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Inspection on 17/08/09 for Camplehaye Residential Home

Also see our care home review for Camplehaye Residential Home for more information

This inspection was carried out on 17th August 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff have respect for the people in their care and try hard to provide a good service. The standard of personal care provided is good. There is a keen interest in providing suitable group activities for people at the home and also ensuring that people have social interaction and so do not become socially isolated. People are protected from abuse and any concern or complaint will be well received and looked on as a way to improve services. Most parts of the home are pleasant, well furnished and homely in nature. The patio and garden areas are of a very high standard and people are able to access them easily and use this safe and pleasant outside space. Staff receive training, supervision and support in their work. There is regular monitoring of the quality of service provided at Camplehaye. The manager of day to day care has good leadership skills and a keen interest in finding ways to improve the service.

What has improved since the last inspection?

There is now up to date information on the service provided at Camplehaye. This helps people decide if the home is suitable for them. There is now a full program of activities at the home and recreational needs appear to be met. The external grounds are now much extended, with attractive patio and garden areas with good access. There has been improvement in adapting the home to meet the needs of people who live there, especially those with dementia who will benefit from signage and good use of colour. The duty rosta now includes all the people working at the home, including the registered manager. The clarity of the contract (terms and conditions) is now improved and should be clearer and better protect people. The Chef is knowledgeable about meeting the specialist dietary needs of people at the home. The entrance door has had its glass replaced and people are now at less risk of accident when it is opened.

What the care home could do better:

Medicines prescribed to be given `as necessary` or `as required` are still not part of planned care which leave their use open to inconsistency and increases the possibility of mishandling by staff. Although this requirement has been repeated it is clear that the home have not understood what was expected to achieve it. They now do. Assessment of people`s needs and care planning do not fully protect people as there is some inconsistency of information and some important information is missed. Staff are therefore not fully informed. Also, the home must evidence that the person, or their representative, is involved in their assessment, planning and review of their care. People`s independence must be promoted. Assessment records must be clear in the information about any Advanced Decisions that people have made in relation to their care or finances and any legally binding arrangements where a person is acting on their behalf, such as Lasting Power of Attorney and Independent Mental Capacity Advocacy. There should be a stock control system for medicines to ensure that several packets are not opened at the same time. The home must ensure that the storage of any controlled drugs in use complies with the Misuse of Drugs (Safe Custody) Regulations 1973. All staff at the home must be clear as to how to alert concerns which might be abuse, so that the correct procedure is always followed and people properly protected. Soiled laundry must not be put on the floor. The laundry should be kept clean and all surfaces in the laundry should be readily cleanable. These measures will help to reduce the likelihood of cross infection and contamination.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Camplehaye Residential Home Lamerton Tavistock Devon PL19 8QD     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: Anita Sutcliffe     Date: 1 8 0 8 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 30 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 30 Information about the care home Name of care home: Address: Camplehaye Residential Home Lamerton Tavistock Devon PL19 8QD 01822612014 01822611480 avenscare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Avens Care Homes Ltd care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 43. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) Physical disability (Code PD) Date of last inspection Brief description of the care home Camplehaye is a large detached period house set in its own grounds on the outskirts of the village of Lamerton. 43 0 43 Over 65 0 43 0 Care Homes for Older People Page 4 of 30 Brief description of the care home It is registered to provide residential accommodation and personal care, for a maximum of 43 older people for reasons of frailty connected with age, physical disability or dementia. In addition, the home may provide accommodation for people with a physical disability from the age of 55. All health care needs are met through the community health care services, such as the district nursing service. The home provides three lounge rooms and two dining rooms on the ground floor. There are three double bedrooms. All of the bedrooms have en suite facilities or a toilet and sink for personal use close by. Stair lifts and a vertical lift provide access to the upper floors, however a small number of rooms are accessible by a short flight of stairs. Outside space comprises a patio area and enclosed gardens. We were told on 4th November 2009 that fees range from £350 to £450 a week. Additional charges are made for newspapers, personal toiletries, incontinence pads, telephone and transport and escort, visiting hairdresser, dry cleaning, dentist, chiropodist, clothing, and other items of luxury or personal nature. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Care Homes for Older People Page 5 of 30 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: The Commission has collected information about Camplehaye since the last key inspection August 2007. A review of the service was undertaken August 2008. This included surveying peoples opinion of the service. This key inspection included two unannounced visits to the home, one early evening. The information sent to the Commission each year by the care provider gave us some numerical information about the service, such as how many people are resident and how many staff employed. It also gave the home the opportunity to tell us what they do well, what barriers there may be to improvement and what improvements are planned. Surveys were sent to people who use the service, staff and health care professionals so they could comment about the home but none were returned in time for the inspection. Care Homes for Older People Page 6 of 30 However, we sought the opinion of a district nurse who visits the home regularly. As part of the visit to the home we looked at all communal areas and several bedrooms. We spoke with several people who use the service and observed staff going about their work. We looked closely at the care of three people. This included speaking with them and staff about the care and support they need and looking at records of their care. We looked at records and documents and spoke with the manager of day to day care, the deputy and several staff. We met and discussed the home with two family who were visiting. The registered manager was not available. People who use the service may be described within this report as clients, service users or residents. What the care home does well: What has improved since the last inspection? What they could do better: Medicines prescribed to be given as necessary or as required are still not part of planned care which leave their use open to inconsistency and increases the possibility Care Homes for Older People Page 8 of 30 of mishandling by staff. Although this requirement has been repeated it is clear that the home have not understood what was expected to achieve it. They now do. Assessment of peoples needs and care planning do not fully protect people as there is some inconsistency of information and some important information is missed. Staff are therefore not fully informed. Also, the home must evidence that the person, or their representative, is involved in their assessment, planning and review of their care. Peoples independence must be promoted. Assessment records must be clear in the information about any Advanced Decisions that people have made in relation to their care or finances and any legally binding arrangements where a person is acting on their behalf, such as Lasting Power of Attorney and Independent Mental Capacity Advocacy. There should be a stock control system for medicines to ensure that several packets are not opened at the same time. The home must ensure that the storage of any controlled drugs in use complies with the Misuse of Drugs (Safe Custody) Regulations 1973. All staff at the home must be clear as to how to alert concerns which might be abuse, so that the correct procedure is always followed and people properly protected. Soiled laundry must not be put on the floor. The laundry should be kept clean and all surfaces in the laundry should be readily cleanable. These measures will help to reduce the likelihood of cross infection and contamination. 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 30 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 30 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. Information about the home will assist them to make an informed decision as to its suitability. Assessment of peoples needs should be further improved so that accurate information is available from which to plan the care and support they would like. Evidence: At the visit we were provided with written informed about the service (called the Statement of Purpose and Service User Guide) and the home reports that this can also be provided in a format suitable for people with dementia. We saw a website providing information and clear pictures of some of the facilities available at the home. A sample contract is included with the written information. People are also encouraged to spend time at the home before deciding if it is suitable to meet their needs. We looked at the care of the last two people admitted to Camplehaye. This included Care Homes for Older People Page 11 of 30 Evidence: meeting them and looking at assessment records. The home uses a set format for assessment. Information was not as detailed as it might have been and there were some inconsistencies, such as a person apparently being at low risk of falls (in one section) and described as high risk in another. This was discussed with the person in charge. Assessment tools were used, such as prevention of pressure sores, nutritional assessment, falls and moving and handling but there was limited actual information recorded. However, there was some information about preferences, likes and dislikes and that relating to family and history, which help staff understand the person as an individual and is very important in planning their care. We saw no indication of who had been involved in the assessments; neither the potential service user or their representative was mentioned. This was also found at the previous inspection, in 2007. The home must demonstrate that the potential service user, and/or their family, is fully involved in providing information about them. We discussed with the person-in-charge the need for assessment to include information relevant under the Mental Capacity Act and deprivation of liberty safeguards, not found in the two assessments we examined. We also discussed the importance of ensuring peoples diverse needs are understood and recorded on admission. We were told that the person who manages the day to day care and/or the deputy undertake assessments and visit people to do so where ever possible. Care Homes for Older People Page 12 of 30 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. Peoples health care needs are met. Evidence: We looked at the care of three people who use the service. Each person living in the home must have a plan of care that accurately reflects his or her care needs and identifies the action required by staff to meet those needs. The plan of care must be reviewed regularly in consultation with the person or their representative and updated when the persons needs change. This is to ensure that a persons changing needs are assessed and met. We found that two