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Inspection on 27/04/09 for Courtenay House Nursing & Residential Home

Also see our care home review for Courtenay House Nursing & Residential Home for more information

This inspection was carried out on 27th April 2009.

CQC found this care home to be providing an Good 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 3 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

The Home provides comfortable and homely accommodation which meets the needs of the residents. Each resident has a single room and there is a choice of two lounge/dining rooms for residents to spend time in. There is also a small quiet room which can be used by residents and relatives. The residents feel that they are well cared for and that the staff are kind. Comments were made in the residents surveys such as: `I`m happy with the staff` `I could not be happier` `the staff are exceptional` `I always receive excellent care and support`. The residents enjoy their meals and are offered a choice. They feel that they are able to have an alternative if they wish to and that they have enough food. Comments about the meals were made such as: `plenty of food available` `excellent meals` `usually very nice home cooked food`. The views of the residents and their relatives are sought on a regular basis and action taken to address any issues or in response to suggestions for improvement.

What has improved since the last inspection?

A new Manager was appointed in June 2008 and she completed the registration process with the Commission in March 2009. The Manager provides very good leadership and is highly thought of by residents and staff. Additional comments were made such as: `outstanding new manager`, `everything is so much better this year`, `manager is very approachable, she listens`. An activities co-ordinator has been employed at the Home and she works five days per week. The range of activities available to residents has greatly improved and residents told us that they really enjoy the opportunity to take part. Links with community groups such as primary schools and the local churches has improved and greater liaison takes place which the residents enjoy. New equipment, such as commodes and toilet frames, have been purchased to replace older, worn out equipment. Further decoration has taken place around the Home following the major refurbishment in 2007/2008.

What the care home could do better:

There is a need for the Manager to carry out a review of staffing to ensure that there are enough staff at busy times of day such as when residents get up, go to bed and at mealtimes. There is a need for additional training for staff to ensure that they receive appropriate training that enables them to carry out their roles effectively. Further work is needed to ensure that all of the bathrooms receive the maintenance and decoration that needs to take place.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Courtenay House Nursing & Residential Home Fakenham Road Tittleshall Norfolk PE32 2PF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lella Hudson     Date: 2 7 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Courtenay House Nursing & Residential Home Fakenham Road Tittleshall Norfolk PE32 2PF 01328700646 01328701320 courtenay.house@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd Name of registered manager (if applicable) Suzanne Martin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Forty-two (42) older people may be accommodated. Forty-two (42) older people with dementia may be accommodated. The total number of services users not to exceed forty- two (42). Date of last inspection Brief description of the care home Courtenay House is a large detached property in the village of Tittleshall. There has recently been refurbishment of the Home with a reduction in rooms. There are now 42 single bedrooms, three of which are ensuite. The home has a variety of communal rooms for the use of residents. There are gardens with a car park to the rear of the property. Care Homes for Older People Page 4 of 31 care home 42 Over 65 42 42 0 0 Brief description of the care home Fees are currently between £385 - £537 per week. Please contact the Home for further details about fees. A copy of the Statement of Purpose for the Home and a copy of the latest Inspection report by the Commission can be obtained from the Manager and are on display in the Home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report includes information gathered about the Home since the last Inspection in April 2008. It includes information provided by the Manager within the Annual Quality Assurance Assessment which she returned to us and which provides us with the Homes review of the service provided. We received completed surveys from residents, some assisted by relatives, and from staff. The report also includes information gathered during an unannounced visit which we carried out at the Home on the 27th April 2009. Care Homes for Older People Page 6 of 31 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 Care Homes for Older People Page 7 of 31 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents have good information about the Home prior to moving in. The needs of prospective residents are assessed effectively. Evidence: Since the last Inspection the organisation have introduced new formats for the pre admission assessment of prospective residents. We saw one of these which had been completed and it contained detailed information about the needs of the residents. It also showed that information had been gathered from the resident, their family and from health/social care professionals involved in their care. The responses within the residents surveys indicate that they had received good information about the Home prior to moving in and that the majority are aware that