Inspection on 15/07/09 for Overbury House Nursing & Residential Home

This inspection was carried out on 15th July 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Overbury House Nursing &... 14/02/08

Overbury House Nursing &... 05/03/07

Overbury House Nursing &... 27/07/06

Overbury House Nursing &... 26/10/05

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Overbury House Nursing & Residential Home Staitheway Road Wroxham Norwich Norfolk NR12 8TH     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: Jane Craig     Date: 1 5 0 7 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 28 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 28 Information about the care home Name of care home: Address: Overbury House Nursing & Residential Home Staitheway Road Wroxham Norwich Norfolk NR12 8TH 01603782985 01603783425 admin@overburyhouse.healthcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Healthcare Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 61 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home Overbury House provides nursing and residential care for up to 61 people who have dementia. The home is owned by Healthcare Homes Limited. Overbury House is a large detached building of traditional design with a number of modern extensions that have been added over the years. The residents accommodation is located on the ground and first floors. Some have en-suite facilities and there are ample toilet and bathrooms around the home. There are a number of communal lounges and dining areas. Fees are based on the assessed needs of the individual and their chosen room. Information about the home, including the latest inspection report is available from the manager. Extra charges are made for hairdressing, personal newspapers, chiropody and toiletries. 61 Over 65 0 Care Homes for Older People Page 4 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 last key inspection on this service was completed on 14th February 2008. We also did a random inspection on 28th July 2008 to look at specific issues around the health and personal care of one resident. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 15th July 2009 by one regulatory inspector. At the time of the visit there were 53 people resident in the home. We met with some of them and where possible asked about their views of Overbury House. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. Care Homes for Older People Page 5 of 28 We talked to the registered manager, visitors to the home and members of the staff team. We looked around the home and viewed a number of documents and records. As part of the key inspection surveys were sent out to people living and working at Overbury House. Most residents were assisted to complete the surveys by family members. Their responses have been taken into account when making judgements about the service. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? After the random inspection we made four requirements to improve different aspects of care plans and risk assessments. During this visit we found that all those requirements had been met and there was a good standard of care plans. This helped to ensure that residents received the care they needed in the way they preferred. We made a requirement after the random inspection to keep a record of what people ate, to ensure they were receiving a nutritious diet. There had been improvements in this area and all residents had a daily record of what meal they had chosen and how much they had eaten. This helped staff to quickly identify if someone was not eating well and needed more support. Care Homes for Older People Page 7 of 28 A previous requirement to review the complaints procedure had been carried out. The complaints procedure contained all the necessary information to help people to make a complaint and to understand how it would be dealt with. Every resident was given a copy of the procedure and those who sent in a survey said they knew how to make a complaint if they needed to. 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 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. People thinking of moving into the home received sufficient information to help them to make a decision and staff received sufficient information to understand the persons needs. Evidence: A great deal of thought and effort had gone into producing information packs for prospective residents and their families. In addition to the statement of purpose and service users guide, there were comments from relatives, sample menus and information about activities and events celebrated in the home. Some of the documents were available in large print and audio versions. In the main, the information was aimed at families of prospective residents and discussions took place with the manager as to how some of the documents could be made more meaningful to people with dementia. People were encouraged to visit the home and a relative told us that after visiting Overbury House they made the decision that it was the right place because, It doesnt look or feel like an institution. Care Homes for Older People Page 10 of 28 Evidence: The manager told us that no-one was admitted to the home without having been assessed to ensure that their needs could be met. Part of the assessment was also to ensure that the person would fit in with the people already living there. The residents we case tracked had health and/or social care assessments on their files as well as assessments carried out by staff at the home. The combined documents provided staff with detailed information on which to draw up an initial care plan. Staff told us that they made sure the assessment information was still correct when the person moved into the 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. Residents health and personal care needs were met. Evidence: We looked at the care records for three residents as part of the case tracking process and others to check specific issues. Each resident had an assessment of their daily living activities. As previously required, care plans were drawn up wherever the assessments identified that the resident needed support in that area. There were some very good examples of person centred care plans. This meant that were directed to provide care to meet residents individual needs, and also take into account their wishes and preferences. The majority of plans contained very detailed directions to help to make sure residents received care in a consistent way. Several directions were aimed at helping people to maintain their independence and self esteem. Care Homes for Older People Page 12 of 28 Evidence: Residents had care plans to address complex behaviour. However, care plans to support people to meet their needs specifically associated with dementia were not as person centred as other plans. For