Inspection on 13/01/09 for Coton House

This inspection was carried out on 13th January 2009.

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

Coton House 04/11/08

Coton House 09/07/08

Coton House 18/10/07

Coton House 22/06/06

Coton House 26/09/05

Coton House 12/10/04

Coton House 08/06/04

Coton House 08/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Coton House 55 Coton Road Penn Wolverhampton West Midlands WV4 5AT     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: Rosalind Dennis     Date: 1 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Coton House 55 Coton Road Penn Wolverhampton West Midlands WV4 5AT 01902339391 F/P01902339391 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) : Coton Care Limited care home 27 Number of places (if applicable): Under 65 Over 65 12 27 dementia old age, not falling within any other category Additional conditions: 0 0 The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 27 Dementia - over 65 years of age (DE(E)) 12 Date of last inspection Brief description of the care home Coton House is situated in a very quiet area of Penn, some 400 yards from Goldthorn Hill. The property was built in the 1930s and has been a residential home for the elderly for many years. Coton House is registered for 27 service users aged over 65 years and can admit up to 12 residents with mild dementia. In 2001 the Home had major development and refurbishment with a new purpose built wing of 10 en-suite bedrooms being added. The home is well maintained and as a result of a low turn over of staff has an experienced staff team. Weekly fees range from £349.00 to £400.00 per week. Care Homes for Older People Page 4 of 29 0 4 1 1 2 0 0 8 Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: One Inspector carried out this inspection on 13 January 2009. In addition our pharmacy Inspector visited on 29 January 2009 and assessed the homes progress in managing medications. The outcomes of the pharmacy inspection are included in this report. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the us as key. These are the National Standards which significantly affect the experiences of care for people living at the home. Care Homes for Older People Page 6 of 29 Prior to visiting Coton House, we planned the inspection using information available to us about the history of the service. We took this information from past inspection reports, the homes annual return to us, a legal document telling us what the service feels it does well and needs to improve and the homes improvement plan submitted after the last key inspection when we considered it to be providing a poor service. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. In the absence of the manager, the proprietors were available throughout the day to answer questions and support the inspection process. We looked in detail at the care provided to three people. We also spoke to three staff, residents and a visitor. We sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, accidents and complaints. We toured the premises and we were able to observe the care of residents during this time. All this information helped to determine a judgement about the quality of care the home provides. What the care home does well: What has improved since the last inspection? What they could do better: Although care plans have improved, there is still scope for more detail to guide staff more precisely as to how people can be helped in the way that they prefer and to ensure all their needs are met. Whilst medication has improved, there still needs to be better information available to staff, based on medical advice, about how some prescribed treatments should be administered. Work with people with dementia requires a lot of understanding and skill to promote their abilities day to day and maintain both their physical and mental well being. As the staff group becomes more knowledgeable and confident, further work should be done to develop individual plans and techniques so that peoples independence and well being are preserved as much as possible. The service needs to develop the way in which it gathers feedback from people such as residents, relatives, visitors and staff about how it is performing, so that any shortfalls Care Homes for Older People Page 8 of 29 or problems are identified at an early stage and become part of an overall improvement plan for the home. The management team need to have ways of routinely checking that systems and ways of working are being carried out as well as possible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We were not able to fully assess this as there have not been any new admissions to the home. However, systems to help improve peoples experience of moving in have improved. This will better assure people that the home can meet their needs before they are offerred a place. Evidence: There have not been any recent new admissions to Coton House, so for the purpose of inspecting this outcome group we looked at the processes, which the home intends to use at the time of a persons admission to the home and also discussed these processes with the provider. We observed new documentation, which demonstrates that the service has recognised where weaknesses previously existed with its assessment and admission process and we view that the service has made improvements to these. The home has also completed assessments for people on a retrospective basis using the new format and this shows that peoples care needs and Care Homes for Older People Page 11 of 29 Evidence: preferences have been sought and are clearly documented. The provider confirmed that, for any new admission, the home conducts a full assessment of a persons needs and seeks information from all people, involved in their care prior to making the decision to admit the person. This will help to ensure that people are only admitted to Coton House if the service is confident it can meet their needs. Three people who were admitted to Coton House prior to the key inspection in July 2008, spoke of their satisfaction with all aspects of the service since their admission. We saw that copies of the homes Statement of Purpose and Service User guide were available throughout the home in large print format, and both documents provide people with information about the home, facilities and services offered. Information on the homes fees is included within the Service User guide. The Statement of Purpose notes that the service provides care to people with mild to moderate dementia and we had reassurances from the provider that the home will only admit people with moderate dementia, if the service is sure it can meet those needs. The service has improved the content of individual contracts so that people are now provided with clear information on responsibilities for funding arrangements. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are generally being met. However some gaps in written guidance available to staff might prevent some aspects of peoples care needs being met consistently. Evidence: At the key inspection in July 2008 it was found that the health, social and personal care needs of people were not always met. We conducted a further inspection on the 4th November 2008 and found that the home had made some improvements to the way peoples needs were documented within care records. However we identified by speaking with people and looking at their care records that gaps in the recording and monitoring of peoples needs, could result in people not always receiving the care they need. At this inspection we spoke with four people who described how staff care for them throughout the day and they viewed that their needs are met at the home. Two people who need assistance to move spoke of how staff are gentle when they help them to Care Homes for Older People Page 13 of 29 Evidence: move. We looked at their care records, which described the equipment and techniques needed by staff to move them safely. We later saw staff using the equipment as described in the care plan. We looked at the care plan for a person who needs to drink plenty of fluids, the care plan described to staff how to meet this persons needs. We saw staff assisting this person to have drinks and the amounts that the person had drunk during the day were documented on a chart. However for another person who has a similar condition, their care plan did not provide staff with enough information on how to meet their needs, although we observed this person being provided with regular drinks. This suggests that staff are providing the care but arent always documenting it within the care plan. For a person who needs a special diet, their care plan reflected this and the cook demonstrated an awareness of specific nutritional needs, however when we looked at this persons care plan it described that the individual needs their blood monitoring regularly, but didnt define how often. Although the task of monitoring the blood appears to be conducted mainly by one member of staff, the risk of not providing clarity as to how often the monitoring needs to take place could result in the person not having their blood monitored, especially if the particular member of staff is not on duty. Observation of peoples care records shows that the home is not providing enough information to staff on how to meet peoples dementia care needs as the care plans we saw described how staff are to promote health and well-being, but did not say how staff could do this based on the individuals needs and abilities. The home has introduced a chart to record and monitor behaviour for a person whose behaviour may challenge and observation of this document shows that staff are completing the document and noting whether there were any factors, which might have triggered the behaviour. This is good practice, as it should enable staff to identify whether there any specific practices, staff, and events, which act as trigger factors for a change in behaviour. Observation of peoples care files shows that Coton House contacts health and social care professionals when appropriate and two people spoke with us about how the home contacted the GP quickly when there were concerns about their health and they needed medical attention. A visitor we spoke with confirmed that the home keeps them informed of any changes to their relatives condition. We observed staff interacting well with people who are less able to communicate their views, speaking clearly to people and providing support to them when they walked around the home. People looked well cared for and we saw staff undertaking regular checks to see if they were comfortable. We found that the recording of the receipt administration and disposal of medicines Care Homes for Older People Page 14 of 29 Evidence: had significantly improved compared to the last inspection. As a result of these improvements, we could see that all medication could be accounted for and that the people who used the service were receiving their medication as it had been prescribed by their doctor. We found that all of the staff who were administering the medication had been subjected to an assessment of competency by the management team, and the management team were also carrying out regular audits to ensure that the medication was being administered properly. We found that staff were monitoring the maximum and minimum temperatures of the fridge on a daily basis ensuring that the fridge temperature was being maintained within the correct range. We found that although information about medicines in the care plans had improved further improvements were required to ensure that medicines were given properly. Two people who used the service had been prescribed when required medication. When examining their care plans there was no information about how and when to administer the medication. It transpired that their GP had told the home that these people were able to make the decision for themselves. This information had not been recorded in the care plan. The home had indicated, on the MAR chart, for another person who had been prescribed some antibiotic eye drops that the eye drops were to be administered for seven days. There was no account of how the decision to administer the eye drops for seven days had been arrived at. Another person had been prescribed some artificial tears with the directions of one drop as directed. The medication record in the care plan indicated that one drop should be instilled into both eye once a day. There was no information as to who had been contacted to obtain this information. We felt that the person receiving the artificial tears would benefit from additional administrations of these eye drops during the day and the home agreed to contact the persons GP to discuss this further. The home had contacted that GP about a person who had been prescribed some laxative sachets on an as directed basis and the GP had told them, which was recorded in the care plan, that one sachet could be given up to four times a day. We found that the home needed to contact the GP again and obtain additional information about what dose was appropriate for the different circumstances that could arise with this person. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are continuing to develop their understanding of the sorts of activities that may suit people with dementia. However, people enjoy the activities available to him and can choose whether to join in. Visitors are welcomed and can visit when they want to enabling people to keep in touch with family and friends. Evidence: Information is available on different notice boards describing forthcoming events and activities including visits by singing and musical entertainers, exercise and craft activities. We spoke with three people about how they spend their days at the home. Two people spoke of how they prefer to spend time in their rooms watching TV, reading, listening music and they confirmed that staff respect the decisions they make. Another person spoke of how they take part in events and activities and they like what is provided by the home. Organisation of day to day activities is the responsibility of care staff and we looked at documentation, which shows that staff document on a daily basis activities, which have taken place. Staff also document any notable response from the person to indicate enjoyment or dislike of an activity, which is good practice for people who are Care Homes for Older People Page 16 of 29 Evidence: less able to communicate their views so that staff are able to plan alternative activities. We saw that the home has sought information about peoples spiritual and religious needs and the provider has confirmed that the home will ensure that people can continue with any interests they have, including arrangements to meet religious needs. Two people confirmed that families and friends are able to visit and see them when they wish and a visitor we spoke with described how they are made to feel welcome when they visit the home. We were unable to obtain feedback from many people about their views on the meals served by the home. One person we spoke with said they enjoy all meals and two people spoke of how some meals are better than others commenting that the food is not like home cooking but described how they are generally satisfied with the quality and choice of meals. We observed staff patiently assisting people who needed help with eating and drinking at lunchtime and staff were observed providing people with regular drinks throughout the day. We looked at the menus for the home, copies of which are supplied in the Service User guide. Menus show that choices are available at each meal and we heard staff offering people choices on the day of inspection. A discussion with the cook demonstrated they are aware of peoples individual nutritional requirements and described how the home uses a mixture of fresh and frozen produce in the preparation of meals. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Coton House are protected. People know how to complain and are confident that their concerns would be taken seriously and acted upon. Evidence: The complaints procedure is displayed in the Reception area and within the service user guides, copies of which were seen in peoples bedrooms. The complaints procedure provides people with information on the process to follow and who to contact if people want to complain. Three people we spoke with confirmed their awareness of this procedure and felt confident that if they had any concerns the manager or other staff would act quickly to ensure their concerns were acted upon. We looked at individual staff training records at our inspection in November 2008 and at this inspection, which shows that staff are provided with training in adult protection. Two staff we spoke with confirmed their awareness of the process to follow should an incident of abuse occur, another member of staff who is newly appointed hasnt yet received training but could describe their role in keeping people safe. The provider has attended training to equip him with the skills to train staff in techniques on how to intervene in a non violent way with people whose behaviour is particularly challenging. The provider confirmed that at the present time the service does not have a person who is exhibiting that level of behaviour and spoke of Care Homes for Older People Page 18 of 29 Evidence: intentions to provide staff with training appropriate to the needs of people at the home. The provider is aware of the Mental Capacity Act 2005 and associated legislation and intends to attend training and then cascade training and awareness to staff. The Act governs decision making on behalf of adults, where they lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a homely and warm environment and are happy with their individual rooms. Some steps have been taken to adapt the environment to meet the needs of people with dementia; this is considered to be work in progress and needs to be kept under review to ensure that people are provided with maximum opportunity to maintain their independence. Evidence: We looked at the communal areas of the home and the bedrooms of the people whose care we had case tracked. There is one communal lounge where most people choose to sit and although the chairs are quite close together people seem happy with this arrangement. The lounge has a fish tank, television and stereo. As at the inspection in November 2008 people appeared to enjoy listening to music. There is one dining room, another smaller seating area and conservatory. We saw some people moving around the home independently, but for most people staff were supporting and assisting them to move. Since the last key inspection, steps have been taken to provide signage to try to help to orientate people in their surroundings, without this the layout of the building could prove disorientating. We view that the home should keep the effectiveness of this signage under review and also to look at ways to enhance sensory stimulation, for people with dementia. We observed people eating in the dining room at lunch time and people did not seem to be experiencing difficulty with the glass dining tables as had been observed at the key inspection in July 2008. Care Homes for Older People Page 20 of 29 Evidence: The provider therefore needs to monitor this and take action if people are found to be having any difficulty. We spoke with two people who share a room and have another room as a sitting living room, they spoke of their satisfaction with this arrangement and how they are pleased they have a key to the doors of their rooms, which means they are able to keep their door locked when they choose. They confirmed how their rooms are always kept clean and the temperature of the room and the hot water is to their preference. All the rooms we looked at including bathrooms and toilets were clean, with soap and paper towels available. We did not notice an offensive odour anywhere in the home at the time of our inspection. Records showed that for a person who we had been concerned about during the inspection in November 2008, the service had subsequently sought advice from an occupatonal therapist regarding the persons seating arrangement. We looked at their care plan which provides staff with the information they need to ensure the person is able to sit on an appropriate cushion. Since the inspection in November the home has also increased the availabilty of hoist slings, so that people who need to be supported to move using a hoist do not have to share a sling. A lift provides people with access between the different floors of the home if they are unable to use stairs. At the inspection in July we had seen portable heaters in use, which had not been risk assessed to ensure peoples safety. In November 2008 we saw that risk assessments had been drawn up, although they were somewhat brief. At this inspection, the provider confirmed to us that radiator guards have been put in place to cover portable radiators, we saw a bedroom where this had been undertaken and this appeared safe. The provider confirmed that the home will be looking to provide a more permanaent solution in rooms where people find that the homes own heating system is not sufficient to meet their individual needs. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by the numbers and skill mix of staff who receive appropriate training. New staff are checked before they start to ensure they are suitable to work with vulnerable people. Evidence: Since the last key inspection in July 2008, staff have completed a distance learning course about caring for people with dementia and observation of staff working at this inspection show that staff are putting this training into practice, through how they support and speak with people. We discussed with the provider that as staff develop their skills in caring for people with dementia then other areas of the service should also develop. Three people and a visitor we spoke with viewed that staff have good caring abilities, always respond to requests promptly and that there are enough staff on duty. At the time of our inspection sufficient staff appeared to be on duty to meet the needs of people living at the home and the staff we spoke with viewed that there are enough staff working at the home during the day and night. Most of the staff who completed surveys for us confirmed within these that there are enough staff. The staffing rotas have been improved to show the full names of staff and their roles. We looked at information included within staff training files which shows that staff have individual training and development plans, which identify the training they have Care Homes for Older People Page 22 of 29 Evidence: already undertaken and training which is needed for their role. Where training needs are identified the provider was able to show us evidence to demonstrate the homes plans to provide this training, such as infection control and food hygiene training. We spoke with two staff who had recently started at the home and they confirmed they had received an initial induction, documentation was also present on their files to confirm this had taken place. We saw evidence to confirm that the homes more in depth induction programme for staff who have less care experience and qualifications meets the Skills for Care standard. Information provided within the AQAA had identified that over 80 per cent of staff have attained a recognised qualification in care at Level 2 NVQ, during the inspection the provider estimated that the figure now would be in excess of this figure, which indicates that the staff team should have an effective knowledge of social care. When we visited the home in November 2008 and looked at how the home recruits new members of staff, we found practice to be generally acceptable although not fully in line with regulation or as stated in the homes improvement plan. At this inspection we looked at the personnel files for three members of staff and we observed that the home had ensured information including references and CRBs had been obtained prior to these new staff starting work at the home. However on scrutinising one reference we established that the home had sought a reference from the persons last place of employment but had not ensured the reference was from a senior member of staff, such as the manager of the home or equivalent. The home took steps to rectify this and we received evidence soon after the inspection to demonstrate that the home had obtained a reference from a senior member of staff. All other information we saw confirmed that the home has improved its recruitment procedure but this highlights a need for the service to initiate further steps to tighten up on processes. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We are satisfied that the management of the home has improved and as a result that people are safe. The home now needs to show it can sustain and further develop these improvements for the benefit of the people who live there. Evidence: The manager has not been at work for some time, which has resulted in the providers leading and managing the home for the interim period. When we visited the home in November 2008 the manager, Kalwant Chahal was on duty and we established that Kalwant along with the providers had made improvements at the home to meet our requirements, although we identified that further improvements were still needed. This inspection finds that home has continued to improve, the home now needs to demonstrate that it can initiate improvements based on its own quality assurance and monitoring process. We observed questionnaires which the home is intending to distribute to people who live at the home, their significant others and staff and when feedback is obtained intends to draw up an action plan. The providers confirmed the Care Homes for Older People Page 24 of 29 Evidence: last time it obtained formal feedback from people in the form of surveys was in June 2008. We advised that it would be good practice to increase the frequency to twice yearly. We saw that the home does keep people informed of planned events and other matters through distributing letters and through relatives and residents meetings. Observation of staff files and discussion with staff confirms they have access to formal supervision sessions, which provide opportunity to reflect on their practice and to discuss their training and development needs. We looked at records relating to the management of small amounts of residents personal monies and the process used by the home appeared robust with receipts kept to show spending and transactions checked by two people. Information was provided within the AQAA to confirm that servicing and maintenance of equipment is undertaken and policies and procedures are reviewed. At this inspection we looked at a selection of records, which also confirmed ongoing checks to ensure the home is kept safe, such as checks on the temperature of the hot water and restrictors on windows to prevent them being opened too far. The fire officer visited in November 2008 and the home has confirmed to us the action it has taken to meet the areas identified as needing attention. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 13 Appropriate information 28/02/2009 relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including when required and as directed medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. This will ensure that staff know how to use and monitor all medication to ensure that all medication is administered safely, correcly and as intended by the prescriber to meet individual health needs. 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 Care Homes for Older People Page 27 of 29 improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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