Inspection on 20/04/09 for Polebrook Nursing & Residential Home

This inspection was carried out on 20th April 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Polebrook Nursing & Residential... 18/08/09

Polebrook Nursing & Residential... 23/04/07

Polebrook Nursing & Residential... 07/04/06

Polebrook Nursing & Residential... 11/10/05

Polebrook Nursing & Residential... 25/04/05

Polebrook Nursing & Residential... 26/10/04

Polebrook Nursing & Residential... 29/04/04

Polebrook Nursing & Residential... 05/02/04

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Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Polebrook Nursing & Residential Home Morgans Close Polebrook Cambridgeshire PE8 5LU     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: Kathy Jones     Date: 2 0 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Polebrook Nursing & Residential Home Morgans Close Polebrook Cambridgeshire PE8 5LU 01832273256 01832741970 Birchesterplc@yahoo.co.uk helenrussellrgn@AOL.com Birchester Medicare Ltd care home 51 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The total number of service users accommodated at Polebrook Nursing and Residential Home must not exceed 51 To be able to admit the named person of category OP (under 65 years) named in variation application no. V34916 dated 7th September 2006 To provide care for one named service user under the age of 65 years Date of last inspection Brief description of the care home Polebrook Residential and Nursing Home is a fifty one bedded purpose built care home located in the village of Polebrook, which is three miles from the town of Oundle. Birchester Medicare Ltd own the home. The home provides for older people requiring personal care, nursing care or dementia care. The accommodation is all located on the ground floor, with a mixture of single and double rooms , the majority of which have en-suite facilities. The home has several communal rooms and a large Care Homes for Older People Page 4 of 29 Over 65 51 51 51 0 0 0 Brief description of the care home conservatory area. The following fees were provided by the registered manager as being current on 20 April 2009. Privately funded people are charged between £575 and £625 dependent on assessed need. Local Authorities who are funding residents are charged at the rate which is set in their contract and again this depends on peoples assessed needs. For people funded by a Local Authority a `top up fee is usually required to be payable by the person using the service. The fees include personal care and where applicable nursing care, meals and accommodation. Chiropody, hairdressing services, and newspapers can be arranged and are charged separately. Other costs would include clothing and toiletries. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Standards identified as key standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for people who use the service. Inspection of the standards was achieved through review of existing evidence and an unannounced inspection visit. Prior to the inspection we reviewed the information we had received about the service through correspondence or contact with the service and people associated with the service. This included an annual quality assurance self assessment which was submitted by the registered manager. We used this information to plan an inspection visit which was carried out by one inspector, unannounced over the period of a day. On this occasion this was a weekday. Prior to the inspection we had arranged with the registered manager that we would Care Homes for Older People Page 6 of 29 send surveys to a sample of people involved with the service. Unfortunately they were not received by the service. However following the inspection visit we spoke with a sample of professionals associated with the service to gain their views. We have taken this information into account as part of the inspection. The unannounced inspection visit involved a method of inspection called case tracking, which includes selecting samples of peoples records and tracking their care and experiences. We spoke with some people who use the service, a relative and staff about their experiences. We also observed interactions between staff and people who use the service. The management of peoples medication was checked through reviewing prescribed medication for a sample of people. A sample of staff files were also reviewed to check the adequacy of the recruitment procedures in safeguarding people who use the service and looked at the training staff receive. Shared areas such as lounges and dining rooms were seen during the inspection and a sample of peoples rooms. Verbal feedback was given to the registered manager during the inspection and we have had some telephone discussion with the registered manager following the inspection. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The statement of purpose and service user guide which are documents to help inform people about the service would benefit from having more detailed information about the range of needs that can be met and fee information. The document also needs checking to remove/alter out of date information. We found that some things that needed to be improved were addressed by the registered manager during and following the inspection. These included obtaining written confirmation from the Pharmacist and the General Practitioner that the properties of a medication being administered in a drink were not affected. We have made two requirements relating to medication which the manager has confirmed are being addressed. These related to the need to ensure that medication held and administered is prescribed and administered to a particular person. Care Homes for Older People Page 8 of 29 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 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A thorough assessment of peoples needs is carried out prior to admission helping to ensure that their needs can be met. More detailed information would help people make more informed choices. Evidence: There is a combined statement of purpose and service user guide, which provides information about the services provided at Polebrook Nursing Home. We requested an up to date copy, which we have reviewed following the inspection. The document was not dated, however it appears to have been partially updated as reference is made in some parts to the Care Quality Commission who took over the regulatory responsibilities for care homes from the Commission for Social Care Inspection on 1st April 2009. It does however contain information about categories of registration which are no longer used, indicating a need for a complete review. The statement of purpose does inform people how they are able to obtain a copy of Care Homes for Older People Page 11 of 29 Evidence: the most recent inspection report and there was also a copy available in the foyer. This helps people in making informed decisions when choosing