they have a contract. The Manager said that they have now got a welcome pack which includes a lot of information about the Home and the services provided there. Care Homes for Older People Page 10 of 31 Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans contain detailed information about the residents needs and how these should be met. The residents basic personal and health care needs are met but staff have little training about providing care to residents with dementia. Medication is managed in a safe way but there are times when residents are not getting medication at the prescribed times due to the time it takes to administer. Evidence: We looked at two of the care plans in detail and at two other care plans for some specific information. The format and quality of the care plans has improved since the last Inspection. There is now much more detailed information about the residents needs and how these should be met. There is evidence that regular reviews take place and that the care plans are updated to reflect this. However, it would be easier for staff to locate the information if the whole care plan was updated when changes are made rather than adding the information to the review section. The care plans also include risk assessments relating to identified areas of risk, such Care Homes for Older People Page 12 of 31 Evidence: as use of bedsides, falls and mobility. These are also reviewed and updated on a regular basis. The staff who spoke to us said that they are aware of the content of the care plans and that they are involved in reviews. The responses within the staff surveys state that they feel that they get up to date information about the residents needs. The care plans contain information about the residents health and personal care needs. Assessments are carried out with regular reviews and there is evidence that health care professionals are contacted as appropriate, with any advice incorporated into the care plans. The nurses employed at the Home deal with any nursing issues for those residents who are assessed as needing nursing care whilst the District Nurse attends the other residents. The Manager and staff told us that they feel that there are good relationships with the District Nursing team and the GP practice. The care plans contain information relating to continence assessments and one of the senior carers takes additional responsibility with regard to this area. She is responsible for liasing with the continence assessor and ensuring that care plans are updated with regard to continence. The care plans contain detailed information about pressure care for those residents at risk of developing pressure sores. The staff who spoke to us were clear about the care that needs to provided to these residents. The Manager said that the majority of the residents have some form of confusion or dementia. She said that the Dementia training that had been planned recently had not taken place. She said that this is now being reorganised as she is aware of the need for staff to attend the training to ensure that the residents with dementia are receiving appropriate care. Some training has been provided with regard to individual residents needs. For example the senior care staff have received training with regard to those residents with diabetes so that they are able to take blood sugar levels accurately. The majority of the residents surveys state that they feel that they get the care and support that they need whilst four stated usually and one stated sometimes. An additional comment was made that states I always receive excellent care and support Care Homes for Older People Page 13 of 31 Evidence: We spoke to two residents who said that they receive good care. They said that they are able to do a lot of things for themselves but that staff are always available if they need support. The responses in the residents surveys are mixed with regard to whether the staff are available when they need them. The majority answered usually with some stating always and some sometimes. The staff who spoke to us said that they feel that there are enough staff on duty to meet the residents needs. The usual staffing levels are for there to be one nurse on duty and six care staff from 8am to 2pm and then for there to be one nurse and four care staff on duty from 2pm to 8pm. There is one nurse and three care staff on duty overnight. The care staff are not responsible for laundry, cleaning or catering as there are additional staff who are responsible for these tasks. There are several residents who require two staff for mobility and there are also a number of residents who are in bed all the time and others who need assistance at mealtimes. The current staffing levels are ensuring that the residents basic needs are met but staff do not have much time to spend with residents on an individual basis. However, we were told that there are several residents who get up quite early in the morning and who are assisted by the night staff. The night staffs records confirm that residents start to get up from about 6am. It is not clear from discussions with staff about whether this is the residents choice or whether it is to assist the morning staff. The care plans are not clear about issues such as residents choices about getting up and going to bed. The Manager has agreed to carry out a review of this area for all residents and to ensure that the residents have a choice about what time they get up and go to bed. We were shown the medication system by one of the nurses. Medication is stored appropriately and regular audits take place which means that any issues can be identified quickly. There is a record of medication received and that returned. There were some medicines in the cupboard which should have been returned to the pharmacy as they had not been used for some time. The nurse said that she will ensure that this takes place. The guidance for the use of PRN (as required) medication is not detailed enough. It is only the nurses who are responsible for administering medication. As there is only one nurse on duty this means that administering medication can take up to 2.5 hours, particularly in the morning. This means that the nurse is not available for any other tasks at this time and also that some residents are not getting medication at the Care Homes for Older People Page 14 of 31 Evidence: prescribed time. The Manager said that she will review this situation and look at whether two staff should administer medication in the mornings. We spent some time in the lounge and dining room chatting to residents and observing the care provided. The staff were respectful and kind when talking to residents. Two of the residents told us that staff are always polite and kind. However, more care needs to be taken to protect the dignity of female residents when using the hoist. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to take part in a range of meaningful activities and have a say in what is available. The residents dietary needs are met and residents enjoy their meals. Evidence: The Home has employed an activities co-ordinator and she has worked very hard to ensure that the residents have a choice of activities to take part in if they wish to. Discussions with residents and staff as well as a look at the photographs displayed around the Home show that a range of activities take place at the Home. These include fish and chip supper, church services, outing to the coast, cooking pancakes and cakes, music and movement sessions. The activities co-ordinator said that she is developing links with local groups in the community and that the local primary school have come in for different activities such as celebrating Mothers Day. On the day of our visit a group from the local primary school were visiting to take part in an Easter Egg hunt. Residents told us that they really enjoy seeing the children and one resident said that it brightens my day to see the children. Care Homes for Older People Page 16 of 31 Evidence: The activities co-ordinator is developing the use of volunteers so that more residents are able to attend activities away from the Home. For example, residents are supported to attend church services and coffee mornings at the local church. The responses in the residents surveys were positive about the availability of activities. One of the residents told us that they like having the choice about whether they take part in group activities or not. The activities co-ordinator also spends time with individual residents who prefer not to, or are unable to, join in with groups. Records show that at least one resident has individual time where the Activities Co-ordinator reads to her. The co-ordinator has undertaken training in putting together Life Story Books and we could see that this work has started for some of the residents with the involvement of their families. She has also undertaken training about Reminiscence therapy and is currently completing training in Extend so as to be able to provide these exercise sessions to the residents. The co-ordinator is enthusiastic about her role and clearly enjoys enabling residents to take part in meaningful activities. She said that she receives a lot of help and support from the Manager and the care staff. Residents told us that the co-ordinator is good at her job and that she listens to them when they make suggestions about what they would like to do. On a day to day basis the residents are offered choices in a lot of areas but there is a need to ensure that there are enough staff on duty to enable residents to be able to make their own decisions about issues such as what time they get up and go to bed. The Home has a cook and kitchen assistants who provide the meals for the residents. Residents told us that they enjoy the meals and that they are given a choice. One of the residents said that they are always able to have as much food as they want to have. This was confirmed within the residents surveys that we received. Additional comments were made about the food such as: usually very nice home cooked food excellent meals plenty of food available. We spoke to the cook and had a look around the kitchen. The cook said that they receive good information from the Manager about the dietary needs of any new residents and that they are able to meet residents dietary needs. The kitchen was clean and there was no out of date food in the fridge. Food was stored appropriately. In March 2009 the kitchen was awarded a Good Food Hygiene Award from the Environmental Health department. Care Homes for Older People Page 17 of 31 Evidence: We observed part of a mealtime and residents were offered support in a respectful and individual way. However, we did note that one of the residents who was having their meal in their bedroom appeared to need more help than they were given at that time and it is recommended that a review of staffing is carried out to ensure that there are enough staff to assist residents at mealtimes. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home has a complaints procedure which the residents are aware of. Any concerns/complaints are dealt with appropriately by the manager. Training and procedures are in place to protect the residents from abuse. Evidence: The Manager and most of the staff have attended Safeguarding training within the last year. The Manager said that the staff who need updates will be attending in the next few months and that she is planning to attend the Advanced Safeguarding training. Staff who spoke to us confirmed that they had attended Safeguarding training and were confident that the Manager would deal appropriately with any concerns they raised. The Home has a complaints procedure and all of the residents surveys that we received state that they are aware of how to complain. The staff surveys all indicate that they know what to do if someone wants to make a complaint. One of the residents told us that the Manager chats with them regularly and asks them how they are. They also said that they now have residents/relatives meetings at which they are encouraged to bring up any issues. The Manager and Area Manager have worked positively with the Commission and the local Safeguarding team regarding two recent concerns that have been raised with Care Homes for Older People Page 19 of 31 Evidence: them. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides comfortable and attractive accommodation which meets the needs of the residents. Evidence: We were shown around the Home and looked at all of the communal areas as well as some of the bedrooms. A lot of improvements have been made to the accommodation over the last two years and there is an ongoing plan for redecoration to maintain these improvements. Some of the bedroom doors have pictures on to help the residents identify which room is theirs. There are also pictures on some of the bathrooms. The Manager is aware of the need to improve the signage around the Home to assist residents who may be confused find their way around. The bathrooms are the areas that are still in need of some improvements and the Manager said that there are plans in place for this work to be carried out. She said that they will then decorate them to make them more homely and attractive rooms for residents to spend time in. New toilet frames and commodes have been purchased since the last Inspection. The residents have the choice of two lounge/dining rooms to spend their time in as well as their own bedrooms. There are courtyard areas with seating for when the Care Homes for Older People Page 21 of 31 Evidence: weather is nice. The Home has an aviary in one of the courtyard areas which residents told us they like to look at. The residents are encouraged to personalise their bedrooms and the maintenance member of staff is happy to put up shelves and pictures as well if residents wish him to. Notices are on some bedroom doors to warn staff and the resident that there is a trailing wire due to the call bell. There are plans in place to get extensions for these call bells and to ensure that there are no trailing wires. The bedroom doors are heavy and residents are not able to have them open without propping them open. The Manager said that she has ordered door guards so that residents are able to have their doors open safely. We had a discussion with the Area Manager after the visit and he confirmed that these will be delivered the week after our visit and will be fitted immediately. There were no unpleasant smells in the Home and there were good stocks of aprons, gloves and hand gel around the Home. The Home employs domestic and laundry staff on a daily basis. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels currently provided are adequate to meet the basic needs of the residents. Residents feel that the staff are kind and that they provide a good level of care. Appropriate recruitment procedures are followed prior to staff starting work at the Home. Staff are not receiving sufficient training to ensure that they are able to meet the residents needs. Evidence: Discussions with the Manager and staff show that the usual staffing levels are for there to be one nurse and six care staff on duty from 8am to 2pm and one nurse and four care staff on duty from 2pm to 8pm. There is one nurse and three care staff on duty overnight (8pm to 8am). In addition to this there are catering and domestic staff as well as an activities co-ordinator, administrator and the Manager. The organisation has recently introduced a policy of staff working 12 hour shifts but currently staff are doing a mix of these long days and shorter shifts. If staff are working a long day then they are entitled to have breaks which have to be taken into account when planning rotas. Staff are not paid to attend handovers but the Manager said that staff come in early or stay late to ensure that effective handovers take place. Whilst we do not have clear evidence that the staffing levels are not sufficient to meet Care Homes for Older People Page 23 of 31 Evidence: the needs of the residents there are times, such as getting up and going to bed and mealtimes, when it may benefit the residents to have additional staff. It is recommended that the Manager carries out a staffing review to ensure that the staffing levels meet the needs of the residents. The residents surveys all state that the staff listen and act when residents raise issues with them. The responses are mixed with regard to whether there are enough staff with four stating always, seven stating usually and two stating sometimes. Additional comments are made in the surveys such as: happy with the staff at times have to wait to use the commode could not be happier staff are exceptional staff always ready to listen One of the residents told us that there are enough staff to help them if they need help but that they are encouraged to maintain their independence. We observed staff supporting residents in a positive and kind way. During discussions with staff they told us that they feel that the staffing levels are sufficient to meet the needs of the residents. The responses in the staff surveys confirm this and also make reference to the fact that the staff work together well as a team and that there have been improvements in this area since the new Manager started work at the Home. We looked at a selection of recruitment records and these show that appropriate checks are carried out prior to staff starting work at the Home. The Manager said that the staff follow an induction programme that meets the Common Induction Standards. We were given a copy of the training matrix and discussed training with staff and the Manager. There have been problems with the provision of training over the last few months with training being cancelled or not arranged in the first place. However, the Manager said that this has improved recently and that she is confident that staff will receive appropriate training. At the last Inspection a requirement was made for training to be provided with regard to individual residents needs and whilst some training has been provided, such as diabetes, this requirement has not been met and will be repeated in this report. In particular there is a need for all staff, including the Manager, to attend relevant training with regard to Dementia. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home is well managed by an enthusiastic and knowledgeable Manager who provides good leadership. The health and safety of the staff and residents is protected. Evidence: The Manager was appointed in June 2008 and completed the registration process with the Commission in March 2009. The Manager is a qualified nurse and knew the Home prior to starting work there as she had previously been a District Nurse providing a nursing service to the Home. The Manager intends to start the appropriate Managers Award in the next few months. She is also aware of the need to attend additional training such as Dementia Care, Mental Capacity Act and Deprivation of Liberty. The responses from residents and staff about the Manager and her style of leadership have all been very positive. Within the surveys and in our discussions with staff and residents we were told the following comments: outstanding new manager manager is very approachable, listens and I feel at ease with her everything is working so Care Homes for Older People Page 25 of 31 Evidence: much better this year I get excellent backing from the manager Manager is enthusiastic and easy to talk to The Manager receives regular support from the Area Manager who visits at least monthly and carries out the Regulation 26 visits and provides a report following these. The Manager also meets with the other managers within the organisation on a regular basis. The previous deputy manager left the Home in January 2009 and a new deputy has been appointed who started work at the Home the day before our visit. She is a qualified nurse and will be working some shifts as part of the staffing rota and also having some time to carry out management tasks. The Manager said that whilst there has not been a deputy that it has been hard to carry out the formal supervisions for staff. However, there is a plan for these to start again now that the deputy has started work. Staff confirmed this but did also say that they had felt that they could talk to the Manager at any time if they had wanted to. The Manager had completed the AQAA in a detailed way which showed a good understanding of the improvements that have been made and those which are still needed. The organisation has a detailed system in place for the regular auditing of the service provided. The Manager and other staff have recently completed a full audit of the Home and the Manager now needs to collate the responses and put together an action plan resulting from this. We looked at notes of staff meetings and residents meetings and could see that action is taken to address issues that are raised. Staff and residents told us that they feel that they are listened to. We looked at a selection of records relating to health and safety. The maintenance member of staff is responsible for maintaining the majority of these and it is clear that regular maintenance and servicing takes place of equipment. Action is taken to address any problems that are identified. As previously mentioned, action has been taken to address the problem of trailing wires and the heavy fire doors both in the short term to protect residents safety and to solve the problems. We spoke to the administrator and looked at records relating to the arrangements in place for looking after money for one of the residents. Clear records are kept and there are financial care plans in place for the residents. Care Homes for Older People Page 26 of 31 Care Homes for Older People Page 27 of 31 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 30 18 (c)(i) Staff must receive training in 30/09/2008 subjects relevant to the needs of the residents to ensure that staff are able to meet the residents needs Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 It is required that clear written guidance is available for the use of PRN medication To ensure that the resident receives the medication at an appropriate time 22/05/2009 2 9 13 It is required that medication that is no longer needed is disposed of in a timely way To reduce the possibility of errors occurring 22/05/2009 3 30 18 It is required that staff receive training about individual residents needs, including dementia care To ensure that the staff team have suitable training to enable them to meet residents needs 31/08/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 29 of 31 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 It is recommended that a review of staffing is undertaken to ensure that enough staff are on duty to meet the needs of the residents at all times It is recommended that more than one member of staff is responsible for administering medication in the morning to ensure that residents receive their medication at the prescribed time. It is recommended that a review of staffing is undertaken to ensure that the residents all receive appropriate support at mealtimes. It is recommended that the signage around the Home is improved to assist those residents who may be confused. 2 9 3 15 4 24 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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