Inspection on 19/11/08 for Prospect House Nursing Home

This inspection was carried out on 19th November 2008.

CSCI found this care home to be providing an Excellent 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

Prospect House Nursing Home 10/01/07

Prospect House Nursing Home 22/02/06

Prospect House Nursing Home 15/07/05

Prospect House Nursing Home 11/11/04

Prospect House Nursing Home 11/05/04

Prospect House Nursing Home 22/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Prospect House Nursing Home High Street Malpas Cheshire SY14 8NR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anthony Cliffe     Date: 1 9 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 29 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Prospect House Nursing Home High Street Malpas Cheshire SY14 8NR 01948860011 01948860006 peterhowell@prospecthousemalpas.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Anne Leslie Type of registration: Number of places registered: Prospect House (Malpas) Limited care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: Staffing must be provided to meet the dependency needs of service users at all times and shall comply with any guidance that may be issued through the Commission for Social Care Inspection The regsitered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection This home is registered for a maximum of 44 service users to include:- * Up to 44 service users in the category of OP (Old age, not falling within any other category) * Up to 9 service users in the category of DE(E) (Dementia over 65 years of age) in receipt of personal care only * Up to 4 service users aged 40 years and above in the category of PD (Physical disability) * Up to 1 service user in the category of TI (Terminal illness under 65 years of age) Care Homes for Older People Page 4 of 29 Over 65 9 44 0 0 0 0 4 1 Date of last inspection Brief description of the care home Prospect House is a large detached house located in the Main Street of Malpas Village. The building is close to all local services, public amenities and local transport. Most of the accomodation is provided in a purpose built extension. Access to the service is located to the side of the building and is accessible to those with mobility difficulties. The home has an internal passenger lift and staircase to the first floor bedrooms. The second floor contains the administration offices. Bedrooms are mainly single but some have double occupancy and some larger bedrooms are available to accomodate couples. Most bedrooms have en suite toilet facilities. Bedrooms contain connections for a television or telephone and have a call point. There are six lounges/sitting areas and a dining room. There are front and rear gardens and an enclosed rear garden to which people that use services have direct access. Both nursing and personal care are provided at the home as well as intermediate, respite and day care. Fees for those funded through the local authority or Primary Care Trust are at a locally agreed rate and the standard weekly fee is five hundred and thirty nine pounds per week. People that choose to use the services can obtain information about the home including a copy of the last visit report directly from the home or from the homes own website. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: References to we or us represent the Commission for Social care Inspection. This unannounced visit took place on the 19th November 2008 and lasted Nine hours. One inspector carried out the visit. As part of the inspection we were accompanied by an expert by experience who is someone who has experience of using care services. The expert by experience helps us get information to make judgements about the quality of life that people that use services have when using a care service. This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what Care Homes for Older People Page 6 of 29 they thought they did well, what they needed to do better and what they had improved upon since the last visit, to provide up to date information about the service provided. This helps us to determine if the management of the home see the service they provide in the same way we do and if our judgements are consistent with home owners or managers. We provided questionnaires for people that use services, staff employed at the home and social and health care professionals involved in their care to find out their views about the service the home provides. During the visit various records and the premises were looked at. People that use services were spoken with and gave their views about the service. We also received questionnaires from staff that said the home had good recruitment procedures and staff received excellent support and training. In March 2008 we did an annual service review of the home, which told us the home was still providing a good service but had also made further improvements. An annual service review is a summary of our knowledge about how a service that has not had a visit in the last year. It is also how we decide if a service is still as good as we thought it was since the last visit or annual service review. What the care home does well: What has improved since the last inspection? The recruitment of staff had improved so that previous errors that allowed staff to have contact with people that use services before the required employment checks were in place were not repeated. Care Homes for Older People Page 8 of 29 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided for people that use services so they can make an informed choice about using the service. Information is gathered about their needs and choices so they receive regular consistent care. Evidence: We looked at the information that is given to people that may choose to live at the home which is called the statement of purpose. This provides information on the aims objectives and arrangements of how people that live at Prospect House are cared for. This also included information that Prospect House offers respite and day care and the arrangements for these. The home offers services to people with dementia and the provider said he was looking at how he could provide an information sheet on dementia to people that may wish to live there or their relatives so they had information on some of the common features of dementia. Care Homes for Older People Page 11 of 29 Evidence: People that choose to use the services were provided with information about the home including a copy of the last visit report. The home had its own website so information can be obtained directly from this. The statement of purpose included a lot of details on the facilities and services that were available at the home and included a copy of the contract and fees for services so people where aware of how much their care cost. The information on fees had been revised in September 2008 and the standard weekly fee was five hundred and thirty nine pounds. The information also included details on peoples rights to treatment under the National Health Service and how the people that live at Prospect House have a say in how the home is managed and developed. The