a care home. A fee guide was attached to the statement of purpose, which gives a starting cost or residential care and also nursing care with examples of additional charges. It does not tell people if charges are the same for people who receive funding for their care and people who pay for their own care or what the full fee range is. This information is important in helping people to make informed choices, compare costs in care homes and also in planning their finances. The statement of purpose encourages people to visit prior to admission, which is important in helping people to see if the home will meet their expectations. We looked at the care file for someone who had recently been admitted to see how their needs are assessed, which is important in helping to ensure that they can be met. We found that a comprehensive assessment had been carried out which looked at peoples health and personal care needs and also at their social interests, hobbies and religious needs. Consideration was given to any specialist equipment that people might need. This detailed assessment is important in helping to determine if peoples needs and expectations can be met. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work with health professionals to meet peoples health care needs, though some improvements in the management of medication are needed to ensure it is safely managed within the legislative framework. Evidence: We looked at samples of the care files for four people to see how their care is planned and supported and how their health and well being is monitored. We found that there were care plans in place to guide staff in the care to be provided to meet peoples care and health needs. This is important in helping to ensure that people get consistent and appropriate care. People using the service or their representative had signed to confirm that they were in agreement with the care to be provided. Discussion with staff and where possible people who use the service confirmed that the care plans covered areas where care and support is required. A relative told us that they were very happy with the care provided. Some of the care plans contained fairly general statements such as has her hair cut and washed regularly. It is important that the plans are more specific to ensure that Care Homes for Older People Page 13 of 29 Evidence: peoples needs and expectations are met. It is not clear if the visiting hairdresser is to be used and if so how often. The term regularly will mean different things to people. We looked at a care plan and associated records for someone who is fed via a Percutaneous Endoscopic Gastrostomy (PEG) feeding tube. We found evidence that health professionals had been involved in giving advice to staff about the feeding regime and the care of the PEG and PEG site. Clear instructions were in place to guide staff in the care to be given. We discussed the care of one person with the nurse on duty whose records identified the presence of an infection. The nurse on duty contacted the Homeward nurse who provides advice on the care of people with PEG feeding tubes, for further advice regarding the care of this person. We spoke with a dietician and a Homeward Nurse who have been involved with the service and they told us that there have been improvements in the care provided to people with PEG feeding tubes. The Homeward nurse had provided staff with training and found they were very responsive to the guidance given and they have no concerns about the care being given. The registered manager told us that Polebrook Nursing Home receive a good level of support from health professionals in the area which helps them to meet peoples health care needs. They advised that there are difficulties in the area in obtaining dental treatment, however will continue to explore options for people. There are close links between Polebrook and the local General Practitioner. The majority of people at Polebrook Nursing Home are registered with her and she visits Polebrook twice a week and as and when necessary. The registered manager advised that there is regular telephone contact with the General Practitioner which allows any concerns or queries about peoples health to be discussed. We found that care plans were clear about any pressure relieving equipment that people required and that this was in place. We spoke with the Tissue Viability Nurse for the area who confirmed that necessary equipment is obtained as and when required. Care records show that the condition of any wounds is monitored. The Tissue Viability Nurse was contacted on the day of inspection by the nurse in charge for advice about a wound that was continuing to deteriorate. The Tissue Viability Nurse confirmed to us that staff seek advice appropriately and act on the advice given. We looked at a sample of medication and associated records to see if peoples medication is managed safely. We found that medication was securely stored and that records were in place to confirm medication that had been administered to people. We found that peoples medication is reviewed by the General Practitioner and altered as required. Care Homes for Older People Page 14 of 29 Evidence: A sample check highlighted that medication for one person with dementia was being disguised in a drink. The practice of administering medication covertly should only be given as a very last resort and it is important that there is evidence that a multidisciplinary decision has been made that this is in the persons best interests. We also advised that it is important that the pharmacist is consulted about each medication as adding it to a drink may affect the properties of the medication. Written confirmation of the advice was obtained from the General Practitioner and the Pharmacist during the inspection by the registered manager. The registered manager confirmed that she would seek advice about the application of Deprivation of Liberties Safeguards (new legislation which came into force on 1st April 2009) to ensure that all options have been explored and the persons rights protected. We found an example of an instance where one person had been given medication (a laxative) prescribed for someone else. While staff advised that this is a medication that can be purchased without a prescription and the General Practitioner had prescribed this medication for this person, it is important that medication is only administered to the person that the prescription label relates to as part of safe practice. Polebrook were holding a palliative care pack of drugs which were not prescribed for a named person.Staff advised that these were kept to help ensure they were available for anyone who may require them as part of end of life care. Records were kept of this medication and all were within the expiry dates. Following the inspection we have discussed the need for a home office licence with the manager who has advised that they will either apply or look at alternative arrangements. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People spoken with were satisfied with their daily lives, they enjoy the meals and activities, however the quality of life for people with dementia may be improved by providing more resources and opportunities for engagement. Evidence: Information is gathered as part of the assessment and care planning process about people and things that are important to them such as their families and information about their interests and what has been important to them through their life. This is important in helping staff to understand people and their lifestyle and meet their individual needs. People at Polebrook have a wide range of different needs and some are able to follow their own interests while others need support. We observed that one person with dementia was particularly restless. The care plan for this person stated that they were unable to join in activities as they were too restless but that they liked going for a walk. The registered manager took this person for a walk around the garden which they enjoyed, but they were very restless on return and continued wanting to be outside. There is not a safe enclosed area outside that people with dementia can safely access independently. There were also no activities or items to stimulate Care Homes for Older People Page 16 of 29 Evidence: peoples interest and provide opportunities for engagement for people on an ongoing basis on the dementia unit. The statement of purpose advises that there are no restrictions on when people receive visitors and this was confirmed by someone who was visiting a relative. Visitors were made welcome by staff, which is important in encouraging people to visit which often enhances peoples daily lives. The lunch time meal on the day of inspection was battered fish with a sauce, broccoli, peas and mashed potato. People confirmed that alternatives were available. There are two dining rooms and people are able to choose where they eat, with some eating from their arm chair and others in their room. People on the dementia unit eat in the dining room on that unit. We observed that a lot of people need staff assistance with their meal, which means that service of the meal takes quite some time for some people to get their meal. Staff were observed to sit with people and assist them appropriately where necessary. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that any concerns will be addressed and staff are aware of their responsibilities for safeguarding people who use the service. Evidence: The Commission for Social Care Inspection who were the regulatory body for care homes up until the 1st April 2009 received no complaints about Polebrook Nursing Home and the Care Quality Commission who took over the regulatory powers from 1st April 2009 have received no complaints. The annual quality assurance self assessment submitted by the registered manager in February 2009 stated that no complaints had been received in the previous twelve months. The manager identified the reasons for this as being that any problems or issues are dealt with as they arise. A relative and someone who uses the service told us that they had no concerns but felt able to raise any issues that they might have with staff and were confident that they would be addressed. The annual quality assurance self assessment submitted by the registered manager identifies the need to encourage people who use the service to raise any concerns without any fear of retribution. People we spoke with said they had no concerns about raising issues, however it is positive that the manager understands the need to keep reminding people of this so that any concerns can be acted on quickly. The registered manager and a staff member spoken with are aware of their Care Homes for Older People Page 18 of 29 Evidence: responsibilities in relation to safeguarding people who use the service. Referral to Northamptonshire County Council through safeguarding vulnerable adults procedures has been made with appropriate action taken to safeguard people who use the service. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home. Evidence: During this inspection we saw lounges and dining rooms and a sample of peoples bedrooms. All areas were clean and tidy and someone who uses the service told us that they were encouraged to bring personal items such as ornaments and pictures into the home to make their room more personal and homely. There is a glass ceilinged room in the centre of the home which is spacious and light, though people told us that unfortunately this room cannot be used in the summer due to the excessive heat. The day of inspection was quite a warm day for April and people were finding it necessary to move to other areas of the home. There is a separate unit for people with dementia which consists of a lounge/dining room with bedrooms off a small corridor. As detailed in the daily life section of the report although there are gardens, there is not a safe area which people are able to access independently which for some people may improve the quality of their lives. As also mentioned in the daily life section consideration of the environment in relation to peoples needs, for example with the provision of readily accessible opportunities for activity/engagement and stimulation may benefit people. Care Homes for Older People Page 20 of 29 Evidence: The annual quality assurance self assessment (AQAA) identifies that appropriate arrangements are in place for maintenance, decorating and replacement of equipment. Areas that have been improved include the provision of two wet rooms and the replacement of a bath hoist. However there is no mention in the AQAA of the action taken to protect people from the risk of burns from heaters and radiators without low surface temperature covers, which has been the subject of previous requirements. A member of staff confirmed that this work although not completed was ongoing. Priority had been given to areas where people were independently mobile and therefore at risk of falling and sustaining burns and this work had been completed. There is a member of staff employed full time to deal with any maintenance and decorating. The AQAA confirms that equipment is serviced regularly which is important for keeping both staff and people who use the service safe. A sample check of records confirmed this. The AQAA confirms that all staff have received training in infection control and a staff member spoken with confirmed that they had received this training. Staff were observed to wear protective gloves and aprons which is one measure to help reduce the risk of infection. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements support people who use the service. Evidence: People who use the service, staff and a relative spoken with were satisfied that there are generally enough staff to meet the needs of people. There was a member of staff short on the day of inspection due to someone being off sick. Staff were observed to be responsive to peoples needs during the inspection and presented as being caring and committed. The manager advised that it is rarely necessary to use agency staff which helps with the consistency of care. Staff confirmed that this was the case. There is just one registered nurse on each shift and we were advised that a senior care assistant supports the nurse in carrying some tasks such as setting up Percutaneous Endoscopic Gastrostomy (PEG) feeding systems. There was evidence from speaking to the member of staff and from looking at their records that they have received training to do this. The nurse on duty understood that she was accountable for the staff members practice. We have advised of the need for the accountable nurses to carry out and record regular reviews of staff competence to ensure safe practice. The sufficiency of nursing staff also needs to be kept under review to ensure that peoples nursing needs are fully met. Care Homes for Older People Page 22 of 29 Evidence: Following the last inspection and towards the end of 2007, some concerns had arisen about the management of Percutaneous Endoscopic Gastrostomy (PEG) feeding systems. The Primary Care Trust (PCT) provided additional training to help address the issues. Discussion with staff confirmed that they receive regular training and support and following the inspection we have heard from a member of staff from the PCT who told us that the training has been well attended by staff and the manager. This is important in helping to ensure that staff maintain their skills in specific procedures and people receive appropriate care. There is a company trainer who works to arrange and provide training for two care homes. In addition there is a member of staff who has been trained to provide some training. The notice board confirms that a variety of training is offered and available to staff. It was difficult to gain a clear overview of the training that the whole staff team had undertaken from the records available at the time of the inspection. We did however talk to a member of staff and look at a sample of records which confirmed that staff are receiving training. The AQAA confirms that fourteen out of eighteen care assistants have achieved a National Vocational Qualification in care. We discussed dementia care training and it was identified that staff have received some dementia awareness training and are then asked to complete a work book to test their knowledge. The manager acknowledged that dementia care training is an area where continued development is needed to ensure that peoples needs can be fully met. We looked at a sample of staff files to check the adequacy of the recruitment process in protecting people who use the service. We did find evidence to confirm that appropriate references had been obtained and checks made. The requirement made at the last inspection has now been met. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an experienced registered manager who works in the best interests of people who use the service. Evidence: There is an experienced registered manager in post who is a qualified nurse. The home appears to be well organised and managed. The registered manager was present on the day of the inspection and was receptive to advice given addressing and clarifying issues as they arose. Quality assurance systems are in place and this includes gathering views from people who use the service, relatives, and staff about the quality of care provided. The results identified that the majority of people were satisfied with their care. The results of the surveys had not yet been collated, however there was evidence from previous quality reviews that there is a process for addressing the issues and comments raised. The manager confirmed that this would be followed through. This is important in helping to ensure that peoples views are taken into account and where possible their Care Homes for Older People Page 24 of 29 Evidence: expectations met. Monthly unannounced visits are carried out by a representative of the company who report to the company and the registered manager on their findings regarding the quality of care and outcomes for people who use the service. This is important in ensuring that any shortfalls can be identified and addressed quickly. An annual quality assurance self assessment (AQAA) was submitted by the registered manager prior to this inspection. Aspects of the service that are done well and those that can be improved were included and acknowledged which is important in continuing to improve outcomes for people who use the service. The registered manager advised that no money is held or managed on behalf of people who use the service. Payment for additional services such as hairdressing and chiropody is dealt with by the company and people are then invoiced. This reduces the risks associated with holding cash on behalf of residents. We did not identify any health and safety risks during out inspection. Staff were observed to follow safe movement and handling practice when assisting people and confirmed that they have received training. The replacement/covering of radiators with high surface temperatures was continuing and staff confirmed that areas where these had not been done yet were those where people are not independently mobile. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5A People must have information about the full range of fees and of any differences in charges between people who have their care paid for, and those who fund their own. This is to help people plan their finances and understand the charges. Medication must only be given to the person for whom it is prescribed. To help ensure the safe management of medication and compliance with legislation. 17/08/2009 2 9 13 17/07/2009 3 9 13 If controlled drugs that have 17/07/2009 not been prescribed for a specific individual are to be kept a home office licence must be obtained. Care Homes for Older People Page 27 of 29 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 To help ensure the safe management of medication and compliance with legislation. 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 1 All information in the statement of purpose should be updated and reviewed regularly to ensure that all information is accurate and up to date including the categories of registration. In addition to the planned activity programme, explore the provision of readily accessible activities which would capture peoples interest, particularly those people with dementia. Consideration should be given to ways of reducing the temperature within the central glass ceilinged room. Consideration should be given to the environment in relation to meeting the needs of people with dementia. This may include providing a safe outside area. 2 12 3 4 19 19 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Older People Page 29 of 29 - 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!