Inspection on 21/04/09 for Little Holland Hall Nursing Home

This inspection was carried out on 21st April 2009.

CQC found this care home to be providing an Good 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

Little Holland Hall Nursing Home 27/08/09

Little Holland Hall Nursing Home 17/06/09

Little Holland Hall Nursing Home 04/04/07

Little Holland Hall Nursing Home 16/01/06

Little Holland Hall Nursing Home 07/07/05

Little Holland Hall Nursing Home 09/12/04

Little Holland Hall Nursing Home 26/05/04

Little Holland Hall Nursing Home 28/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Little Holland Hall Nursing Home Frinton Road Holland On Sea Essex CO15 5SS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Laker     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Little Holland Hall Nursing Home Frinton Road Holland On Sea Essex CO15 5SS 01255813402 01255813962 manager.littlehollandhall@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ellerash Limited care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Persons of either sex aged 40 years and over, who require nursing care by reason of a physical disability (not to exceed 8 persons) Persons of either sex, aged 55 years and over, who require general palliative care (not to exceed 3 persons) Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical disability (not to exceed 41 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 3 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 41 persons) 0 41 3 Over 65 3 41 0 Care Homes for Older People Page 4 of 28 The total number of service users accommodated must not exceed 41 persons Date of last inspection Brief description of the care home Little Holland Hall is situated in Holland on Sea, North Essex. It is part of a larger complex that includes sheltered housing; warden controlled flats; and privately owned homes for older people. Near to the nursing home, on the same site, there is a two storey listed building. Ellerash Ltd, which is part of the Care UK group, owns the Little Holland Hall complex. Care UK is a national care organisation. This nursing home has 41 single rooms divided between two floors. All of the rooms have en suite facilities. The home offers nursing care for up to 41 older people. Within this number, three beds are also registered for residents with palliative care needs. The home is not registered for dementia care. Current resident fees range between 442.54 pounds and 725.00 pounds, per week. 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: 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. This means the people who use this service experience good quality outcomes. This inspection was carried out as part of the annual inspection programme for this home. The proprietor and manager were available on the day of the inspection. The inspection focused on all of the key standards. A tour of the premises was undertaken. Evidence was also taken from the Annual Quality Assurance Assessment (AQAA) completed by the management of the home and submitted to CSCI. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvement be noted as this contributes to the inspection process and indicates the homes understanding of current requirements, legislation changes and own audited compliance. Most of the residents were seen and eight residents, three relatives and six staff were spoken with during the inspection. Information was also obtained via completed CSCIs Care Homes for Older People Page 6 of 28 feedback survey sheets. All comments were taken into account when writing the report. Observations on the day of inspection showed residents looked happy, relaxed, and comfortable. Overall the comments within the returned surveys were positive and are reflected on in more detail in this report. The site visit also consisted of a tour of the home, observing the care given and reading of documents. The inspector would like to thank the staff and residents for their help and hospitality during the visit. 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Prospective residents are supported by the transition arrangements for admission into the home and can be confident they will receive information to enable them to make a positive and informed choice about where they wish to live. Evidence: During the site visit to this home copies of the updated Statement of Purpose and Service User Guides were reviewed. A further review is now required as there has been a change in management and the new manager had only been in post for two days on the day of inspection. Both documents contained appropriate information to enable prospective users of the service to make the correct choice regarding admission. Copies of the updated and agreed documents will be sent to the local office of the Care Quality Commission upon completion, where they will be filed accordingly. The assessments of three recent admissions to the home since the last inspection Care Homes for Older People Page 10 of 28 Evidence: were inspected. All of the assessments seen were noted to have been completed prior to or on the admission date and cover the all areas relating to the health and welfare of individuals. Attention to dates, times, signatures and specific detailing was discussed with the manager, this must be given more prominence so it is consistently maintained. The manager reported that pre-admission assessments were undertaken by another senior staff member at the prospective residents own home, at the hospital or at Little Holland Hall depending on the needs and circumstances of the individuals at the time. The AQAA states We encourage, where possible, pre-admission visits to Little Holland Hall. This provides an opportunity for relevant people to be given visual, verbal and written information about the Home, and the services that we provide. Residents and relatives spoken with reported that they had experienced this approach and found it helpful and reassuring. One service user spoken to stated I love the atmosphere and the staff are so nice. Care plans are reviewed after the first month in consultation with the resident, families, representatives and the manager. Intermediate care is not offered at this home. Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Peoples needs are assessed in a person centred way that enables staff to have a better understanding of each individual, however people must be further assured that the care and support in some areas that they require to meet their needs is planned and recorded sufficiently well to guide staff in promoting their well being and safety. Evidence: There is an existing care planning system in place consisting of an assessment, care plans and risk assessments. Care UK operates a computerised care planning system throughout their nursing and care homes, called Saturn. The Care Quality Commission previously the CSCI has reviewed the Saturn system nationally and the inspector for this home was enabled to review care plans on the system during the site visit. A total of four resident care plans were reviewed. Care plans cover the residents identified needs. They are generally informative and contain sufficient detail to ensure residents needs can be met. The completion of daily care notes was noted to vary depending on who had completed the entry. The quality of recording in the daily report section of Care Homes for Older People Page 12 of 28 Evidence: the care plans varied greatly from good detail, cross referenced to specific areas of the care plan, to very basic information and repetition, this was discussed with the manager and senior clinical nurse as this highlights a support need for staff via further training. The AQAA states that Care UKs IT system Saturn enables the accurate and effective recording of assessments (Waterlow, weight, nutrition, continence etc.) and associated plans of care. Care plans incorporate privacy and dignity. The system enables to development of good practice templates for plans of care, which can then be modified to ensure person centred planning. Care UKs IT system also enables prompt and effective action when routine reviews are due, as per National Minimum Standard 7.4. This is effectively monitored and controlled, via weekly statistics generated by Care UKs Head Office personnel. Risk assessments relating to all areas of life were present on the files with action plans to minimise any identified risks whilst supporting individuals to enjoy their lives. A monthly review system is in place and this is generally consistent. Those seen completed showed a good staff appreciation of residents needs and changes, however attention is still required to including dates, times and signatures. This was discussed with the manager and senior staff on the day of inspection. Work is being progressed to involve residents and their relatives in the care planning process more, as this still needs to be addressed. Discussion with residents and visitors and observation of interaction between staff and residents on the day of the inspection and documentation reviewed made it clear that residents are treated with respect and core values such as privacy and dignity are maintained. With the further development of the care plans and the person centred approach this will allow the team to evidence that they have a good appreciation of the diversity of the residents in the home. Staff approach to privacy is good, staff were seen knocking on doors and interaction between staff and residents was seen and heard to be friendly, caring and respectful. All medication administration records were reviewed throughout the home. There were no omissions, entries were clear, changes were dated and signed, and Care UK policies and procedures were being followed. There was no overstocking of medications found anywhere in the home, all controlled drugs were reviewed and showed that documentation was good throughout homely remedies had all been bought over the counter and were in date, the medication room was air conditioned room and fridge temperatures were taken and recorded daily and the interactions between staff and residents, observed during the medication administration rounds, were of a high standard. The AQAA states A range of specialists are involved with the individuals at Little Holland Hall. These include Chiropodists, Dentists, Opticians, the local Tissue Viability Nurse, Social Workers, Dieticians, Physiotherapists, the Cardiac Nurse, and the Tracheotomy Nurse, the Parkinsons Nurse, etc. The Home has good links with the local Hospice. The Clinical Lead Nurse continues to work to make further contacts in specialist roles, as required to assist in meeting individual needs. Those who use the services at Little Holland Hall Care Homes for Older People Page 13 of 28 Evidence: are respected as individuals. Their privacy and dignity are considered and promoted at all times. As essential values, they are integral to all work activities, at all levels. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents continued contact with family and friends is welcomed and encouraged by the home and they are provided with a wholesome, tasty and balanced diet. The social care needs of residents in this home are met. Evidence: During the site visit the inspector reviewed activities available with residents and visitors, but was not able to speak to the coordinator. Residents and visitors were very happy with the individualised and scheduled group activities offered. Residents felt they were given choice and that the activities offered suited their needs. The coordinator tries to ensure that all residents have one to one time with either her, or one of the carers. During this time the coordinator, or carer, took time to assess the individual residents likes and dislikes. Little Holland Hall is part of a larger complex (see Brief Description of the Service,) and the activities coordinator also arranges activities with the residents in other parts of the complex to enable broader interaction