needed for residents care plans in relation to continence. The care plans are not linked to the continence assessment and are not sufficiently individualised, for example saying toilet regularly and wears pads etc. It was also noted that the continence assessment is quite complex and, from discussion, not always understood by staff in the home. This requires review in order to promote best practice. Residents who have developed urinary tract infections also need a more detailed plan of care in place that addresses hygiene needs and the plan for fluid intake, including monitoring. Fluid charts reviewed showed that the staff approach to completing these was inconsistent at times and therefore not always giving an accurate picture. Daily notes were seen to be quite informative and gave a good picture of the care residents had received and their social life. It was also clear that some staff in the home are promoting independence with residents and have a more person centered approach but this is not across the whole team. Risk assessments were in place for a variety of subject matters. These included manual handling, pressure sore risks and falls etc. Generally these assessments were up to date. It was noted that one new resident was identified as being at risk of developing a pressure sore but there was no evidence of any action taken to reduce the risk. The resident then developed a pressure sore and was subsequently given a pressure relieving mattress. A more proactive approach is needed by the team to ensure that residents do not develop pressure sores. Residents with challenging behavior had risk assessments in place, but whilst they contained some good information for staff, more work is needed on highlighting the triggers for such behavior, so that staff are aware of these and the detailed management approach to be taken. Some residents were seen to be using wheelchairs without footplates and no risk assessments were noted in the care plans for those residents. From the records, it is clear that residents are seeing their Gps and other healthcare professionals, such as chiropodists, when they should be. Residents weight monitoring in the home needs to improve. Records show that residents are weighed inconsistently and therefore their nutritional needs are not being sufficiently monitored and possibly addressed. Nutritional risk assessments were seen but unfortunately some were not dated or were out of date, November 2008, for residents with identified needs in this area. It was also noted that residents with nutritional needs did not always have care plans in place, despite being prescribed supplement drinks etc. The staff team use a blister pack system to administer the majority of the medication in the home. Each resident was seen to have a good medication profile in place with a Care Homes for Older People Page 12 of 27 Evidence: photo and information for staff. Generally the medication is well managed and good records are available. It was noted that additional prescriptions, added during the month, need to be properly signed in and where PRN medication is given, staff need to identify, were appropriate, how many tablets were administered. This was highlighted at the last inspection. Topical creams that are administered by care staff are recorded separately as these are given. There was evidence of GP medication reviews on the charts and there was evidence of a management audit in the previous month. Dates of opening should be recorded on all liquid medications and a review of the use of laxatives may be of value as it was noted that use in the home was high. Controlled medications were appropriately stored and recorded. When the inspection officer arrived at 09.40 a.m, the medication round was still ongoing in the dining room. At 10.30 medications were still being administered. Two staff spoken to reported that they are practicing a person led approach to medication. However, this must not impinge on the need for medicines to be given at regular intervals and whilst the approach is commended, it needs to be monitored to ensure it is not detrimental. Staff assured us that where it was vital that residents received medication on time, such as with Parkinsons disease, this was happening. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall residents experience good outcomes with regard to activities and mealtimes but this could still be better. Evidence: From discussion with staff there is generally a person centered/resident led routine, but some staff were observed to have a more committed approach to this than others. Staff talk about letting residents have choice and of a flexibility within their morning routine to enable, for example, residents to stay in bed longer should they so wish. When on duty, staff are responsible for a set of residents all day in relation to their needs, including food and drinks. Staff do need to be more proactive in some aspects of their work, especially the food and fluid intake of residents. In the homes recent internal audit, from January 2009, it was also noted that some staff members appeared task orientated and that they will require further development to promote activity based care. Care plans showed that family trees had been completed which give staff good background information on the resident as an individual. On discussion with the staff, they knew the residents well. Activities were clearly on display around the home for Care Homes for Older People Page 14 of 27 Evidence: both residents and relatives interest. These included a recent pub lunch and a planned show. There is a residents information board and this displays a planned activities programme that covers the weekends as well. The activities officer leaves all her records available to care staff for reference. The activities officer works three days a week. She has attended training on Dementia and is undertaking an NVQ in this subject. Discussion with her demonstrated that she had a good knowledge of the residents and their social preferences. She described a wide range of activities offered but felt that more could be provided but the hours were limited. SONUS sessions are provided, which are sensory sessions and usually 4 to 8 people attend. She would like to develop more 1 to 1 sessions on this. She feels that the group activities go well but getting round to 1 to 1 visits is an issue. Records show that a record of what activities people would like to do is in place and this is linked to some family and social history. There is good evidence that she is trying and in some cases, does meet residents individual needs but not always. A more proactive approach to an actual social care plan to help wherever possible, to promote residents independence, self worth and the retention of skills, would be of value to ensure that residents abilities are optomised. The residents benefit from have a dedicated activities room that has good seating, a small kitchen, a television and reminiscence items. It has a homely relaxed feel and on observation, it is evident that a lot of work goes