statement of purpose said that people would be respected at all times and that whatever their religious beliefs, cultural background, sexual orientation or if they were disabled they would be treated with dignity and respect. The home has a contract for one intermediate care bed with the local primary care trust. At the time of the visit the home had arranged for someone to use this. The home do not always have the opportunity to gather information on people that use the intermediate care service as they usually come straight from hospital so rely on information from other professionals involved in the their care. The home use a very detailed document to gather information on people using the intermediate care or respite service. This document had been developed between the home and the primary care trust so consistent information about people that use services would be provided and the home could provide appropriate care to people using these services. The document allowed information to be gathered about people that use services inclusive of personal details, medical history, social contacts, religious beliefs, wishes around death and dying, personal and health care needs inclusive of personal choices about their care and routines so important information was available to staff about their needs. Information about mental health could be gathered and this information could be transferred into a care plan that people could see and sign to say they agreed to the information so they could agree their care . The document also included information on how known risks to the health and safety of people using services were recognised so plans were in place to maintain their safety. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services receive their care with dignity and respect but their care plans need to reflect more personal information about them so care staff can provide consistent care based on their decisions and routines. Administration and management of medicines was safe so people that use services were supported to take their medicines safely. Evidence: We examined the care records of two people that use services.The home demonstrated a strong commitment to involving people that use services in their daily lives. The records we examined had care plans relating to their health and personal needs. These were reviewed every eleven weeks with people that use services, their representatives or families. A relative said that the reviews every eleven weeks were an opportunity to have your say and worked well as the visitor had agreed routines about her mothers personal care. The care plans we looked at were revised regularly and demonstrated positive outcomes for people that use services. An example of this was a persons health improving and medicines prescribed for a medical condition being discontinued. Care Homes for Older People Page 13 of 29 Evidence: Care plans could be improved by them reflecting more personal information about people that use services such as their level of independence to care for themselves, their preferred daily routines and how they make choices about when and how they receive personal care so they provide more details about the lifestyles and choices of people that use services. Staff have the right skills to recognise when people that use services need to be seen by their doctors or other health professionals such as a general practitioner, dietitian, optician or dentist so they had access to appropriate health care. A person that used the service talked about receiving new hearing aids. She said staff had helped her get these and these where better than her old ones. She said she enjoyed her stay at Prospect House and that she was very well provided for. One of the senior staff is the link nurse on tissue viability and had done additional training on this. Her role within the home was to contact the tissue viability nurse or doctor if necessary but could prescribe dressings for pressure or leg ulcers. The home use the Liverpool care pathway for end of life care. This was not in use at the time of the visit as people that lived at Prospect House were enjoying good health. The home is working toward the gold standard framework for palliative and end of life care with the local primary care trust. This includes training for both registered nurses and care staff and links with the local hospice for training and guidance. We could see by examining the records of three people that use services that their health care needs were met. The home has regular weekly visits form local doctors to look at the health of people that use services. The local doctors also provide a summary of medical conditions in case an emergency doctor is called and the doctor does not know the people that live at Prospect House so consistent information is provided about their needs. As part of the visit a local doctor returned a survey to us and said staff always sought and acted on advice about the health care needs of people that use services. The doctor said that Prospect House always did things well. We looked at the arrangements for receipt storage administration and disposal of medication including controlled drugs. The arrangements were satisfactory and the recording of the administration of medicines was good with no missing signatures found so staff follow the policies and procedures of the home. We found one minor error where the amount of medicines received for one person had not been recorded. Some people that use services kept their own prescribed inhalers. Their prescribed medicines were recorded as received on their medicine administration records and no gaps were found on the administration sheets. Each month the manager does an audit Care Homes for Older People Page 14 of 29 Evidence: of the medicines inclusive of expiry dates of medicines. We checked the arrangements for the receipt, storage, administration and disposal of controlled drugs and all where correct.The home had the correct containers for the disposal of medicines including controlled drugs. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services make decisions about their lives, take part in a range of activities and have a well balanced diet so have control over their lifestyle. Evidence: The home employs an occupational therapist and additional staff to plan and assist with activities. At the time of the visit one of the activities staff was helping people that use services to make lavender bags. They seemed to enjoy the activity and the majority were involved. There were details of the weekly activities and events planned in the home displayed around the home so people had information about planned activities taking place. For example people that use services had been involved in a quiz and keep fit session. People that use services spoke positively about the activities staff and made positive comments about their commitment. People that use services said they enjoyed living at Prospect House. One person said I was isolated and lonely at home but here I have friends. I have been here a year and it has been a happy wonderful year. I have made a friend and we spend time