for all residents in the complex. The AQAA states An Activities Co-ordinator is employed at the Home for 30 hours per week. She works with individuals on either a one to one or group basis, to meet their needs and preferences. The available Care Homes for Older People Page 15 of 28 Evidence: activities programme has been reviewed and updated so that the provision offered is now effectively structured and suited to the needs and preferences of the individuals at Little Holland Hall. Examples of activities undertaken include therapeutic manicures, gardening, board games, quizzes, group games, seasonal tasks etc. She also works to maintain links with individuals at The Lodge, an independent living complex for older people, located on the site. For example, through arranging coffee mornings. Support is provided to individuals who wish to go shopping in town, or for a cup of coffee on the sea front. External resources are also accessed and used, to provide entertainment. Special events, such as Easter, Comic relief and Christmas, are widely celebrated. Significant others are encouraged and enabled to take part in activities. Individual choice is considered and promoted at all times, as an essential aspect of daily life, it is integral to all work activities, at all levels. As part of this, individuals consistently have the opportunity to exercise their right to choose in related to all the aspects of daily life and choice is incorporated within care plans and daily progress notes. Ten residents were consulted as part of this inspection visit via discussions and survey responses, and all confirmed feeling satisfied with their lives at the home. One stated It is lovely here you couldnt ask for more It was reported at this and the last inspection that routines of daily living were not cast in stone and that individuals needs and wishes were taken into account. We are informed that records are maintained of which residents take part in various activities and what the participation entails. Records examined did not all evidence this consistently and gaps of days were evident. The AQAA identifies that Recording of activities within the relevant progress notes continues to lack descriptive content. Nursing and care staff input remains limited. This was discussed on the day of inspection. Residents spoken to confirmed that they are encouraged to maintain or build relationships outside the home as well as inside it. A number were looking forward to a trip planned for the next day to the Harbour Lights the co ordinator stated We listen to what residents say about where they would like to go and what they would like to do and try and act upon this. As well as individual discussion between staff and residents, regular resident meetings are held and activities and outings planned. Records of activities are kept in the home and these help to create conversation with residents or between residents and their families. A discussion was held with the manager regarding the importance of documenting in this regard as this varied depending upon which staff member completed the record and again gaps were noted. A review of the care plan items attached to activities are reviewed monthly by the activities coordinator or the key worker for the individual resident. Residents are encouraged to keep contact with family and friends, with open visiting practices as routine. Visitors said that they were always made welcome and they felt that they could talk to the manager or the staff about anything. Visitors spoken to also said that they felt their relatives were offered very good care and that staff in the home Are very good and helpful. During the site Care Homes for Older People Page 16 of 28 Evidence: visit residents were observed being given choice, time and consideration in all interactions. A physical tour of the building provided evidence to confirm that residents were able to bring their own possessions such as items of furniture and photographs into the home to individualise their personal space. Residents and visitors said that food choice and quality was very good. Menus reviewed demonstrated a wide range of meals offered and that there was a number of choices at each mealtime, with the proviso that if there wasnt anything they fancied on the list they could ask for something different. The lunchtime meal offered a good choice and care assistants were observed giving residents choice in what they wanted to eat and the quantity required. Some residents eat in their rooms and there is a servery on each floor where the staff distribute the meals from, to ensure they are as warm as possible when they reach the individual resident as the kitchen is in a different building. The dining room at the home was pleasantly appointed and the lunchtime experience was observed to be relaxed and unhurried with staff providing discreet and sensitive assistance where needed. 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. This judgement has been made using available evidence including a visit to this service. Residents can feel confident about how to complain and can expect to be listened to and their complaints acted upon. Residents can also be assured that all carers are adequately trained to safeguard their welfare. Evidence: The residents at Little Holland Hall are supported by the homes robust complaints policy and practices. The complaints records include details of any issues raised by residents or their representatives. None were observed to present any risk to residents health and safety however were generally treated with appropriate sensitivity and respect. The manager reported that any complaints were referred through the manager and Care UK. the AQAA informs us that All concerns and complaints are recorded on the Care UK IT system Saturn. These contain details of any investigation and any action taken. Complaints are responded to promptly and effectively. In February 2009, this system was updated to further ensure the effective management