on, especially painting and promoting the retention of skills such as making drinks etc. Male residents were seen to be enjoying each others company and watching a black and white western film together. Residents who commented on the activities said they are very good, I have been out on a few occasions for a walk with some-one, I like to go to the activities room the activities lady is marvelous, I really look forward to the activities and we had a lovely Christmas, lots to eat and drink and the staff made it a jolly time. Records show that, for example, residents have a visiting PAT dog, have access to an old fashioned sweet trolley, undertake daily living takes, such as cleaning shoes etc., do crafts and gardening. Residents were seen to be sitting in the dining room, since breakfast, up to late morning without any social stimulation. When this was commented on by the inspector, she was told that is what they like to do. When querying the need for some social stimulation, the manager went and obtained some items of interest for the residents which they found of great interest and this promoted interaction between the three residents. It is a concern that care staff do not notice this and prompt some social stimulation themselves. It was also observed that staff are telling residents to sit down when there is no need and this is an institutional approach to care and shows a lack of understanding by some staff as to person centered care and individuals right to choose. Care Homes for Older People Page 15 of 27 Evidence: Mealtime arrangements were reviewed. The manager said that 2 meals are on offer and residents choose at lunchtime. The menu was displayed near the dining room and the manager said that they are trying to use more pictures to show the menus now. Some residents do chose to eat, especially breakfast, in their rooms. It was noted that late morning these residents were still sitting in there rooms with their uneaten breakfast/drink in front of them. Staff need to ensure that these residents are having the intake they need. It was noted during the day that jugs of juice and stacks of cups were in the communal areas but residents were not enabled by staff to have this. Staff need to have a more proactive approach to residents fluid intake. Lunch was observed and staff were seen to be helping residents appropriately, however there was little or no staff interaction with residents during this time, when the opportunity could be taken. Staff were observed to feed residents soft diets that had been specially prepared by the kitchen staff into separate items so residents can taste different foods and experience different textures. However staff were seen to mix this food all together and on discussion did not understand why this had been done for the resident. Residents who commented on the meals said there is a choice at mealtimes and its well cooked and presented nicely, Its hot and there is plenty of it, the bread is often dry, The food is very good and sometimes you get a choice of a couple of things, there is squash in the lounge if you ask for it and I can and do have seconds !. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that any concerns they have would be listened to and dealt with properly and that, as far as possible, they would be protected in the home. Evidence: The complaints procedure is clearly displayed in the main areas of of the home and at wheelchair height, with large print. Some residents spoken to were clear about who they would raise any concerns with and others were unsure. Since the new manager started work at the home she has dealt with 13 complaints, the majority of which were upheld and were seen to have been dealt with in an open and objective way. The complaints related to minor personal care issues, the care of laundry and other miscellaneous issues. They were properly recorded and dealt with in a timely manner. Staff spoken to confirmed a good understanding of adult protection procedures and attendance at training. They could also locate the current guidance on the subject. Training records showed that all staff at the home were up to date with their adult protection training which is good. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 well maintained and safe home. Evidence: A partial tour of the building was undertaken with the manager. All floors, including the basement were visited and this included a number of bedrooms on each floor. All communal areas and the majority of bathrooms were seen. Over the home was seen to all be very clean and tidy. Odours were not noted in any rooms but were noted from armchairs, despite them being cleaned the previous night. Consideration should be given to the management of this issue. It was also noted that wheelchairs around the home also required a good clean. The home is in good decorative order and on the day of the inspection, the maintenance man was sen to be painting bedrooms. Bedrooms were nicely personalised and residents spoken to were very happy with the standard of cleaning in the home and the facilities in general. Comments included this home is nicely situated, my room is fine, always clean and Its peaceful here and I like to look at the scenery. Signage around the home is quite good and helps residents with their independence. It was noted that the laundry door does not have a lock and this should be addressed Care Homes for Older People Page 18 of 27 Evidence: with the resident group in the home - who do have access to this area. The home has a small conservatory to the rear which lead out to pleasant gardens, overlooking the estuary and boats. There is good access and plenty of hard standing and raised beds. The manager is planing to introduce further raised beds so that residents can grow vegetables. The manager has a maintenance man who works 30 hrs a week, ten of which are for cleaning carpets and furniture. Records seen show that staff are good at reporting any small item that needs attention and the maintenance man signs these off when completed. Gloves and aprons were freely available to staff around the home and hand washing facilities were good. Fire safety records were reviewed and found to be in good order with staff attending fire drills, systems being consistently checked and maintenance certificates in place. The manager also has a fire safety risk assessment in place for the home but this now needs review. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having a stable and generally well trained staff team. Evidence: The current staffing levels at the home are, in the morning, 1 care team manager and 5-6 care staff, depending on the number of residents in the home. In the afternoon and evening, 1 care team manager and 5 care staff are on duty and at night 1 care team manager and 3 care staff are on duty, due to the current needs of the residents who are often awake during this time. It is positive to see the manager being flexible with the rota to meet the needs of the residents. Rotas show that, on the whole the staffing levels are maintained and if not covered this is due to late notice to cover a shift. In addition to this there is a full team of ancillary staff which means that the care staff can concentrate on caring for residents. The manager does have some care and domestic hours vacant, but is in the process of recruiting to these. There has been some care staff agency use recently but this varies from week to week. Residents spoken to did not highlight this as an issue. From discussion with the management team the home has a stable core staff team and a standard turnover of staff. The manager is supernumerary to the care hours and the deputy manager has one shift a week supernumerary to enable her to review care management etc. Residents who commented said the staff are quite good but there are not a lot of Care Homes for Older People Page 20 of 27 Evidence: them around, there are not enough staff to stop and chat with you, the staff are very polite and try to help you but I like to be independent, some staff are very good but some dont have time, the staff are kind to me and always help me, the staff are efficient and The staff team are very nice but its better when they are all on duty, sometimes they are short. Staff spoken to confirmed that they are undertaking NVQ qualifications and where appropriate doing in house Care Team Manager training before they can work in this role. From discussion with the management team, two care staff are undertaking care team management training, including completion of competencies and those already in post have a good level of experience. Records showed that out of 16 care staff, 8 have completed NVQ training and more staff are undertaking NVQs including NVQ 3. Three staff files were checked in relation to recruitment practices in the home. The staff files were found to be in good order with all the required checks and documentation in place. There was good evidence to show that the management team had explored any gaps in employment and records showed that staff had completed the in house induction and the common induction standards with Skills for Care. Staff spoken to confirmed the induction system and said that they had been able to shadow on shifts before starting work properly at the home. Staff spoken to confirmed that the training provided in the home was good and staff files showed evidence of current training certificates. Training records showed that nearly all the staff had attended training on caring for people with dementia and the compliance level with statutory training such as manual handling and fire safety was also very good. The majority of staff have had training in first aid and approximately half of them have been trained in infection control practice. More work could be done on providing training on medical conditions associated with old age and nutrition to give staff a more knowledge based approach. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a generally well run home where the team are committed to further improvements. Evidence: The manager of the home has been in post since mid 2008 and is a qualified nurse who is planning to undertake the registered managers award. She has logged an application to be registered with the CQC but this is underway. Staff spoken to were positive about the management arrangements in the home and confirmed that staff meetings are held along with additional workshops on subjects such as care planning. Staff said that they felt the current management of the home was good, changes were positive and that there was a lot more training on offer. Residents spoken to also commented that the home had improved with the new manager in post and one said that the new manager is very nice and does more than the others I got to know. The provider has a quality assurance system in place and the home has been recently Care Homes for Older People Page 22 of 27 Evidence: audited, achieving a score of 90 . The report was available and showed that residents and relatives had been asked for their views and that standards in the home had improved from the previous year. Comments from residents included Im very happy here and Since I came here I have improved in so many ways. Residents and families meetings are held quite regularly and show that items such as activities are discussed and that residents are encouraged to raise any queries or concerns they may have. Other audits are also carried out in relation to medication, health and safety and floor audits, which cover a range of issues and these are often completed daily and involves the manager or a senior member of staff walking the home and checking various things that relate to residents, care provision and the home itself. Records of floor audits were seen to be objective and showed evidence of issues noted being followed up with staff where appropriate. The manager has a staff supervision programme in place and this is currently up to date, although it was a little inconsistent at the end of 2008. The manager feels that this is steadily improving and records on staff files confirm that the supervision sessions are carried out and are a valuable system. Accident records were reviewed and were found to be completed well and provided sufficient information. It was noted that many residents accidents are recorded as found on floor. It may be of value for the manager to undertake some more analysis of these accidents to see if anything can be done to reduce the number. The manager has access to the local falls prevention team and reports this is mainly by telephone as their resources are limited and they rarely visit the home. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Ensure that detailed care plans are in place for all identified needs and that staff use the plans to direct the care they provide. So that residents needs are met in a way that they would prefer. 30/06/2009 2 8 12 Ensure that residents health care needs are met in relation to nutrition, pressure sore prevention and pain relief. So that residents health needs are met in full 14/06/2009 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 1 Undertake a review of the service user guide to ensure it is user friendly and consider systems to ensure that all residents have access to a copy of this document, especially on admission. Page 25 of 27 Care Homes for Older People 2 12 Review the arrangements for activities in relation to the hours provided and consider training for care staff in relation to the provision of social stimulation. Continue to develop the person centred care in the home so that all staff appreciate the approach that they should be taking. Give consideration to providing staff with training regarding mealtimes and the importance of fluid intake in elderly residents. Ensure that armchairs are sufficiently cleaned to eliminate any odours. Consider a more in depth review of accidents on a regular basis to see if any reduction can be achieved. 3 12 4 15 5 6 19 38 Care Homes for Older People Page 26 of 27 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. 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