example, the plan to support a resident who was agitated, directed staff to, use diversionary techniques, but did not specify what was right for that person. We discussed with the manager that the safe hold technique referred to in care plans should have a more specific explanation. This would help to ensure that new or temporary staff provided the right level of support. Most people living at Overbury were not able to be involved in drawing up and reviewing their care plans, therefore, their family was consulted. One family carer said that they had signed up to the care plans and they spoke to staff about the care as and when they needed to. Care plans were reviewed at least once a month. In areas where the resident needed extra support, the plans were reported on and the care evaluated more often. There were some good summary notes to show the progress the resident was making and whether the care was effective. Everyone had a set of assessments to monitor risks to their health, for example, from falls, pressure sores or poor nutrition. There were care plans in place to make sure that staff minimised the risks and promoted residents health. For example, one resident had been assessed as being at risk of poor nutrition. There was an excellent plan to direct staff to address all aspects of nutrition in a way that suited that particular resident. There was evidence that ongoing health care needs were monitored. Residents were referred to other professionals where necessary. We spoke to two health care professionals who said they had no problems with the care or care records at Overbury House. One said that she had been able to identify a resident just by reading their plan. People who completed surveys and relatives we spoke to were happy with the care and access to medical attention at Overbury House. One wrote that they were especially happy with the care and said, The nurses show great perseverance and patience. Another commented, We are lucky to have discovered Overbury House. Care plans reminded staff to promote peoples privacy and dignity. During the course of the visit staff were seen to treat people with respect and offer care in a sensitive manner. All personal care was provided in private and we saw staff knocking on bedroom doors before entering. A number of relatives made comments about dignity and respect. One wrote, I have always found they are treated with dignity, and another wrote, staff are very caring and respectful. Care Homes for Older People Page 13 of 28 Evidence: There was a full set of policies for the management of medication in the home and staff had good practice guidance to refer to. Residents who received nursing care had their medicines administered by registered nurses and others by care staff who had received appropriate training. Medicines were stored safely and there was no excess stock. There was a safe system for ordering medicines. There were complete records of medicines received, disposed of and of any stocks of medicines carried over from the previous month. These records contributed to the audit trail and helped to minimise any risk of mishandling. As required after the random inspection, there were records of medicines that residents had taken into hospital with them. Prescribed creams were stored safely in residents bedrooms. However, there were no records to show that they were being applied as they were prescribed. The medication administration records for other medicines were complete, which indicated that those medicines were being administered according to instructions. Staff carried out regular checks to ensure that the stocks of medicines correctly matched the records. We checked a random sample of medicines not in the monitored dose system and found them to be correct. There were some good examples of care plans to direct staff when to give medication that was prescribed when required. Pain assessments were used to assist with the administration of medicines to people who found it difficult to communicate. Variable doses were recorded, which helped staff to evaluate the effects of the medicine. Controlled drugs were stored, recorded and administered in accordance with the policy. 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. Residents were supported to make choices in their daily lives and the level of activities and occupation met the social and recreational needs of most residents. Evidence: The residents we case tracked had life history books, which helped staff to get to know about the resident and important events in their life. The manager said they were also used to help with reminiscence topics. Residents also had a document, how can you help me enjoy my day, on their files. These provided some information about the residents current interests and preferences for activities. This information was used to help plan monthly group activities and one to one time. For example, there had been recent sessions for people who enjoyed making models. There was a regular programme of group activities but there were a number of people who were not able or did not wish to join the groups. The manager had recently introduced the concept of butterfly moments. These were very quick, simple activities that would suit people with poor concentration, and that could be carried out by staff in their everyday contact with residents. There was a list up in various areas of the home to remind staff. Care plans included information about the residents preferred routines and choices in Care Homes for Older People Page 15 of 28 Evidence: all aspects of their daily lives. A relative said, staff go out of their way to find out what people like. The manager and staff said that the routines in the home were very relaxed and revolved around the residents. Throughout the visit staff were seen to consult people and give them choices, for example, about where they wanted to sit or what they wanted to do. The AQAA told us that there were regular residents meetings to encourage participation in the running of the service. There was open visiting, which helped residents to keep in contact with family and friends. Family members told us they felt welcome in the home. One said, they always say hello and offer us a drink. Relatives and friends were invited to events at the home. This meant that residents could enjoy parties and celebrate special events with a family group. Some residents were able to maintain contact with the local community and went out regularly with family. A few others went out with staff on individual shopping trips. The AQAA told us that the manager encouraged community groups to visit the home, such as the church choir. Records showed that residents were offered a varied diet with a choice at each mealtime. The daily menu and specials were on display outside the kitchen. Residents who had