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Inspection on 24/03/09 for Kenwith Castle Nursing Home

Also see our care home review for Kenwith Castle Nursing Home for more information

This inspection was carried out on 24th March 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Kenwith Castle provides people with a spacious, well maintained peaceful environment that has been decorated and furnished to a high standard. Personal and health care needs for individuals is well planned and delivered by staff who treat people with respect and dignity. People who live at Kenwith Castle said ``staff are brilliant, could not do things any better. If the girls are busy they will explain and come back a little later.`` ``My sister chose this place for me and it could not be better, the staff, especially the matron is splendid.` One visiting relative said `` my x has been very ill and care and staff have been brilliant.`` The home ensures that social needs are met and that people are given opportunities to exercise choice in everyday decisions. Meals offered are very well presented and plenty of choice and variety is given throughout the menu. Staff are reasonably well trained, know the needs of the people they support and provide care in a kind and respectful way. The home is very well run and have proved to work toward meeting high standards for the people they care for. Individuals views are sought in a variety of ways and used to improve the quality of care and support.

What has improved since the last inspection?

The home have developed a sensory garden that is accessible to wheel chair users. The homes AQAA states ``We have introduced a new welcome pack which identifies the services that we offer and how our service users can access those services. We have developed our garden areas to improve access for those with limited mobility and sensory impairment. Our menus have been developed to include improvements suggested by our service users.``

What the care home could do better:

Medication records should have clear audit trail at all time. Where a variable dose is prescribed the nursing staff should make sure they make it clear what dose has been administered. Any handwritten changes to medication records should be double signed to help prevent error occurring. Recruitment procedures must be more robust. The home have listened to our feedback and now made their recruitment policy clear in stating that new staff will only be employed once all checks and references are in place. This will help to ensure that only people who are suitable to work with vulnerable people are employed.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kenwith Castle Nursing Home Kenwith Castle Nursing Home Kenwith Castle Nursing Home Abbotsham Bideford Devon EX39 5BE     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: Joanne Walsh     Date: 2 6 0 3 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 28 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 28 Information about the care home Name of care home: Address: Kenwith Castle Nursing Home Kenwith Castle Nursing Home Kenwith Castle Nursing Home Abbotsham Bideford Devon EX39 5BE 01237470060 Telephone number: Fax number: Email address: Provider web address: kenwithcastle@aol.com Name of registered provider(s): Type of registration: Number of places registered: Two Rivers Investments Ltd care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of placements will be fifty-nine (59) in the category of Older Persons (OP) who may require nursing Date of last inspection Brief description of the care home Kenwith Castle is situated in a rural area of North Devon, a few miles to the South West of Bideford. The home provides 24-hour nursing care to 55 older people (not including people with dementia or mental health problems). The building is a large two-storey building, which has been sympathetically converted to retain some of the original features. There are extensive grounds surrounding the home, which command fine views to the front. A lake within the grounds provides a haven for wildlife and also a variety of freshwater fish. A long driveway leads to the visitors car park at the front Care Homes for Older People Page 4 of 28 Over 65 59 0 Brief description of the care home of the home. There is level access and automatic doors to the front entrance. Accommodation is provided on both floors with lift access to the upper level. There is level access throughout the home. The current fees can be obtained directly from the home. Additional charges are made for hairdressing (dependent upon individual requirements), chiropody, physiotherapy, toiletries and newspapers (dependent upon individual requirements) Care Homes for Older People Page 5 of 28 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: This inspection took place over two days during March and centered around gaining the views of the people who live at the home, their relatives and the views of the staff. We spend time talking to people about their experiences of receiving care and support and looked at some of the key documents used in the home. These include plans of care, pre admission assessments, records relating to medication and individuals monies as well as staff training and recruitment files. This helps us gain insight into how well the home is run. Prior to the inspection taking place we sent surveys to a sample of people who live at the home and to a sample of staff. Their views and those gained during face to face interviews are included in the main body of the report and have helped us to make judgments on the quality of outcomes for people who use the service. Care Homes for Older People Page 6 of 28 The home is also asked to complete an Annual Quality Assurance Assessment (AQAA). This gives us information about how the home maintain a safe environment and ensures good training policies and procedures are in place. 