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Inspection on 13/08/09 for Holmwood Care Centre

Also see our care home review for Holmwood Care Centre for more information

This inspection was carried out on 13th August 2009.

CQC found this care home to be providing an Good 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.

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 atmosphere of the home is friendly, warm and welcoming. People using the service appear relaxed and were seen interacting well with all the staff. Choices of meals are offered and food is well presented. The home can cater for special diets, including individual preferences, dietary and cultural needs which, means people should receive food that they like. Accommodation for people is on three floors and a passenger lift assists people with mobility problems to access all areas of the home. People are encouraged to personalise their rooms with items that are familiar to them so it allows them to place their own identity on it. There is a committed staff team some of whom have worked at the home for many years. This means that people know the staff who are looking after them.

What has improved since the last inspection?

Since the last inspection the service have made improvements to the home, upgrading lounges, bedrooms and corridors which have improved the appearance and the comfort for people living in the home. People using the service are more involved with the development of their care records, providing the staff more information about the individuals wishes. People are able to have a telephone line fitted to their bedroom if they chose to, which helps them maintain contact with family and friends.

What the care home could do better:

They could review the staffing skill mix in respect of registered nursing provision. Given the size and layout of the home, the number and dependency levels of people receiving nursing care a review is necessary to ensure that their health care needs can be met at all times. It is recommended that the arrangements for domestic and laundry cover is reviewed to ensure there is sufficient cover and staffing levels do not reduce the home`s ability to deliver direct care. A review of the activities available in the home should be undertaken especially for the more dependent people.

