Inspection on 24/03/09 for River View Day Care & Respite Centre

This inspection was carried out on 24th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

River View Day Care & Respite... 07/01/07

River View Day Care & Respite... 22/02/06

River View Day Care & Respite... 23/05/05

River View Day Care & Respite... 13/12/04

River View Day Care & Respite... 20/07/04

River View Day Care & Respite... 05/03/04

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: River View Day Care & Respite Centre Astor Drive Mount Gould Plymouth Devon PL4 9RD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Stella Lindsay     Date: 2 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: River View Day Care & Respite Centre Astor Drive Mount Gould Plymouth Devon PL4 9RD 01752253974 01752251618 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Plymouth Age Concern care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Age 50yrs Respite only Date of last inspection Brief description of the care home The previous inspection was carried out on 7th and 8th January 2007. River View provides day and respite care for older people who require this service due to dementia. River View as the name suggests has uninterrupted views over the Plym River. The service is run by Plymouth Age Concern. The building is located next to The William and Patricia Venton Centre, also a Plymouth Age Concern establishment. The day centre occupies the ground floor of River View, the respite residential unit occupies the first floor and the administrative centre occupies the second floor. Those Service Users resident in the respite unit are invited to attend the activities organised in the Care Homes for Older People Page 4 of 27 Over 65 6 6 Brief description of the care home day centre. The respite residential unit has a lounge/diner, kitchen (used for cooking simple meals and snacks), a bathroom, four single and one double bedroom. A washing machine has just been installed in a new utility room. The current charge is 68 pounds and 50 pence per 24 hours, and service users are expected to pay for their own hairdresser, for chiropody and for newspapers. Copies of the Service User Guide, including complaints procedure, are provided to each Service User as part of their initial assessment. Additional copies of the Service User Guide and Statement of Purpose are kept in the office at River View. As well as the residential respite facility, the service also offers a twelve week carers education course, a monthly carers support group, day care including an extended evening service, and support phone calls to carers of people who use the service. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This inspection took place on 24th to 26th March 2009. An Expert by Experience accompanied the inspector on the first day. An expert by experience is a person who either has an experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. Prior to the unannounced inspection we sent questionnaires to people who live at the home, and to people who work there. Nine service users or their representative and eight staff completed and returned these. The former Registered Manager sent us their annual quality assurance assessment (AQAA) when we asked for it. It was clear and gave us all the information we asked for. The AQAA is a self-assessment that focuses on how well outcomes are being met Care Homes for Older People Page 6 of 27 for people using the service. It also gave us some numerical information about the service. During our visit we spoke to five people who use the service, the Manager, training officer, Assistant Director and five other staff members on duty. We shared lunch with the service users, and joined their family carers for their regular monthly support group. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to the residents, met with them and made observations if they were unable to speak to us. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. What the care home does well: What has improved since the last inspection? What they could do better: We found that the early morning routines needed to be reviewed, in line with the person centred aproach of this service. Some residents may not wish to be woken Care Homes for Older People Page 8 of 27 early, and may not need to get up for breakfast at 8am. Management assured us there is no establishment need for the residential premises to be vacated at a particular time. Staff were keen to extend their training in dealing with challenging behaviour, and other training to enable them to enhance the lives of the service users. The organisation was planning to raise staff awareness of the relevance to their work of the Mental Capacity Act, and the Deprivation of Liberty safeguards. We were told that research was being carried out, to find a system of door alarms that would provide security while not impinging on peoples enjoyment of the service. Staff said that a different sound for each door would be ideal, so that they may know immediately which door had been opened, and ensure that service users are safe. Staff were vigilant to ensure residents safety, but were caused considerable anxiety by the current policy of not using the alarm system during the day, as the noise was disturbing for service users. This did not effect people staying in the residential suite overnight, as alarms were always turned on out of office hours, to ensure security. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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. Good information is given to service users and their carers before they come to River View. A contract is given before a residential stay. Full assessment of the service users needs is made before a service is offered, in order to reach the decision as to whether the service can meet these needs satisfactorily. Care needs are reviewed before each stay, so that staff may be kept informed of peoples changing needs. Evidence: Most people who stay at River View have previously attended for day care, so are familiar with the staff, and may already have visited the residential suite. Six of the nine people who returned our surveys said they had received enough information before their stay. Some of the others may have only attended for day care as yet. One carer said they had been sent a brochure beforehand, while another said, I was very impressed by the way I was welcomed, and knew my husband would be happy and Care Homes for Older People Page 11 of 27 Evidence: well cared for. The Statement of Purpose was being revised and up-dated by Senior Management, and was not seen at the time of this inspection. We saw the Service User Guide which included information about the admission procedure, saying that the initial assessment would normally be done by the care management team, but before admission a suitable member of staff from River View would visit the person at home to assure themselves that the centre would be able to meet their specific needs. We heard from carers, during the monthly Carers Group, that plans were being carefully made to reassure a service user who was due to stay overnight for the first time. Before any repeat admission, a Senior Carer phones the service user or their carer to ensure that all details on the care plan reflect their changing needs. Care Homes for Older People Page 12 of 27 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. Care plans were detailed in order to give staff clear information on how best to provide care. The care plans were reviewed frequently, in order to keep up to date with peoples changing needs. Medication was administered carefully. Evidence: We looked at four care plans in detail. They included good practical information to inform staff of the persons needs and how care was to be given. They were written with respectful language, and included the choices that each individual was capable of making. Risk assessments, for example with respect to falls or spilling hot drinks, included actions for staff to take to minimise risk. The sample that we looked at were all kept up to date. This represents very good work, as over ninety people currently use this service. River View does not have a hoist, and therefore is not able to care for people who are unable to weightbear. Staff told us that problems had arisen when peoples health was deteriorating, and they were sometimes able to stand, and not at other times. The Manager had arranged for multidisciplinary assessments of these service users, in Care Homes for Older People Page 13 of 27 Evidence: order to decide on the best way of providing their care in the future. