Inspection on 26/01/09 for Fremington Manor

This inspection was carried out on 26th January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fremington Manor 15/01/07

Fremington Manor 20/12/05

Fremington Manor 30/06/05

Fremington Manor 09/02/05

Fremington Manor 23/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fremington Manor Fremington Manor Fremington Manor Fremington Barnstaple Devon EX31 2NX     The quality rating for this care home is:   three star excellent 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: Jane Gurnell     Date: 2 6 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 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Fremington Manor Fremington Manor Fremington Manor Fremington Barnstaple Devon EX31 2NX 01271377990 01271859067 fremingtonmanor@medscape.com 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) : Two Rivers Investments Ltd care home 70 Number of places (if applicable): Under 65 Over 65 21 70 21 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 Registered for 21 in the categories OP, MD[E] and PD [E] for residential care Registered for 50 in the category OP for Nursing Care Date of last inspection Brief description of the care home Fremington Manor is a large house set in extensive grounds; care has been provided here since 1985. The original building has been converted for use as a care home and a large purpose built extension has been added. The home is registered to care for 70 residents. The registration categories cover people requiring nursing care and older residents with mental health or physical disability needs. There are Registered Nurses on duty throughout the day and night. There are 39 single rooms within the home, 23 of which have en-suite facilities. There are 15 double bedrooms, 10 of which have enCare Homes for Older People Page 4 of 31 Brief description of the care home suite facilities. The home has completed work to extend the accommodation to Benedict wing by adding 4 en-suite double rooms, which would be used for married couples or others wishing to share, or people wishing to enjoy a larger living space. Local shops are within walking distance and a regular bus service runs to and from the local town of Barnstaple. Respite care is available. The average cost of care ranges from 322.00 to 760.00 pounds per week, depending on individual needs. Comprehensive fee levels are available in the home. Additional costs, not covered in the fees, include chiropody, hairdressing, dry cleaning and personal items such as toiletries and newspapers. Current information about the service, including CSCI reports, is available to prospective and current residents. 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: three star excellent 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 previous inspection of Fremington Manor was undertaken on 15th January 2007 when the home was judged as providing good outcomes to the people living in the home. This unannounced inspection took one day to complete and was undertaken on 26th January 2009 between 09:45am and 4:30 pm. There were 57 people living at the home at the time of the inspection. In order to understand the experiences of people using this service, we looked closely at the care planned and delivered to seven people. During the course of the day we met with a number of people living in the home and spoke with 15 in some depth Care Homes for Older People Page 6 of 31 about life at the home, as well as four visitors. Time was also spent observing the care and attention given to people by staff. Twelve staff members were spoken with including the Registered Manager, 3 nurses, 5 care staff, the Recreational Therapist, and housekeeping and catering staff. As part of the inspection we sent surveys to people living in the home for them to complete with the help of their relatives, staff and health and social care professionals asking them their views about the service provided at the home. We toured the premises and inspected a number of records including peoples assessments and care plans and records relating to medication, recruitment and health and safety. Prior to the inspection the Registered Manager had completed an Annual Quality Assurance Assessment, which is a document that provides general information about the home and details what has improved over the last 12 months as well as future development plans. The Registered Provider was available during the inspection and he as well as the Registered Manager were keen to ensure that the home continues to maintain good standards of care. What the care home does well: What has improved since the last inspection? The home has a new Registered Manager since the previous inspection. Ms Topps Care Homes for Older People Page 8 of 31 registered with the commission to manage the home in March 2008. Ms Topps has worked at the home for approximately 9 years and has an open management style: both people living in the home and staff reported a more inclusive style of management. Ms Topps has addressed the requirements made at the previous inspection including those relating to the admission process, ensuring that people whose needs cannot be met are not admitted to the home. Medication practices have been reviewed to ensure the reason for medicines that are given when needed are recorded and that all prescribed medications are available within the home. The Recreational Therapist has consulted with people regarding their social interests and hobbies and has developed an activity programme to provide both group and individual activities. The doors to bedrooms where people prefer to have the door open have been fitted with hold open devices that close in response to the fire