of concerns and complaints. Complaints are responded to promptly and effectively, in line with requirements. Care UK employs a Customer Experience Manager, who is available to support and assist with the management of concerns and complaints. Furthermore, he has responsibility for the remote monitoring of concerns and complaints, via Saturn, to ensure effective local management. The ethos of the home is to welcome comments and complaints Care Homes for Older People Page 18 of 28 Evidence: and the manager of the home actively promotes this. All staff are encouraged to promote this and to not be defensive when residents or their relatives complain. It also states that nine complaints have been received since the last inspection , six of which were upheld and that one safeguarding referral has been made. this concurs with the homes complaint records and no complaints have been received by the CQC regarding this service and all records indicate they have been dealt with professionally and appropriately. Records provided evidence that staff members had attended annual training in the Protection of Vulnerable Adults. The AQAA informs us that the homes plans for the next twelve months include The format used for presenting the complaints procedure is limited. Alternative options should be created, to enable effective communication and ensure understanding. This was as detailed within the AQAA of January 2008, and some preliminary work was undertaken to address this. However, we were advised that the procedure was being re-developed centrally by the Care UK Customer Experience Manager, and so this piece of work is currently pending. Residents and relatives spoken with stated they would know how to make a complaint if the need arose. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. The home provides a safe, well-maintained environment that is accessible to the people who live there, homely and meets their individualised needs. Evidence: The inspector on made a complete tour of the home. The home was bright, airy and clean. There were no malodours throughout and the cleaning staff obviously take pride in their work. Although the environment was not the main focus of this inspection, communal areas and individual rooms seen during the inspection appeared nicely decorated and well maintained, containing various amounts of the residents personal belongings. On each floor there is a bookcase with a selection of books and magazines for the residents to use. Storage space in this home is lacking, but the staff make the best use they can of the space available and the corridors were generally clear of obstructions. Staff spoken to were able to demonstrate an awareness of the safety needs of the residents and the environment. All hoists and electric baths had been serviced within the previous six to twelve months. All COSHH items, throughout the home were stored appropriately. Sluices were clean and tidy. Bathrooms were safe, clean and free from obstructions. Infection control procedures in the home are good and staff understand their importance. Alcohol gels were evident throughout the home, staff and visitors are encouraged to use them on entering each room. Care Homes for Older People Page 20 of 28 Evidence: Previously the home has arranged a visit by the local Primary Care Trust infection control specialist to ensure they are carrying out all procedures necessary to protect the residents. The AQAA states Maintenance recording systems have been fully reviewed and updated, to reflect requirements. They are now clear and accessible. A range of different audits that have been undertaken have all given rise to different action plans, which have either been completed or are being progressed. This has greatly supported continuous improvement within the home to date, and will continue to do so. All items are now stored as required, making the best use of the available space. A comprehensive fire risk assessment has been assessed as being fully compliant with requirements. The associated action plans have either been completed or are being progressed, in conjunction with the Care UK Facilities Management team. Environmental changes have been made, based on feedback that has been received from people who use the service. Little Holland Hall successfully secured a Department of Health Grant, which enabled exterior improvements to be made. A decking area has been built, and raised flower beds have been purchased. which provides greater opportunity for residents to enjoy the beautiful surroundings of the home, and interact with the extensive local wildlife. This work was carried out following on from consultation with residents and/or their significant others. With regard to the interior of the Home, Care UK recently invested in a refurbishment of the home. Again, residents and/or their significant others were consulted on this. A formal programme of routine maintenance and renewal of fabric and decoration, in line with relevant requirements, has been developed. This links in to the centrally co-ordinated five year plan for Little Holland Hall. The nurse call system at Little Holland Hall has been replaced. It is a system linked to a computer, to enable management monitoring. Various pieces of equipment have been replaced including profiling beds pressure relieving mattresses and a syringe driver. The domestic function at Little Holland Hall has been fully reviewed, and a housekeeper post has been created. Service users and their relatives spoken too stated they were happy living at the home and felt the environment suited them and was suitable for their needs. 