Key inspection report Care homes for older people Name: Address: Holmwood Care Centre 25 Comberton Road Kidderminster Worcestershire DY10 3DJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christine Potter     Date: 1 3 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Holmwood Care Centre 25 Comberton Road Kidderminster Worcestershire DY10 3DJ 01562824496 01562822935 admin@holmwood.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Cloud Care Plc Name of registered manager (if applicable) Mrs Gail Elizabeth Gilbert Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: Accommodation to be used for a maximum of 45 nursing places. Category PD is restricted to persons aged between 55 -64 years. The home may accommodate one named service user over the age of 50 years with learning disability (LD). Date of last inspection Brief description of the care home Holmwood Care Centre is a 60-bedded care home situated a short distance from the centre of Kidderminster. The home has 56 single rooms with many offering en-suite facilities, the service can also accommodate people who wish to share a room. Care Homes for Older People Page 4 of 29 0 0 0 5 Over 65 40 1 60 60 Brief description of the care home Accommodation is provided on three floors with a passenger lift providing access to rooms on the upper floors. Other areas of the home used by people include, lounges, dining room, toilets and bathrooms. Handrails are appropriately fitted to assist people to walk around the home. Ramps are fitted to assist people in wheelchairs to go outside to the enclosed garden. The registered manager for the home is Mrs Gail Gilbert who is a first level registered nurse and many years experience working in care for the elderly. Gail has completed the Registered Managers Award. The home is owned by St Cloud Care PLC and the providers takes an active role in the home and the people who liove there. A range of activities are provided for the people living at the home and assist people to maintain links with the local community. Information about the fees are not included in the Service User Guide, for up to date information about the fees please contact the home direct as the fees are based on individual needs and assessments. Additional charges are made for hairdressing, daily newspapers and chiropody. 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: 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: The quality rating for this service is 2 star. That means the people who use the service experience good outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for the people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. We visited the service during the day on the 6th August 2009. The last Key inspection was on the 18/07/2007 and this rated the home as good. We did an annual service review in August 2008. During this inspection we spent time observing daily life, and we met with people and Care Homes for Older People Page 6 of 29 relatives who use the service. We spoke to the manager, and many staff who were present on the day of the inspection. We looked at care files and records completed by the service which must be kept by the home to show that it is being run properly. Before we visited the service we looked at the information we had about the service since the last inspection. This included an annual service review, surveys sent to us by people using the service and the Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment is completed by the manager and informs us how well the home think they are performing and provides us some information about the home, staff and people who live there, improvements and plans for improvement which we would take into consideration. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 Care Homes for Older People Page 8 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sufficient information available for people to decide whether Holmwood Care Centre is right for them. There are opportunities for people to visit the home before making up their minds. The home carries out assessments of peoples needs before they move in, so that staff can provide the care that is needed. Evidence: The home provides written information in the form of a Service User Guide to help people decide whether they wish to live at Holmwood Care Centre. One person told us that they had received the information and came to visit the home prior to moving into the home. We saw copies of the Service Users Guide in the reception area of the home, and in the residents bedrooms. The home have the ability to have the documents translated and made available in other formats including large print, and audio. The Statement of Purpose, Service User Guide and a copy of the homes inspection report are available in the reception area of the home. The Annual Quality Assurance Assessment received from the home informed us of their plans to improve Care Homes for Older People Page 11 of 29 Evidence: the information available for people and this included adding information about the home from the current residents and including more photographs in the Service Users Guide. We looked at the pre admission assessments for three people who had recently moved into the home. The assessments provided sufficient information for the service to decide whether they would be able to meet the persons needs if they chose to move into the home. People using the service and relatives confirmed that the manager had visited and assessed their relative prior to them being admitted to the home. We received six completed surveys from people using the service who confirmed that they had received enough information about the service. One person rated the home as excellent. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The last inspection report rated these standards as good. The Annual Quality Assurance Assessment received from the home for this inspection provided us with some good examples of how a number of people had improved following their admission to Holmwood. We looked at three peoples care records in detail and these showed that each person had an individual plan of care. They showed that personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each persons records. The care plans incorporate various problems for the person under one heading which can be confusing, given that they do not clearly evaluate all the problems. For example one care plan included under mobility, pain and personal care, but the evaluation only referred to mobility. It was recommended that staff clearly evaluate each assessed need for the individual more clearly. Three staff spoken with during the Care Homes for Older People Page 13 of 29 Evidence: inspection were able to demonstrate the care needs of the people who were being case tracked. Staffs only wish was that they had more time to sit and talk to people. Peoples privacy was seen to be maintained by the staff, they were knocking on doors before entering and speaking to people courteously. Residents and relatives confirmed that all staff respects their privacy and dignity. Staff meet the individual needs of the residents well, dignity and privacy are always maintained. Everyone appeared contented during the inspection and were seen enjoying the activities, visits from family, watching television and reading newspapers. There was a friendly relaxed atmosphere throughout the home, and all staff were polite and courteous. Staff told us that they were provided with sufficient information about the residents care needs to enable them to look after them. They also confirmed that they were given time to look at the residents care records for additional information about any health needed. The home has good procedures in place for the management of medication. Medication is stored safely, and accurate record keeping enables the home to know which medications