alarm, thus providing safer fire protection and reducing the risk of smoke inhalation. Cleaning materials are safely stored in a locked cupboard thus reducing access to these potentially harmful chemicals. A number of recommendations for good practice were also made it the previous inspection and all of these have been addressed by the Registered Manager. These include providing all people living at home with either a contract or a copy of the terms and conditions of residency: completing the preadmission assessment more comprehensively: reviewing the information held in the care plans, although there are still some further improvements recommended: involving family and health care professionals in decision-making with regards to risk management, and providing individual and group supervision for staff team to monitor their performance and identify their training and development needs. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 9 of 31 240 7535. Care Homes for Older People Page 10 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 11 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. Prospective residents and their relatives have access to detailed information about the home to help them make an informed decision about whether the home is right for them. The assessment and admission process is generally well managed to ensure that the home can meet peoples needs. Evidence: People living at Fremington Manor said they had received enough information about the home before moving in so they could decide if it was the right place for them. The homes Statement of Purpose is very detailed and gives people a good idea of the services available at the home. Copies of the Statement of Purpose and the latest CSCI report are kept in reception and are freely available. The Registered Manager confirmed that all people living in the home receive either a contract, if privately funded, or a copy of the homes terms and conditions if funded by Care Homes for Older People Page 12 of 31 Evidence: the local authority, to ensure people understand their rights. Seven care files were looked at. All files held copies of a pre-admission assessment containing information relating to the persons needs. A further assessment is completed upon admission and this gave further details of specific care needs. Information was also obtained where possible from relatives as well as other health care professionals responsible for the persons care prior to their admission. Where possible, the Registered Manager or the Deputy Manager visit people considering moving to Fremington Manor to talk about their individual needs and give information about the home: this was confirmed by several of the people spoken with. If the person is admitted from outside of the county or the admission is of an urgent nature, the home will gather information over the phone from relatives and other professionals. Care Homes for Older People Page 13 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. There are systems in place for informing staff about peoples care needs, although a lack of detail in some care plans may lead to inconsistencies in care and a risk that some people may not receive all the care they need in their preferred way. Peoples dignity and privacy is respected by staff and is generally well supported by good care practice. Evidence: Fifteen people living in the home responding with surveys said they always received the care and support they needed and four said they usually receive the support required. Those people spoken with at the visit to the home told us they were happy with the care provided. Comments included, staff are very good to me and understanding, the care is fantastic, very pleased and I am happy with all care at Fremington Manor. We spoke with four relatives, all of whom were all satisfied with the overall care, as were three health and social care professionals who had given us their views through Care Homes for Older People Page 14 of 31 Evidence: the surveys. Seven care plans were looked at to check how care is planned and delivered. The home uses a pre-typed template to identify certain needs and adds to these the needs specific to each person. Five care plan included good details about the persons complex care needs and the action required by staff to meet these needs. Two however were found not to be so detailed. For example, one care plan said the person needed aids to walk but did not give details of what these were or how far the person could walk. Another said the person required help with personal care but gave no details of what the person could do for themselves and in what way staff should offer assistance. Information was available in other documents such as the assessments regarding pressure area care, nutrition, moving and handling and the risk of falls. The Registered Manager was advised to ensure all assessed needs were written in the care plan to avoid inconsistencies in support. The care plans and the assessments had been reviewed regularly and had evidence of changes. Not all of the care plans showed the involvement of the person who the plan was about or their family although those people spoken with said they had been asked about their care needs and preferences. The staff on duty had a good understanding of peoples needs and were seen to interact with people in a respectful and friendly manner. Staff were heard to use peoples preferred names and were attentive and sensitive to peoples needs and requests. Staff were seen to knock on bedroom doors before entering, maintaining privacy. Staff use care in progress signs on doors to promote privacy and dignity during care giving. Sixteen people returning a survey said they