peoples care plans contained sufficient detail, were reviewed and up to date. However, the third person, described as having epilepsy in their assessment and taking medication for that condition, had no mention of this in their care plan. We asked two care staff if they knew about this persons condition and they did not; the deputy manager did and we were told that each senior person at the home would have that knowledge and there would always be one senior on duty. Care Homes for Older People Page 13 of 30 Evidence: We saw no indication that the person using the service, or their representative, was consulted or involved in planning the care but were later told that this is always the case. This must be fully documented for each review of the care so it is clear that people are supported to make their own decisions through the care planning process. The home records that staff need more training in completing documentation. We observed a hand over of information between staff groups. The information given to staff was informative and detailed. Staff told us how useful this was. We saw that people were receiving a high level of personal care; they looked well cared for. Two people visiting confirmed that this is the normal standard they witness. A district nurse who visits the home regularly told us that the home contacts them regularly; they have confidence the standard of care provided; peoples personal care needs are met and the overall standard of care provided is good. The home reports that they have supplied 50 of their residents with care beds and pressure cushions to help prevent pressure damage in frail people. Staff told us they thought that one of the things they did best was the care and rated the home as good. Staff appeared to be very competent and professional and did instill confidence. Their approach to providing care was kind and respectful. One person told us they are treated with respect and most staff knock on my door before coming in. We looked at how the home supports people to manage their own medication or does this for them. We were told that no person is able to manage their own medicines at this time. There was a previous requirement, with a timescale for compliance of January 2007, that medicines described to be taken as required or as necessary should be part of that persons planned care. Without this their use may not be consistent which can lead to mishandling and makes judging the effectiveness of the medicine difficult. Medicines are in use at the home which could be misused without clear boundaries for their use. However, it appears that the home misunderstood what was required to achieve this. We were shown a policy, produced following the last inspection, that demonstrates they did not understand. This has now been discussed at length and we expect the requirement to be met in the very near future. The home uses a monitored dosage system and records were mostly complete. Care Homes for Older People Page 14 of 30 Evidence: Medicines are signed into and out of the home and their use can therefore be audited. We were told that the home takes steps to ensure that any change in medication is carefully checked, with two staff signing to confirm it is correct. Medicines are kept on each floor of the home. Although stored in a box in a cupboard the medicines in use at the home, known as Controlled Drugs, do not appear to be stored within the specialist storage arrangement required in law in that storage must be in a metal cupboard of specified gauge, have a specified double locking mechanism, be fixed to a solid wall or a wall that has a steel plate mounted behind it and with either Rawl or Rag bolts. The home have taken external advice and dispute that what they have provided is wrong, but have taken the decision to upgrade their controlled drug storage in each of their homes regardless. We saw that staff had openend and were using several packets of one medicine at once. This can lead to mistakes and is poor stock control. Care Homes for Older People Page 15 of 30 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. People are supported to lead fulfilled lives within their capabilities. Evidence: We looked at whether people are supported to lead fulfilled lives within their capabilities. An activities worker (known as an activities co-ordinator) was at the home during both visits, including early evening. She was clearly very enthusiastic about her role and staff spoke highly of what she was achieving. She organises a program of activities and we saw her visiting people in their room. This is to prevent social isolation where people are unable or unwilling to mix with others. A list of the planned activities is displayed in the home, but we found that the writing was quite small, and therefore unreadable to some, but did include pictures. There are a variety of group activities arranged, including exercises, icing cakes, entertainment and crafts. There is now access to pleasant garden areas as well as an attractive patio. The home has a minibus with disabled access so enable people to make visits away from the area. Care Homes for Older People Page 16 of 30 Evidence: Peoples records describe activities of daily living and how these can be achieved and some, but not all, assessment records included likes and dislikes. Information about peoples background, interests and things of importance to them could have been more detailed. This helps staff understand people who are suffering with dementia. We saw that representatives of a local church visit the home and personal faith is supported. Visitors told us that they can visit at any time and they are made welcome. We saw staff offering people choice and were told that staff try hard to help people choose their own routine. One person told us they are able to go to bed and get up when they choose. The manager told us she was planning a pictorial menu to help people choose which meal they want. The home reports that people are encouraged and enabled to make more choices in their lives. We asked people what they thought of the food. Comments include: Foods alright, quite nice. We met the Chef, who had only been in post one week. He is experienced in his work and we saw him making his own pies and custards. There was three choices of meal available the day we visited and we were told people are asked each day what they would like. We ate the chicken chasseur which we found to be tasty. The Chef told us of his plans to improve the current menu. Staff were seen assisting people with their food. People told us they are offered sherry on a Sunday. A district nurse told us she did not have concerns about the diet and fluid intake of people at the home and we saw that there were drinks readily available for people. Care Homes for Older People Page 17 of 30 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. People are protected through the homes complaints and safeguarding arrangements. Evidence: We looked at whether people are protected through the homes complaints and safeguarding arrangements. The homes complaints policy is displayed on the wall by the entrance door and includes contact details for the Commission in case people are not satisfied with the homes response to concerns they raise. There are also questionnaires available for people to comment about the service provided. Most people using the service would be unable to make a formal complaint but the home appeared to have an open and caring staff and management. The key working scheme is also intended to help staff identify where a person may be having a problem. The home reports that there have been no complaints and the Commission have received no complaints about the service. A person who uses the service and her family told us they felt any complaint they made would be well received and acted upon. We asked the person-in-charge during the visits what action they would take should there be an allegation of abuse. They did not respond with the correct procedure to be followed. However, information about this was displayed on the notice board in the Care Homes for Older People Page 18 of 30 Evidence: office. We spoke to four care assistants who did know the correct response to a concern which might be abuse, knowing that they can take concerns to the local authority safeguarding team. Staff have received training in how to safeguard vulnerable adults. Care Homes for Older People Page 19 of 30 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 environment is suitable for people who use the service but there is room for some improvement. Outdoor facilities are of a high standard. Evidence: We looked at whether the home was suitable and met peoples needs. The home provides three lounge rooms and two dining rooms on the ground floor and we saw people sitting and chatting in other areas of the home. Two of the lounges are well furnished and attractive and overlook the patio area. However, a third is stark, contains very little adornment and appears institutional with chairs around the edge and a television in the distance. There is a secure and very attractively laid out garden and patio space for people to look on to and use. These have full disabled access. There are raised beds, a water feature and planted garden walks. Some rooms have doors which open on to the patio. The manager told us they have all the equipment they need at the home and there has been much investment in new beds, suitable for a high standard of care especially when people become frail. We saw some adaptation within the home for people with dementia, such as highly visible hand rails and some pictorial signage. Ramps help Care Homes for Older People Page 20 of 30 Evidence: people with poor mobility in the house and the garden and vertical lifts help people to the first floor of the home. We found the home to be clean and fresh for both visits. One person who uses the service told us: Its very clean, infuriatingly tidy. We visited the laundry with the manager. There was some debris on the floor and clothes (presumably dirty) piled on the floor. The walls of the laundry room are not readily washable - considered good practice to reduce the likelihood of cross infection - but we were told that the laundry is sanitised and painted regularly. The standard of equipment available is high and meets the needs of the home. We saw that staff have liquid soap, paper towels and hand gel available for hand cleansing and the manager said she watches staff to make sure they use it. There is also personal protective clothing (such as gloves) available for staff use. Care Homes for Older People Page 21 of 30 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. People who use the service benefit from staff which are caring, competent and dedicated. Recruitment could be more robust. Evidence: We looked at whether people were well supported by the staff at the home. Asked about staff people told us: A nice bunch really and Most are friendly. Staff numbers appeared to be satisfactory through out the visit. However, one staff told us: I dont think its good enough because staff cannot give quality time. The manager said she wants to employ more qualified staff. A district nurse told us there are quite a lot of new staff at the home. Staff talked of the much increased access to training. They told us they receive training in dementia, behaviour that challenges, prevention of pressure sores, moving and handling, first aid, safeguarding vulnerable people from abuse and fire safety. We asked if they knew about the relatively new deprivation of liberty safeguards. Neither the deputy or two experienced care staff knew about the legislation, which is to protect people who do not have capacity to make decisions on their own welfare. The person-in-charge had some knowledge about it, has sought further information, and there is information available for reference. Care Homes for Older People Page 22 of 30 Evidence: Staff we spoke with said that they did not want to take formal qualifications in care and the home records that they need to encourage more staff to do this. However, they did appear to be competent in their work. Asked about induction, when staff are new, they said it is satisfactory and equips them to start work with people in the home. They added that they are supported and supervised at this time. We saw that induction was a formalised training with records of what had been learned. We spoke with a district nurse who visits the home regularly. Although she felt staff at Camplehaye could meet most peoples needs she felt some staff lacked the skills and experience