have been given and at what times. We looked at three peoples medication records and they had been completed by the nurse and senior carer responsible for administering the medication. The manager completes a monthly audit of the medication system and these records were looked at and support the opinion that nurses and senior carers are adhering to the homes medication policy. A good range of specialist equipment is available to assist the staff in meeting the health and personal care needs of the people. A good range of pressure relieving equipment is available, and recorded in the health care needs assessment. Staff told us that the home had sufficient pressure relieving equipment to care for the residents prone to skin pressure damage The Annual Quality Assurance Assessment received from the home told us of their improvements in the last 12 months which included: The care plans are written to enable person centred care. Monthly audits of the care plans are assisting to maintain the information documented in them. They have purchased equipment to assist the home to provide symptom free terminal care as required for people. All Nurses have completed annual update on medication training. Care Homes for Older People Page 14 of 29 Evidence: The homes plans for improvements for the next 12 months include; to carry on to develop the care plans We will continue to enable residents to become more independent. We would like to develop a service where we can offer a comfortable environment for relatives to stay when they are visiting from long distances or staying over with residents who are unwell. 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. Improvements have been made and the service is starting to support people to keep up their interests and activities and to be part of their local community. People are able to keep in touch with family, friends and representatives. They have nutritious and attractive meals and snacks, at a time and place to suit them. Evidence: The home employs a designated activities person for 16 hours a week generally spending time in the home Monday to Friday. Holmwood provides a limited range of activities for people living in the home, including external entertainers and bingo, along with a cinema room in which people can watch films. Some people attend day centres in the week. On entering the home appropriate music was being played in the reception area and one person was singing contentedly. The home provides flat screen televisions in the lounges for people to watch. The home has an attractive sensory garden for people to use when the weather permits. Photographs were displayed around the home of various activities which the home has provided for the people living there. The homes fete was being held on the Saturday following the inspection and the manager was pleased with the response from staff and relatives in providing goods for Care Homes for Older People Page 16 of 29 Evidence: the fete. We were told that money raised from the fete will be put towards activities and social stimulation for the people living in the home. A hairdresser visits the home once a week for people wishing to have their hair styled in a way that they prefer. The manager told us that some people choose to have their own hairdresser visit the home to style their hairs. Comments received from people using the service and staff about activities included: Wish we had more activities at the weekends it can be boring at the weekends, it would be nice to have more activities for the more dependant residents in the nursing unit and if we had our own transport we could take people out more. To assist with the planning of a varied program of activities information is included in each individuals care records on admission to the home. Staff told us that the information was respected which included preferences for times of going to bed and getting up. There is an open visiting policy which means that people can see their visitors as they choose and maintain relationships that are important to them. A new chef has been employed since our last visit. The home has a four weekly rotating menu, which offers full cooked breakfast, two hot choices at lunchtime, and a hot and cold choice at tea time. Snacks and refreshments are available throughout the day. The menu provides varied well balanced meals for the residents and caters for cultural and dietary needs. We saw that people had chosen a variety of foods at lunchtime including Lancashire hotpot, savoury jacket potatoes or various options. The food was nicely presented and staff were observed to assist people discreetly. The chef told us that they used all fresh fruit and vegetables, and the owners were currently reviewing the catering budget for the home. The comments received about the food included: the food is excellent, improved with the new cook and we can have what we like. The Annual Quality Assurance Assessment received from the home provided us with clear information. Holmwoods planned improvements for the next 12 months included: Start a residents forum group which would meet regularly to plan activities and discuss problems arising in the home. Provide more residents access clubs and activities in the community. Encourage our residents to participate in a gardening club in the sensory garden. 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 who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. They are protected from abuse, and have their rights protected. Evidence: In the last 12 months the home has received six complaints, of which four were upheld and led to improvements in the care standards. The service responds to complaints and refers incidents to other authorities as appropriate. People using the service and relatives told us they were aware of the complaints procedure, including how to complain to the Care Quality Commission by way of information provided by the home, e.g. the Service Users Guide and notices displayed in the homes reception area. Records demonstrated complaints are investigated by the manager, discussed with the owner and responded to within given timescales. A review of the current accident book showed no occurrences, or trends, in the nature and type of reported accidents, which would cause concern. The homes thorough approach to the prevention and management of incidents, such as falls, was evident through crosschecking with the individual documentation. These showed people recorded as having had falls, had all been risk assessed with regard to their mobility and potential for falling. The home operates an open door policy to allow residents and Care Homes for Older People Page 18 of 29 Evidence: visitors to voice their concerns at any time. Residents and relatives confirmed to us they would have no hesitation in raising concerns they might have. We had discussions with four staff, all of whom were able to describe the action they should take if they were in receipt of a complaint, or observed abuse of a resident. Training records confirmed they had all received relevant adult protection training. The manager confirmed that they had attended Deprivation of Liberty training with the senior staff and had a good understanding of the process. The Annual Quality Assurance Assessment advised us of the homes planned improvements in the next 12 months which include raising the standards of care and documentation to reduce the incidence of complaints. 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. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment. Evidence: Holmwood Care Centre is a large detached home providing accommodation for up to 60 people in single bedrooms. The accommodation is on three levels with a passenger lift to assist residents with mobility problems to access all areas of the home. The manager informed us that the lift is scheduled for replacement in the next few months. The home provides three large lounges and a dining room which are decorated and furnished to a high standard with flat screen televisions. There are quiet sitting areas for the residents and their visitors to use. It has specially designed bathing facilities and equipment to assist in meeting the health care needs of residents. There is good provision of specialist equipment, consistent with meeting the assessed care needs of individuals, and the demands of tasks carried out by care staff. It is recommended that when the lift is replaced that a hoist is provided for use on the third floor. At the moment staff use the hoist from the other floors. The Annual Quality Assurance Assessment told us that during the last 12 months the home has continued with their program of refurbishment, which includes both the main lounges, many bedrooms, with new furnishings, chairs and carpets. The corridors were in the process of being redecorated. Care Homes for Older People Page 20 of 29 Evidence: We looked at some peoples bedrooms and these were found to be personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. One person said, I have everything I need. The home have developed an attractive sensory garden for people to use when the weather permits and people were sitting outside at various times throughout the day. Generally all areas of the home were clean. Some carpets were badly stained and the manager told us that these were in the process of being replaced. However it was recommended that given the size of the home and the number of people being accommodated that the domestic hours for cleaning and laundry were reviewed. At the weekends there is only one cleaner covering which could have limitations for the residents if the care hours are used for general cleaning duties. Infection control is well managed, staff were seen wearing protective clothing, and hand cleanser was available throughout the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained and competent to provide the care that people need. However the skill mix should be consistent for the seven days to ensure that peoples care needs are not compromised at certain times. Evidence: At the time of the inspection the home was accommodating 58 people of which 39 people were assessed for nursing care and 19 for residential care. A review of recent duty rosters was completed during the inspection. It was evidenced that one registered nurse works between the two floors, and when the manager is not on duty, this leaves only one nurse in the building. Given the size and layout of the home and the number and dependency of the people this could result in peoples health care needs not being fully met. The nurse told us that when they are on their own, medication can be administered late if they have an emergency or a visitor or doctor arrives. We were told that they dont have sufficient time to complete the documentation that is required of them. To ensure that the care needs of people are not compromised the staffing levels and skill mix should be reviewed. All staff spoken to acknowledged that they are provided with sufficient information about the residents and have regular hand overs where any changes in the residents are reported. Staff were able to demonstrate a good understanding of the individual and their care needs. A review of files relating to the three most recently employed staff demonstrated Care Homes for Older People Page 22 of 29 Evidence: recruitment practices to be satisfactory, with all elements required by the Care Homes Regulations being completed, and evidence retained on file. Staff told us that they had been recruited properly and provided with induction training. The home has a training matrix and this showed ongoing training in many areas such as pressure care [sore skin], challenging behaviour, dementia awareness, first aid, fire safety, food hygiene, moving and handling, control of substances hazardous to health [COSHH], abuse, infection control and nutrition. The matrix clearly identified where staff required updates. Staff complete an initial induction into the home and work with another member of staff for two or three shifts before they are allowed to work independently. This training should ensure that staff have the knowledge and skills to meet peoples needs. 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 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 Holmwood can be confident that the management and administration of the home is based on openness and respect, and effective quality assurance systems have been developed and used by a competent manager. Evidence: The manager has been in post for 12 months. She is a first level registered nurse and completed the management qualification. She has many years experience working in care homes and told us that she has settled well at Holmwood, and found everyone helpful and supportive. People who live at the home knew who the manager was and told us that she went to talk to them. Relatives told us that she was very good and one member of staff told us that she was very supportive and always approachable if advice was requested. A senior manager from the organisation visits the home and provides support as required. The service has a number of audits in place to monitor the service provision. Care Homes for Older People Page 24 of 29 Evidence: Various staff meetings are held and minutes of these were available for us to see. These meetings give staff the opportunity to discuss any concerns or ideas they may have. The home employs a maintenance person who assists in ensuring that health and safety and maintenance checks have been undertaken in the home to ensure that the equipment remains in safe and full working order. A window restrictor was observed to be broken and was replaced immediately by the maintenance person. Staff receive fire drills and training to ensure that they have the knowledge to safeguard people in the event of a fire. The records were available and up to date on the day of the inspection. The home does not take responsibility for peoples monies but has a system in place for some people to keep small amounts of money for hairdressing. The Annual Quality Assurance Assessment received from the home tells us they have improved in the last 12 months by: Having regular staff meetings and heads of departments meetings for one hour alternate Wednesdays. This helps monitor the service and discuss new ideas. Supervisions have been passed to the senior staff to complete, allowing staff the opportunity to speak to someone on a one to one basis. Annual analysis assessments have been completed which further assists in monitoring the overall service provision. 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 27 18 Given the size and layout of the home, and the numbers and dependencies of people receiving nursing care, the staffing levels and skills mix are in need of review. To ensure that the health care needs of the nursing residents are not compromised. 14/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 To promote continuity of care, care evaluations should include all the identified problems recorded within each care plan for the individual. Opportunity should be taken to review social, recreational and occupational activities to ensure that activities provided are suitable for all people living in the home. Particular attention should be paid to the views and experiences of people regarding social stimulation at weekends. The level of domestic input and availability should be reviewed at the weekends so that care staff are not drawn Page 27 of 29 2 12 3 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations away from providing direct care for people living in the home. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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