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 set out on page 4. Care Homes for Older People Page 8 of 28 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure that all potential new people to the service have their needs fully assessed prior to being admitted to the home. Evidence: The pre admission assessment information for 4 new people to the service was looked at and discussed with the registered manager and some care staff. Where possible one of the senior nurses will visit the individual either in their own home or in hospital and talk to them, their family and any other care givers in order to gain a full picture of the individual strengths and needs. The assessment format is based on the Royal College of Nursing guidance and covers all topics as highlighted in standard 3 of the National Minimum Standards. The AQAA states that any individuals referred through funding authorities are not admitted until an agreed care plan via care management processes has been agreed Care Homes for Older People Page 11 of 28 Evidence: and sent to the home. In cases where an individual is moving from out of the area and therefore a face to face assessment is not possible, a care plan is agreed with family members and reviewed once the person has been admitted. The assessment is used as the base line for the start of a plan of care that highlights what support is needed for daily living and what aims and objectives there are for the longer term outcomes for individuals. Staff spoken to said that usually prior to a new person coming to the home they are given verbal handover and are given access to read the pre admission assessment information, so that they have some idea of the persons needs prior to them being admitted. One person spoken to said that the matron had visited them prior to moving in and said that they had come to see the home with their family before moving in. One visiting relative confirmed that prior to their relative moving in the home a through assessment of need was done including speaking with the family doctor and district nurse team. Care Homes for Older People Page 12 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care needs are well met. Evidence: People spoken to during the inspection gave very positive views about the care and support they receive. Comments included staff are brilliant, could not do things any better. If the girls are busy they will explain and come back a little later. My sister chose this place for me and it could not be better, the staff, especially the matron is splendid. One visiting relative said my x has been very ill and care and staff have been brilliant. Another relative said xx is really well cared for, you get really good care here. One doctor commented Care is very good, I would be happy for a relative of mine to be here. The matron and nursing staff are very good at providing care to people with complex needs. Eight surveys were returned by people who live at the home and again all gave very positive feedback about the care and support provided. Comments included All care is given with a smile. I am perfectly happy here and well looked after by all concerned. Six out of the eight surveys had ticked always to the question Do you Care Homes for Older People Page 13 of 28 Evidence: receive the care and support you need? Two had ticked usually. All had ricked yes to the question do staff listen and act on what you say? Several people spoken to confirmed they were able to see their doctor when asked. The home pays the local surgery a retaining fee that ensures they have two, two hour visits from one of the doctors each week. This gives the nursing staff an opportunity to discuss any concerns they have about individuals and also allows apple opportunity for medications to be kept under review. One person spoken to confirmed that they see a visiting chiropodist and has been assisted to attend other health care appointments. Four plans of care were looked at in some detail. They contain 10 individual sections that cover all aspects of personal and health care needs. They also have a section on recreational, play, faith, beliefs and spirituality. This is where any diverse needs are identified and actions on how these needs are to be met are included. Plans of care give staff detailed information about how identified needs should be met and include assessments in nutritional screening, risk of pressure damage using a Medley score and a moving and handling assessment. Where pressure areas have been identified we saw good recording of what nursing staff had implemented to reduce any damage and how often this was monitored. Appropriate equipment such as pressure relieving mattresses and cushions were being used for people identified as being at risk of pressure damage. We saw evidence that individuals were referred and seen by the continence advisor for the right continence aids. Following discussion with the registered manager, the staff had a system in place for ensuring that all toileting and pad changes were recorded so that there was a good audit trail of consistent care being given. Plans of care are reviewed monthly and any changes to the way care is or should be delivered is clearly identified. Some of the plans had been signed by the individual concerned, to say they agreed to the content of the plan. Two people spoken to confirmed that they had been consulted about the plan and the way they preferred care and support to be delivered. The activities list included opportunities for people to do gentle exercise and the registered provider said that they had specifically developed a sensory garden that is easily accessible to encourage individuals to take regular exercise outside when possible. Care Homes for Older People Page 14 of 28 Evidence: Staff spoken to during the inspection and those who returned surveys said that they were given good information about individuals needs via plans of care. Care staff spoken to had a good basic understanding of the needs of frail elderly people and the nursing staff are experienced and continue to update their training in best practice. Medication is administered by the nursing staff on duty, which is one for each of the two floors. The medication storage and records were looked at and discussed with one of the nursing staff. Mediations are stored appropriately and records in respect of administration of medications are well maintained. It was noted that for one person where their was a variable dose of medication records did not always record whether one two or three tablets had been administered. The home are also reminded that where entries into the medication records is handwritten or changes to dosage is made, these should be double signed to avoid any errors being made. Individuals spoken to confirmed that care and support is delivered in a way that respects their privacy and dignity. Staff were seen to use signs on individuals doors to indicate that they should not be disturbed as personal care was being delivered. Care and support observed was delivered in a kind caring ans supportive manner throughout different times of the day. Ancillary staff as well as care staff were seen to spend time talking to individuals and treating them with respect and kindness. The plan of care includes a section on death and dying and where possible and known the home records individuals wishes in respect of what medical interventions they will and will not consider. The home uses the Liverpool Pathway a clinical tool to ensure that individuals who are terminal get good quality treatment and care in their final days. Letter from families whose relative have died at the home confirm that they do this well Comments included I cant find words to express the depth of gratitude to all of you for your care of xx throughout the six