always and three people said they usually receive the medical support they required. One relative told us Dads care has been exceptional. One health care professional responding with a survey was very satisfied with the overall standard of care at the home, saying it was excellent and felt that staff communicated clearly and understood peoples needs. The home has a close relationship with local surgeries and there are regular GP rounds. People have access to other health care professionals and services such as palliative care nurse specialist, optician, dentist, and chiropodist and out patient services. Records showed that staff take appropriate action and were observant to peoples health needs, calling the GP promptly. Sample tests and results were clear and acted upon. The medication system was inspected. Only registered nurses administer medication within the home. There were good assessments relating to self-medicating and two people newly admitted to the home have chosen to do this at present. Medication received by the home is recorded appropriately and storage facilities are Care Homes for Older People Page 15 of 31 Evidence: secure, including those for controlled drugs. Medicine Administration Records (MAR) were looked at and were found to be accurately completed. Where medicine had been administered as needed the reason for this was recorded on the MAR and in the persons care evaluation notes. Care Homes for Older People Page 16 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Leisure and social activities are well planned and include people who need staff support to participate. Family and friends are always welcome ensuring that people have supportive relationships. People are enabled to express their wishes and make decisions. A balanced and varied diet is provided which takes into account peoples dietary needs and preferences. Evidence: The home employs an Occupational Therapist as a Recreational Therapist. Notice boards hold details of the daily planned activities as does the monthly newsletter. Activities include craft classes, movie afternoons, bingo and quizzes, visits from Pets as Therapy and an exercise and relaxation sessions. Coffee mornings are regularly held and a monthly communion is available. The home also organises external entertainers such as musicians and has an annual garden fete and dog show. Fifteen people returning a survey said there were always or usually social activities arranged by the home for them to participate in: three people said sometimes. The home is commended for employing a member of staff with responsibility to provide Care Homes for Older People Page 17 of 31 Evidence: meaningful and stimulating activities for people who may be at risk of isolation due to their ill health or confusion. The care plan evaluation records contained details of the Recreational Therapists consultation with people about their hobbies and interests as well as their involvement with planned group and individual activities. For example, one person had said of his interest in bird watching and a bird table had been placed outside his bedroom window and staff were instructed to feed the birds to encourage them to use the table. Throughout the day staff were seen to be interacting with people, playing games, in conversation or providing hand massages for those people who were being nursed in bed. These activities, being spontaneous, were not always recorded in the persons care notes. The Registered Manager was advised to record all of these activities to demonstrate the good practice within the home especially for those people who are prone to isolation due to their poor health. All relatives spoken with said they felt welcome at the home and all said they were kept informed of important matters concerning their relative. One relative said very reassuring and helpful too when Dad had a mini-stroke and had to go into hospital. Several relatives and friends were seen to visit people throughout the day and four were spoken with. One said, I can come and go at any time, another said that she spends the day at the home and feels part of the team. Staff offered them tea and coffee. All 19 people responding with surveys felt staff listened and acted on what they said, one person said the staff are very good, another said there is always prompt follow up to any requests or information given. People were given choice throughout the day and all said that they were able to choose when they got up or went to bed. Meal provision was generally very good and comments and surveys from people showed that the majority always or usually liked the meals served at the home. On the day of the visit to the home, the lunch-time meal was a choice of fish and chips or hotpot, vegetables and potatoes, as well as a milk pudding or fruit and shortbread for dessert. Alternatives were available and people were seen to have soup and sandwiches or eggs. People confirmed that could ask for snacks and drinks at any time, including during the night. The chef sees people each morning and asks them about supper and the next days lunch. Hot choices are available for supper and on the day of the inspection it was sausages but the chef confirmed people could have whatever they wanted. There are three dining rooms at the home, including one designated for people who require support throughout mealtimes. Meals were well presented and served in Care Homes for Older People Page 18 of 31 Evidence: congenial surroundings with lovely laid up tables with condiments and drinks. Staff knew peoples likes and dislikes and were attentive. People requiring assistance were helped in a discrete and sensitive way. There was lots of chat and laughter during lunchtime and