difficulty choosing from a written menu were given a visual choice. Staff took round two plates of food and asked which they would prefer. There were three dining rooms. However, there were not enough places for everyone to sit down together. The manager said this was not a problem as a number of people preferred to eat in their rooms or remain in the lounge. However, we noticed that staff served some residents in the lounge without asking them whether they wanted to go to the table, which meant that people may not be given a choice on a day to day basis. People who returned surveys indicated that they liked the meals. At the time of the visit one person said, We had a lovely lunch, it was beautiful. Care Homes for Older People Page 16 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. Residents and their relatives could be confident that their concerns would be listened to and acted upon. Procedures and training were in place to help to ensure that people were safeguarded from abuse. Evidence: The complaints procedure was included in the information pack and also on display in various areas in the home. The procedure was available on audio disk for anyone who had impaired sight. There was a photo of the manager and area manager on display with a short reminder for residents to speak to either of them if they had any concerns. Residents who completed surveys indicated that they knew who to speak to informally if they were not happy and they knew how to make a complaint. The AQAA indicated there had been one complaint in the past year about standards of care. A few of the issues raised had been upheld and action had been taken to prevent them happening again. The manager had put into place a system for residents and visitors to record grumbles. The records showed that these were investigated and responded to. The manager said this helped to ensure those who did not want to make a formal complaint would still be listened to. Recording the grumbles helped the manager to be able to spot any patterns or trends. Staff received safeguarding training during their induction and NVQ training. Some had attended recent refresher courses. The safeguarding procedure had been Care Homes for Older People Page 17 of 28 Evidence: reviewed to provide clear guidance on recognition and reporting of abuse. A concise flowchart was on display around the home and ensured that staff would know exactly who to contact. Staff we spoke to were aware of their responsibilities with regard to adult protection. The manager had referred two possible safeguarding incidents in the past year. Both were investigated but there was no evidence, from either referral, that anyone working in the home had acted inappropriately. All staff had received training about the Mental Capacity Act. This had given them some understanding of how the legislation could affect residents in their care and possible implications for their practice. The manager was also aware of her responsibilities with regard to the Deprivation of Liberty Safeguards. Care Homes for Older People Page 18 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. Residents lived in a homely and comfortable environment. Evidence: The AQAA told us that the home has an ongoing redecoration and refurbishment programme. Bedrooms were decorated as they became vacant. Corridors were being painted at the time of the visit and there were plans to change the style of the bedroom doors in one area. One of the toilets on the ground floor was in need of redecoration. There was discreet signage around the home to assist residents to find their way around independently. Bathroom and toilet doors were painted yellow to assist recognition. Safety measures such as low surface temperature radiators and window restrictors were in place. However, we noted that the pull cords for the staff call system were mostly tied up, which made them out of residents reach. The manager told us that in some cases this was for the safety of residents as they could get tangled in the cord and injure themselves. There were no risk assessments to guide staff as to residents safety with regard to the call bells. There were several lounge/dining areas so residents had a choice of where to sit. Communal rooms were furnished in a homely way. There were sufficient assisted bathing facilities and staff had decorated the bathrooms with pictures, plants and Care Homes for Older People Page 19 of 28 Evidence: ornaments to prevent them from looking too clinical. There was a home cinema room and one of the corridors had a movie theme. The manager planned to create a street scene within another corridor. The garden was thoughtfully designed with a number of different themes. For example, a beach had been created in one corner and there was a bus shelter in another area. The manager told us that residents sometimes liked to help put washing on the line in another area. A relative said their mother loved being in the garden. Residents bedroom doors were personalised with a meaningful picture to aid recognition and ownership. Many people brought in small items of furniture, pictures and ornaments, which helped to familiarise their rooms and make them homely. We spoke with a small number of residents who were unhappy about not being able to lock their bedroom doors to prevent other residents going in and touching their possessions when the room was unoccupied. One told us, you worry all the time you are not in there. The manager confirmed that this issue had been raised before and although there were locks on the doors, the keys had been lost and only master keys to the whole home were available. The manager had suggested to the residents that they ask staff to lock their doors for them but this solution increased their dependence on staff. At the time of the visit the home was clean and tidy. Two of the residents/relatives who completed surveys commented that there was sometimes an unpleasant odour in the home. They specifically mentioned the corridors and more so at weekends. During the visit we noted that there was an unpleasant odour in some areas and previous inspection reports showed that odour control has been an ongoing problem at Overbury. We discussed this with the manager, who was aware of the issue and was waiting for new flooring to be laid in some areas, which should alleviate at least some of the problem. Infection control training was included in the induction programme and staff had regular updates. There was best practice guidance available for reference purposes. There had been an outbreak of minor infection at the home in the past year. The manager sent us a notification which showed the staff team managed the situation well and in accordance with the guidance. Care Homes for Older People Page 20 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 