months she was at Kenwith, but especially for the way in which you helped her and me at the end of her life. I was left with an overwhelming impression of loving care for her and me. Another family said We have been so pleased that xx has been able face his own end with equanimity, indeed to welcome it and want it, and think this owes a great deal to the trust he felt in the care consideration he was being shown by you. Care Homes for Older People Page 15 of 28 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. Individuals social need are well met and people are assisted to exercise choice and control over their own lives. Evidence: People spoken to during the two days of inspection said they were given opportunities to exercise choice and control over their own lives in relation to activities, what meals they wanted, what they wear and where and how they spend their days. One person said I like to spend much of time time in my beautiful room, I enjoy painting and I have everything I needs at hand. I do take part in some of the exercise groups, we all have a good laugh. Another person said There is something on offer every day to do, staff always come and ask me if I want to take part, sometime I do, and sometime I dont feel like joining in. The registered manager has just introduced a new policy for staff in relation to understanding the Mental Capacity Act and reminding staff to always allow individuals time to make choices in their everyday lives, It gives specific examples for staff to reflect on such as ensure people are able to make choices about the food they want and it states Menus should not be written for them without trying to find out what they might want, then if after trying you have to make a decision on their behalf that Care Homes for Older People Page 16 of 28 Evidence: you record in their notes under plan 5, that you have made a choice on their behalf as they were unable. There is a weekly activities timetable drawn up and displayed through the building. Activities for the week of the inspection visits included Sunday services, coffee morning, quizes, board games and exercise groups. They also have several slots for individual visits to people. Staff said this would include chatting to individuals who would not normally want to join in group activities. The home has a bar area and this is open during the evenings for people to meet and socialize. Three visiting family members confirmed that visitors are made welcome at all times, that they can see their relative in private. One said I visit here two or three times a week and always have my lunch. We are treated very well and staff couldnt be more welcoming. Individuals are encouraged to bring in their won personal possessions if they wish so that they can make their rooms personal and omely to them. The home offers an extensive menu with at least two choices of hot meals offered for all three main meal times and snacks and drinks available throughout the day. The chief said that they have recently revamped the menus in line with comments and suggestions from a recent survey sent to people who live at the home. The chief said that they try to use as much fresh and seasonal produce as possible and cater for special diets such as diabetic and gluten free. Meals offered during the lunchtime periods on both days of inspection were attractively presented, and served in an unhurried and relaxed atmosphere in a pleasant and spacious dinning room. The vegetables were served separate to the meal so people could choose what and how much they would prefer. Individuals were offered a range of drinks with their meals including wines and fruit juices and tea and coffee following the meal. The main meal of the day is usually lunchtime and three course are always offered. The menus appeared varied and nutritious. For people who require assistance with meals, staff are available and offered this support in a respectful and discrete manner. Comments from people about the choice and range of meals offered included we are asked our choices the day before and if we dont like or fancy whats on the menu, you can pretty much ask for what you like. The meals are quite good, I have no complaints. I would prefer less fancy food, but I do enjoy what I eat generally speaking. Care Homes for Older People Page 17 of 28 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. Individuals views are listened to and acted upon. Evidence: Individuals spoken to, relatives and staff all said that they could make heir concerns known to the registered manager. All but one survey returned said they knew how to make a complaint and the AQAA States that the home have developed a welcome pack that tells people that they are encouraged to provided feedback about any aspect of the home. The registered manager also ensures that people who live at the home have regular opportunities to have their say via anonymous surveys. The home take complaints seriously and and the outcome of any investigation is recorded so that people are aware of what resolutions to issues there have been. The Commission received one complaint that was anonymous just prior to this inspection taking place. It centered on issues around lack of care in respect of changing continence pads and one person having painful pressure sores. We have found no evidence to substantiate this complaint, but in discussing the complaint issues the registered manager agreed that staff would record when toileting and pad changes have occurred as further evidence that personal are needs are being fully met. This was put into practice following the first day of the inspection. The home has policies and procedures in place to ensure that individuals are protected Care Homes for Older People Page 18 of 28 Evidence: from abuse, and staff spoken to said they had received training in the protection of vulnerable adults. Those asked understood different forms of abuse and knew what they should do if the suspected abuse had taken place. Robust procedures and a good audit trail is in place for dealing with individuals personal monies. Two files and amounts were checked and both were accurate. Care Homes for Older People Page 19 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Kenwith Castle provides people with a spacious, clean and well maintained environment to enjoy. Evidence: During this inspection all communal areas and some of the individual bedrooms were seen. The AQAA sates We offer spacious well maintained environment with a homely atmosphere, in a purpose built nursing and residential home. There are large comfortable communal areas that allow for freedom of movement as well as quiet comfortable corners for those looking for tranquility away from their room. There is generous space in communal areas for religious services and social events. The lighting is domestic in nature in all communal