it was obvious that mealtimes offered a good opportunity to socialise. Care Homes for Older People Page 19 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 satisfactory complaints process with evidence that complaints are listened to and acted upon. Staff understand the principles of adult protection and procedures are in place, which helps to protect people from abuse. Evidence: The Commission has not received any complaints about the home since the last inspection. The home has received twelve complaints over the past 24 months, none of a serious nature, and the investigations into these were looked at. It was evident that peoples concerns were taken seriously and the records demonstrated the Registered Managers actions to resolve the matter and a follow up by her every week for 4 weeks to make sure the person was still satisfied. People spoken with and those responding with surveys knew who to speak with should they have any concerns or complaints. The home has a comprehensive complaints system using a format, which the complainant can fill out in detail. All staff can access the forms, which are then passed to the Registered Manager to action. There are clear timescales and complaints are well managed. Relatives felt that they could talk to any member of staff. People said they felt well cared, describing staff as friendly, kind, lovely and polite. Suggestion cards were available in the main entrance way to allow them to make their views known to the Registered Manager, anonymously if Care Homes for Older People Page 20 of 31 Evidence: preferred. All staff spoken with and those responding with surveys were aware of the Protection of Vulnerable Adults procedure. Records show that staff, including kitchen staff and domestics received adult protection training to ensure people are safeguarded. Staff spoken with were aware of their responsibility to raise any concerns about peoples welfare. The Registered Manager was aware of the local authoritys procedure with regard to the protection of vulnerable adults and she and another senior member of staff had attended the train the trainer programme enabling them to provide this training to the staff team. Care Homes for Older People Page 21 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. Fremington Manor provides a good standard of accommodation that is attractive, clean, homely and well maintained. Evidence: Everyone spoken with was happy with the accommodation provided. Many of the bedrooms were very spacious and all were tastefully decorated with furniture provided by the home or the persons own furniture and personal items. The gardens around the home are accessible and in inclement weather the conservatory offers a comfortable area to look over the garden and watch the squirrels, rabbits and birds. A fountain and raised flower beds also provide interest for people. The home is lovely and warm and provides people with several spacious communal areas, giving the impression of living in a much smaller home that the registration of 70 beds would imply. The rooms in the older part of the manor house were very impressive with tall ceilings, large floor to ceiling windows and carved wooden paneling and fire places. Several people were seen to be enjoying watching the television sitting by the open fire. There is lots of space and people using electric chairs can move around easily. Call bells were available in the communal areas on long leads to ensure people can alert staff to their needs. Care Homes for Older People Page 22 of 31 Evidence: The home is generally well maintained inside and out; with a full time maintenance person employed and records of planned and routine maintenance are kept. There were fresh flowers around the home and all areas were clean and hygienic. People said the home was always or usually fresh and clean. The laundry service was very good with peoples property being returned in individualised boxes to their rooms. The home deals with clinical waste appropriately and there were adequate hand washing facilities and protective gloves and aprons were available to maintain infection control standards. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are generally sufficient to ensure that peoples needs are met in a timely way. People are supported by skilled, experienced and friendly staff who have been recruited robustly in order to protect their welfare. Evidence: People were very complementary about the staff team, comments included, easily the best care home, the staff are lovely, really nice and as soon as I ring the bell the staff are there to see me. People said the staff were always or usually available when needed. The Registered Manager and staff felt that generally staffing levels were good. At the time of the inspection there were 2 nurses and 12 care staff on duty for 57 people. The Registered Manager said there were 2 nurses on throughout the day and night with 12 care staff in the mornings, 8 care staff in the evenings and 4 care staff during the night. These numbers do not include the Registered Manager and her deputy when on duty. Staff are supported by administration, catering, domestic and laundry staff throughout the day allowing them to concentrate on caring for people. Five staff recruitment files were looked at, including one for a nurse, one from an overseas member of staff and one for a newly recruited care staff. These were clear Care Homes for Older People Page 24 of 31 Evidence: and contained all the required documentation including satisfactory police checks. Appropriate action had been taken by management to address any disciplinary issues and the Registered Manager also took into account staff welfare. Staff said they feel very