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. This judgement has been made using available evidence including a visit to this service. The home provides staff that were appropriately trained and qualified and they are in sufficient numbers to meet residents needs. Recruitment practices meet regulatory requirements set out to protect residents. Evidence: Staffing levels and skill mix have not changed since the last inspection and still allow for a minimum of two registered nurses and five care staff on duty during the day and one registered nurse and three care staff during the night time period. There is support from the acting manager, clinical nurse lead and administrator, who are generally supernumerary to these levels. At the time of the site visit there were three housekeeping staff on duty and there were separate staff for the laundry and kitchen areas. The home now has its own maintenance and gardening staff and ensure that one of them is always available to cover the needs of the home. Residents and visitors told the inspector that they were very happy with the quality of the care they received. At the time of the site visit four care assistants had achieved National Vocational Qualifications at level 2 since the last inspection and further care assistants were about to enrol. The newly appointed manager had only been in post two days at this inspection and was a National Vocational Qualification assessor for the Registered Managers Award level 4, previous to commencing this post. He intends to be involved Care Homes for Older People Page 22 of 28 Evidence: with the National Vocational Qualification training in the home to ensure that the present level of 71 of care staff with qualifications is consistently maintained. Four personnel files were reviewed during the site visit. The information required is all logged on the Saturn system with written information kept in separate well maintained document files. Recruitment procedures were robust and good to ensure the safety of the residents. Nursing and Midwifery Council registrations are checked regularly and the manager keeps an up to date list of when each registered nurses registration is due for renewal. Each member of staff has an individual training record both on Saturn and in paper versions. All staff spoken to stated that they were offered a lot of training opportunities, both statutory sessions and specialist subjects. Night staff regularly attend training sessions. Some sessions were undertaken in the evening to accommodate those night staff that are unable to attend training during the day. One of the senior care assistants takes responsibility for booking training and maintaining up to date records of attendance. The system works well and the new manager is intending to maintain this arrangement. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home. Systems are in place to ensure that residents views form part of the monitoring and review of the home. Health and safety practices do promote the health, safety and welfare of residents. Evidence: Since the last inspection the manager has resigned and a new manager is in post. At the time of the site visit the new manager had been in post for two days. He is not a registered nurse but has previous National Vocational Qualification NVQ assessment experience as he ran his own training company for five years. an application for registration with the Care Quality Commission has not yet been submitted but we are informed this is to be made shortly and the application pack will be sent to the regional registration team when complete. The manager and inspector discussed the management of the home, at which time the manager demonstrated a good knowledge of the needs of the residents and staff. The manager as necessary will Care Homes for Older People Page 24 of 28 Evidence: further review management structures and responsibilities within the home over the next few months. The home has adequate nursing staff cover and the Clinical Nurse Lead is a qualified nurse with appropriate skills and experience. Staff and residents spoken to said that they had met the new manager. The new manager has started internal audits of the home, to establish initial impressions of the home and any adjustments needed. The manager also intends to utilise resident involvement forms on a regular basis in an appropriate manner. Staff are encouraged to fill in forms as well so that they feel part of the overall process. There have been no changes to the way in which resident monies are handled and during the site visit resident accounts reviewed, all were correct and the records were good. Staff spoken with were clear about their responsibilities regarding protection of vulnerable adults and how to sort out problems as they occur. All record keeping throughout the home was generally very good with exceptions highlighted regarding general care planning on Saturn. Documentation is stored appropriately to protect confidentiality. Policies and procedures for this home are produced centrally by Care UK and those reviewed were up to date and appropriate. The AQAA states Ranges of different staff meetings have taken place, which have all provided valuable opportunities for the team to contribute to the way in which the service is delivered. A range of different internal and external audits and inspections have taken place over the last year. These include a health and safety audit, an Essex County Council Inspection and an Environmental Health inspection. Where action plans were required, these have either been completed or are being progressed. All certificates and servicing records seen at this inspection were up to date and appropriate for this home, ensuring the health and safety of the residents. Care Homes for Older People Page 25 of 28 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 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 7 It is recommended that some further care planning training be undertaken to ensure all staff maintain a consistent approach with recording. It is recommended that all staff maintain a consistent approach with activity and one to one recordings. The manager should make an application to the Care Quality Commission for registration in a timely fashion 2 3 12 31 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. 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