to care for people, who have dementia, with behaviour that challenges them and other people. We saw no evidence of this during the visits. We looked at whether the homes recruitment practice protects the vulnerable people who use the service. We looked at three sets of staff records with the manager. None of the three had two good references. The first contained one open reference (therefore not provided in response to the request for reference). This makes it of less value. A second reference where it was not possible to tell who it was from. Neither was the persons last employer. The second contained one character reference and one from last employer and the third contained one good reference and one which was of limited information/use. Care Homes for Older People Page 23 of 30 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. People who use the service benefit from a home which is run in their best interests and where the goal is continuing improvement. Evidence: We looked at whether the homes management is effective. At the time of the inspection the registered manager, Mrs. Avins, was not available. The inspection was conducted with the person she employs to run the day to day care of the home. She has worked at the home for nine years and has achieved National Vocational Qualification (NVQ) to level 2 in care and told us she is about to undertake further training. We found her to be innovative and keen to make improvements. She applied to be registered as the manager on 22nd July. She is supported by a capable deputy manager. Through our observations and from talking to people and staff we found that staff appear to be enthusiastic about their work and working as a team in peoples best Care Homes for Older People Page 24 of 30 Evidence: interests. We looked to see if there were restrictive practices in place. Although we would expect the building to be secure from intruders any practice which unnecessarily restricts people should be removed. We found that the key pad number to the main door was not easily accessible to people, even though they would be unable to wander unknowingly away from the grounds. The home feels that the keypad number is adequately displayed. We looked at how the manager ensures continual quality monitoring of the service. Surveys are available at the entrance to the home and feedback is invited from people, who are able, and their family. We saw records of monthly audits of different aspects of the home and how some issues identified have been addressed. A key working arrangement helps to ensure quality of individual service as care staff: should be bringing the individual needs of people to the managers attention. Staff told us that they have regular one to one supervision of their work. We saw a residents meeting advertised and staff meet monthly as a team. A member of the organisation does a monthly, unannounced visit to the home to ensure standards are maintained. People at the home have any expense invoiced to them. Some are able to look after their own financial affairs but most are not. Most rooms have a lockable storage space for valuables and the home keeps a float of money so that no person goes without for lack of cash when needed. The home looked well maintained and we saw records of servicing and maintenance of equipment. Staff receive health and safety training and appear competent in this. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13(2) The circumstance under 01/10/2007 which `as required medication is given must be clearly described and be part of planned care. This requirement was not met on 01/01/07 Care Homes for Older People Page 26 of 30 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 Consultation with the person 31/10/2009 using the service, or their representative, must be recorded when reviewing or planning a persons care. So that it is demonstrable that people have influence over the care they receive. 2 7 15 A plan of care must reflect 30/09/2009 all aspects of the persons needs, including any medical condition which needs staff knowledge or attention. So that peoples health and well-being is promoted. 3 9 13 The circumstance under which as required or as necessary medication is given must be clearly described and be part of planned care. So that its use is consistent and the likelihood of mishandling is reduced. 30/09/2009 Care Homes for Older People Page 27 of 30 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 4 9 13 Stock must be properly controlled; one packet opened at once and used in sequence. To prevent confusion and mistakes. 30/09/2009 5 9 13 Medicines known as Controlled Drugs must be stored in compliance with the Misuse of Drugs (safe custody) Regulations 1973. To reduce the likelihood of mistakes, mishandling and to comply with the law. 30/11/2009 6 26 13 (3) Arrangements must be improved regarding the management of laundry. Soiled laundry must not be put on the floor and the laundry room must be kept clean and hygienic. To reduce the possibility of cross infection or cross contamination. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Assessment information should include any legal arrangements in place which protect people who do not have capacity to make decisions on their own welfare. This includes information on Advanced Decisions, Lasting Power of Attorney and Independent Mental Capacity Advocacy. Page 28 of 30 Care Homes for Older People 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 2 3 It should always be clear who has been involved in assessing a persons needs. If that person cannot do so themselves this must be clearly stated and the reason given. Assessment should contain more open questioning so that people can be confident their diverse needs will be recorded and understood. All staff should be fully conversant with the protocol for alerting concerns which might be abuse. Communal rooms should be comfortably furnished and domestic in nature so that people live in a homely environment. The home should ensure that two good written references are in place when recruiting new staff. 3 3 4 5 18 20 6 29 Care Homes for Older People Page 29 of 30 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). 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. 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