well supported in their role and could talk to any of the nurses, managers and the owner at any time. People living in the home, their relatives and health professionals were confident that staff had a good understanding of individual needs. All of the care staff had either obtained a National Vocational Qualification, a nationally recognised qualification in care or were in training. Various training has been undertaken since the last inspection including mandatory training in fire safety, moving and handling and infection control as well as other relevant training included adult protection, the Mental Health Act and dementia. The Registered Manager confirmed the home obtained training from the local college to supplement the training provided in-house. Staff felt that they could access appropriate training as they wished and the majority felt that they had the necessary support to do their job well. Staff have also attended a pressure care workshop. All staff said they had received induction training to help them understand how to work safely and respectfully. Staff meetings with the Registered Manager are held every two months to talk about the management of the home and staff receive individual supervision from either the Registered Manager or Deputy Manager allowing them to discuss their own training and development needs as well as their work performance. Care Homes for Older People Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fremington Manor is a well managed home. The Registered Manager and her staff team as a whole strive to provide a safe and stimulating home for people that meets their needs in comfort and to their satisfaction. Evidence: The Manager registered with the Commission in March 2008: she is a registered nurse and has worked at the home for many years. Since taking up this senior post, the Registered Manager has undertaken a full audit of the services provided within the home and identified an action plan to improve services further. She was able to describe a clear vision for developing the home, creating a more person-centred, individualised service to people. The Registered Manager is commended for looking critically at the services provided ensuring they meet the needs of the people living in the home in the manner they wish and not in response to maintaining routines that may make staffing easier. Care Homes for Older People Page 26 of 31 Evidence: The Registered Manager and other registered nurses keep their clinical practice up to date by attending training days relating to specific nursing issues and by keeping upto-date with changes in practice through journals and the Internet. All the staff spoken with or who returned a survey expressed their confidence in the management of the home. The Registered Manager goes around the home every morning with the morning papers and post, saying hello to people. People said they enjoy this and it ensures she keeps up to date with daily needs, as well as observing staff going about their duties. The home has a quality assurance system, which uses a questionnaire to enable people living in the home, relatives and professionals to have their say about how well the home is performing and what improvements could be considered. The results of the most recent questionnaire were available and showed a high level of satisfaction. The Registered Manager had summarised the findings and had produced an action plan for future improvements and developments. Many people use the homes safe to keep their personal money and valuables. A random sample of these were looked at and records were accurate. The administrator checks each persons balance and expenditure each week to ensure there are no mistakes. There is a petty cash system should someone not have any funds at any time. Lockable storage is provided in bedrooms. Fire safety appears to be generally well managed; the fire log showed that equipment was regularly checked and serviced to ensure it is maintained in good working order. Aids and moving and handling equipment were in evidence throughout the home and in peoples bedrooms and the hoists showed evidence of recent servicing. Infection control practices were found to be satisfactory with gloves and aprons available throughout the home. One of the registered nurses hold the position of Infection Control Link Nurse and as such meets with other nurses in the community to ensure best practice within the home. He also provides regular training for staff. A visit by an environmental health officer in February 2008 found standards satisfactory within the home and identified the kitchen as performing to a very high standard awarding 5 stars, their highest rating. The maintenance person carries out a regular tour of the building to check for health and safety hazards and also undertakes redecoration when needed. Windows have secure restrictors in place and radiators are covered to reduce any risk to people. Care Homes for Older People Page 27 of 31 Evidence: A range of servicing and maintenance records was seen at this inspection; all were satisfactory including the electrical report for the homes wiring and also for electrical equipment in everyday use, and landlords gas safety certificate. Care Homes for Older People Page 28 of 31 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 29 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 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 7 Care plans should contain all the information identified through the assessment process relating to peoples needs and also detail the action required by staff to meet these needs. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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