together. I always join her for breakfast. I do the things I did at home at the same times. Theres no regimentation or routine. Care Homes for Older People Page 16 of 29 Evidence: There were examples of the arts and craft that people that use services had made and they showed them of proudly. The home keeps photographs of all events and a senior staff member attended a presentation at the local senior school as the school had received an award for work in the local community , which involved people that live at Prospect House. The home is a member of the national association for the provision of activities and during the summer was involved in competitions the association arranged. People that use services were involved in a growing a sunflower competition, bringing the garden inside and treasure hunt competition. The expert by experience talked to people that use services about their experiences of living at Prospect House and shared a meal with some of them. They saw the weekly activities programme was displayed in the reception area with something arranged for each day including Sundays when the programme Sunday papers and coffee morning and songs of praise in the afternoon so people that use services have a variety of activities available to them . The expert by experience said the most common word used by staff to people that use services was choice. Regular visits from clergy for communion and spiritual support is arranged. A visitor said that she visited her mother most days and the flexible visiting helped fit in with work. She said that she always felt welcomed and was offered a drink or could make herself one. People that use services were able to have their own mobile or telephone in their bedroom so could contact relatives and friends privately and cordless telephones were available. People that use services said they were assisted with personal care in their bedrooms or bathrooms. People living in the garden room that was a self contained area where people that experienced memory loss mainly lived were encouraged to mix with other people using the service. The garden room has an electronic lock on the entrance to it and some of the people that use services knew the code to this. One of the people living in this area said, its not to stop us going out its for our safety. We can come and go as we please but if youre not from around here and you go out you can easily get lost. The dining areas were bright and airy. Fresh flowers were placed throughout the home and on dining tables. Tables were set for breakfast and lunch with table clothes, condiments, cutlery, napkins, cups and saucers and either juice or hot drinks that people that use services could serve themselves with. Menus were displayed on dining tables so that people that use services had information about the choices of meals available. Meals were served in two sittings so people that needed more help and time could be served first. Meals were ordered the previous day with people that use Care Homes for Older People Page 17 of 29 Evidence: services and there was always sufficient food prepared to take account of changes of mind. A visiting relative said, I see staff assisting my mum and other residents to eat, they are never rushed and have as much time as needed. Staff ask them what they want for their lunch and then explain they are going to help them. Staff sit next to them and constantly explain what they are doing and helping them with. People that use services said staff were respectful and staff were seen helping them during meal times and during the day. Staff anticipated the needs of people that use services but never tried to rush or do things for them. They encouraged them to be independent and help themselves. The expert by experience shared lunch with people that use services. The expert said that meals were served on warm plates, was attractive, well cooked and generous. Comments such as better than the Ritz, always good, nothing is too much trouble to make sure you get what you want, just as I would cook myself those were made. Care Homes for Older People Page 18 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. Policies and training on promoting the welfare and safety of people that use services protect them from the risk of possible abuse, harm or injury. Evidence: We had not received any complaints about Prospect House and the home had not received any complaints. No complaints were referred to in the information sent to us by the home. The information given to people that use services by the home called the service user guide contained details of how to make complaints. The owner said this could be made available to people that had problems within hearing or vision so people that use services could have the information provided for them should they wish to use the complaints procedure. The home had Information on the local councils safeguarding adults procedure.The safeguarding procedure is how the local council and other agencies involved respond to and manage allegations of abuse against vulnerable adults. Information on safeguarding form the local council was available on the staff notice board so staff had the information on what to do should they suspect that people that use services were being abused or neglected. Since the last visit the home was involved in a safeguarding allegation. The home responded to this positively by cooperating with the Care Homes for Older People Page 19 of 29 Evidence: local council in investigating the matter and as a result changed the safeguarding policy and procedure in the home without being asked so takes the protection of vulnerable adults seriously. The local council praised Prospect House for the management of the situation. We looked at safeguarding training within the home and records for staff recorded that staff training was ongoing throughout 2007 and 2008 with staff receiving annual training on safeguarding adults so staff were aware of the policies and procedures to follow should they suspect neglect or abuse of vulnerable adults. People that use services told the expert by experience they could approach any member of staff should they have concerns. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well maintained so people that use services live in a comfortable homelike environment. Evidence: The manager had attended a seminar run by the Health and Safety executive on health and safety in care homes in order to ensure the home complies with health and and safety regulations so people that use services live in a safe home. A staff member had been appointed to monitor the standards in bedrooms to ensure these were maintained. People that use services could bring their own items of furniture to the home and bedrooms were seen to be personalised with items of furniture, photographs, pictures, ornaments and electrical items. The first floor bathroom has been refurbished and twelve bedrooms redecorated. New dining room furniture has been purchased for the garden suite and there were plans approved by the local council to build a large conservatory onto this suite. In the garden suite the doors of the bathrooms and toilets had been painted different colours so people that use services could distinguish them from bedroom doors. This would be further enhanced if the home introduced aids to assist people with memory loss such as memory boxes next to their bedrooms so they could recognise their own bedroom. Bedroom doors had a picture of the person occupying this and the staff Care Homes for Older People Page 21 of 29 Evidence: member responsible for their care to aid them identify their bedroom. All staff had attended training on health and safety and infection control so were aware of safe hygiene standards. Domestic staff were seen working throughout the visit and the building was clean. There is a maintenance plan in operation and the home had employed a second handyman. At the time of the site visit the call system was being serviced and some bedrooms being redecorated so the home was maintained to a safe and homelike standard. Care Homes for Older People Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate employment policies and procedures and training are in place so staff are recruited and trained and safe systems of care provided for people that use services. Evidence: Staff retention was good with no agency staff used and staff recruitment planned in advance. The home employed thirty care staff. Two of these had an NVQ level 3 qualification and two staff were completing the NVQ level 3. Twenty staff had an NVQ level 2 qualification. Staff received a pay rise for completing NVQ qualifications. We examined the files of four staff employed by the home and all the required employment checks had been carried out prior to employment. This included a Criminal Records Bureau (CRB) disclosure and where necessary a PoVA First check. Staff were not permitted to work with people that use services until their CRB had been received or were supervised when a PoVA first check was completed so people that use services could be confident they were protected from harm. Staff were provided with job descriptions and contracts of employment, so were aware of their responsibilities and the accountability of their jobs. Care Homes for Older People Page 23 of 29 Evidence: We looked at the training records of four people employed at the home. All staff undertake an induction programme and received update training. The induction programme was based on the Skills for Care induction standards. This commenced with two days working alongside the staff team but not as part of the staff rota so staff had the time to familiarise themselves with the building and people that use services. Following the two days staff then commenced a twelve week induction course during which they completed mandatory training courses so they are provided with training and skills to support people that use services. The home had introduced a new induction training record for staff. Following training staff had to complete questions on the training they had completed so they could demonstrate they had understood the training and how the training was incorporated into their work. A staff member spoken with about the induction training said , Im learning a lot of new things. I go home and write about what I have learnt so Im able to show I understand the policies and procedures. We are shown with permission from residents how to learn practical skills like shaving a man or helping with personal care. We have twelve weeks to do our induction and are given time to learn. Staff are provided with an induction pack or handbook, which consisted of a word to staff, confidentiality, the General Social Care Council code of conduct and the homes policies and procedures. During induction staff are allocated a mentor to support them and have twelve weeks to work through the policies and procedures. Care Homes for Older People Page 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is forward thinking so that people that use services benefit from living in a home that is focused on promoting their independence, choice, health and welfare. Evidence: The manager and a registered nurse held the registered manager award and the deputy manager was working toward this. The owners work at the home on a daily basis and have regular contact with people that use services and staff so there is a strong management team that communicates well. All policies and procedures had been revised in 2008 inclusive of the safeguarding adults, induction and supervision policies so people that use services were cared for by an informed staff team. A new system for gathering the view of people that use services is to be introduced in 2009 . Previous visits confirmed a robust quality assurance system was in place. The owner was using our AQAA as a quality assurance Care Homes for Older People Page 25 of 29 Evidence: measure to make judgements on how the service was improving and areas for improvement. The home does regular checks on the standard of meals, risk of falls, records and medicines management as part of the quality assurance system. The call system that had been installed was able to monitor staff response times to how long it took staff to answer calls for assistance from people that use services so staff performance could be monitored. The owner had employed an organisation to look at how the home manages health and safety practise and from this new health and safety risk assessments had been introduced. The home use an annual survey for people that use services to complete and provide their view and comments on how the home is managed so they can comment on how the home is managed. The survey for 2008 was available so people that use services could see how their comments contributed toward the development of good practise. Questions were asked about the quality of information provided to people that use services, quality of communication in the home, attitude of staff, quality of nursing practise, quality of personal care, quality of activities, quality of meals, quality of housekeeping and overall quality of the home. Overall people that use services rated the service provided as excellent. The home had robust financial procedures.The home does not hold or manage the finances of people that use services. People that use services were sent bills for any services not included in the contract for services they receive. The required maintenance and testing had been completed so that people that use services lived in a safe environment. Care Homes for Older People Page 26 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 27 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 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 The home should improve how the personalisation of the care of people that use services are recorded in their care plans so staff and others involved in their care understand how important peoples routines and decisions are to them and how these are transferred into how they receive care The home should improve the signage for people that use services who experience memory problems so they can recognise their own bedrooms. 2 19 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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