areas. A programme of maintenance and renewal is ongoing with most of the work being done by a in-house maintenance team that can deal promptly with repairs/renewals of an urgent nature. We offer easily accessible grounds and gardens with a large range of domestic and wild fowl, that are easily observed. There are communal ares of seating outside that are accessible by those with visual,sensory and cognitive impairment. The building complies with fire regulations and with environmental health legislation. Each service user has a toilet and washing facilities in their private room. Toilet facilities are available in close proximity to all lounges and dining rooms. All toilets have grab rails Care Homes for Older People Page 20 of 28 Evidence: and all doorways are at least 800mm wide. Lifts and level access to all areas of the building. The premises are kept clean and hygienic and free from offensive odours,systems are in place to prevent the spread of infection.Laundry facilities are sited so that no laundry is carried through food areas. Handwashing facilities are sited in areas where clinical waste and soiled laundry is handled. Wasshing machines are industrial type and have programmes that meet infection control guidelines. The home are commended for their level of cleanliness, there was only one small area where there was a smell and this was in the process of being addressed with a deep clean and regular shampooing of carpet area of one bedroom. Care Homes for Older People Page 21 of 28 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. Staff are well trained and reasonably well supported to do their job effectively. Evidence: The staffing levels are sufficient for the number and needs of the current people living at the home. There is normally a trained nurse on each of the two floors, plus 5/6 carers for each floor in the mornings and 4 in the afternoons. The care staff are supported with sufficient ancillary staff who provide meals two chief in the morning for breakfast and an additions one on for lunchtimes plus a kitchen porter and a serving person. There is also quite a large housekeeping team with normally four cleaners each day and two people covering laundry duties. Where possible shortages are covered from existing staff although they do have to use agency staff on occasion. Staff spoken to during the inspection and those who returned surveys said that in general there was sufficient staff on duty, although a few did mention that they were often lower at weekends. This was discussed with the registered manager who said that they were often trying to cover shifts at weekends due to people ringing in sick, not that there was a lower number of staff allocated at weekends. She has been trying to look at having a bank of staff to call upon when they are short at short notice. The registered manager said that they always encourage people to work toward National Vocational Qualification training in care and the deputy matron said that of 34 Care Homes for Older People Page 22 of 28 Evidence: carers 20 have or are working toward NVQ 2 or above, which is almost 50 . She also said that they have a matrix of core training to ensure that all health and safety training is covered. When we looked at this for fire training in 2008 only 11 staff attended one update out of 20 trained staff. This was highlighted as part of the feedback to the registered provider and manager. We have been notified that since the inspection all staff have had updated training in fire awareness, and that notices have been put up to make individuals aware that training in all areas of health and safety is mandatory and staff who persistently fail to attend this training will be disciplined. Staff recruitment files were looked at for four newer staff members. Although they contained 2 written references, an application with employment history and written evidence of attending a formal interview. not all had had relevant checks back prior to them commencing employment. This could place individuals who live at the home at risk. The registered manager said that they would not have done any hands on work but only commenced training until verification had been received that they had been checked to be suitable to work with vulnerable people. This breach has now ceased with clear polices and guidelines in place that individuals can only start work at the home once all checks and references have been received. Care Homes for Older People Page 23 of 28 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. The home is well run and in the best interest of the people who live there. Evidence: The registered manager is qualified and experienced to run the home. Staff and people who live at Kenwith castle say they are confident that their opinion is listened to. The home completed a very comprehensive and through AQAA that gave us good information in order to determine how well they manage health safety and maintenance of the home. The AQAA states Registered Manager has more than two years as a nursing home manager. Registered Manager is a level 1 nurse - holding a BSc Hons Degree in Health and Social Care and a Diploma in Management. There is an annual development plan for the home and the AQAA is part of the quality assurance programme . Policies and procedure are under regular review in the light of changing legislation and Care Homes for Older People Page 24 of 28 Evidence: best practice advice. Kenwith Castle does not administer the finances of any of its service users, except for their petty cash float. Records are maintain of all income and expenditure from petty cash floats for each individual service user, each transaction is signed and countersigned. The registered Manager ensures that policies and procedures are in place to protect the health and safety of the staff and service users. The manager ensures that safe working practices are maintained and adequate training is given for Fire Safety, Moving and Handling, First aid and Food hygiene. Equipment is maintained as per legislation relevant to the equipment. Care Homes for Older People Page 25 of 28 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 29 19 (1)(b)(i) The registered person shall 31/05/2007 not employ a person to work at the care home unless subject to paragraph (6), (8), (9) her has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 9 of schedule 2. The manager must ensure that satisfactory references including POVA checks are obtained prior to employment. Care Homes for Older People Page 26 of 28 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 9 Medication records should always clearly show dose administered, such as a medication that can have a variable dose. All hand written entries into medication records should be double signed to reduce the risk of errors. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!