were recruited safely and were provided with sufficient training to understand residents needs. Evidence: The manager told us that the staffing levels did not fall below the target ratio of one member of staff to five residents during the day. There were also extra staff rostered at peak times during the evening. The manager had the flexibility to increase the staff numbers, temporarily, should the need arise. One of the staff we spoke to confirmed there were enough staff to meet the needs of the residents. Another said the staffing levels were better than they used to be. Most of the residents who returned surveys indicated that staff were usually available when they needed them. However, during the lunchtime period we observed that some residents did not receive the attention they required. For example, one resident needed assistance to find a spoon but this was not noticed by staff. A resident in another area was behaving intrusively towards other residents. In one case this caused some distress but there were no staff in the area to supervise and defuse the situation. We looked at the files of two recently appointed staff. All the required pre-employment checks were carried out to make sure that staff were suitable to work with the people using the service. Relevant checks were carried out to ensure that nurses were registered with the Nursing and Midwifery Council. Care Homes for Older People Page 21 of 28 Evidence: New staff went through a thorough induction training programme. This was a company wide programme, which included six days of taught sessions. Staff then completed an in-depth workbook, with assistance from their mentor. The training covered all the common induction standards and could be used toward evidence for the NVQ training programme. The AQAA told us that over 50 of the care staff had NVQ at level 2 or above. The manager said that several other staff were working towards their qualification. The training records showed that most staff had up to date training in the safe working practice topics. The organisation had a rolling programme to ensure that all staff had opportunities to attend mandatory courses. The records showed that staff had attended various courses relevant to their roles. All staff had received a level of training in dementia care. Some staff had gone on to do more in-depth courses, such as palliative care with a special focus on people with dementia. Other courses were arranged as people requested or as training needs were identified during the supervision and appraisal process. Care Homes for Older People Page 22 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. Residents and staff benefited from a safe and well managed home. Evidence: Overbury House is owned by Healthcare Homes, who also own a number of other services in the area. The company has a clear management structure, providing support and supervision to the registered manager. The manager is a registered nurse who also holds a relevant management qualification. She has many years experience of managing services for older people. She keeps her knowledge and skills up to date by attending training, self study and networking. Throughout the inspection the manager demonstrated her commitment to providing good quality care and wherever possible improving the service. A relative who completed a survey commented that the home was well run. A member of staff also said the management of the home and the company was good. Healthcare Homes held an Investors in People award. Following the appointment of a quality director for the company, there were a number of quality initiatives, in various Care Homes for Older People Page 23 of 28 Evidence: stages of implementation. The last resident and relative survey had been carried out in November 2008. The manager confirmed that the few suggestions that were highlighted from the survey, had been carried out. There were resident and relative meetings. The last relative meeting had been facilitated by the Alzheimers Society. The responsible individual for the company carried out unannounced visits every month to monitor all aspects of the service and the management of the home. There were a number of internal audits of processes and procedures. The manager said that the audit of accidents had prompted extra staff during a high risk period. The company did not assist any residents to manage their finances and the manager did not hold any money on behalf of anyone. Any impromptu expenditure was paid for from petty cash and then reclaimed from the resident or their representative. Staff had clear guidance on health and safety procedures. There were environmental and safe working practice risk assessments. Potentially hazardous substances were stored safely. There was a What If folder that staff could refer to in the absence of the manager, which included emergency procedures and contact numbers for various services and utilities. Staff had received fire safety training and there was a clear procedure to follow in the event of a fire. Fire alarms were tested regularly and other fire safety equipment had been serviced. There was a very brief fire risk assessment which, the manager told us, had been approved by the fire officer. The AQAA told us that maintenance and servicing of the equipment in the home was up to date. Care Homes for Older People Page 24 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 25 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 1 9 13 There must be records of all 31/07/2009 medication given, this would include prescribed creams. This is to ensure that residents receive their medicines as they are prescribed. 2 19 13 There must be a suitable system for residents, who are able, to alert staff in the case of illness or emergency. This is to protect residents health and safety. 31/08/2009 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 2 7 15 Care plans to support residents with specific needs associated with dementia should be person centred. Residents should be given the choice at each mealtime whether they wish to sit at a dining table or have their Page 26 of 28 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 meal elsewhere. 3 24 Subject to a risk assessment, residents should have keys to their bedroom doors so they can be sure their possessions are safe when they go out of their rooms. In order to protect residents dignity and maximise their comfort, unpleasant odours should be controlled more effectively. Staffing levels should be monitored to ensure that there are sufficient staff on duty at all times, to adequately supervise all areas of the home. 4 26 5 27 Care Homes for Older People Page 27 of 28 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). 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. 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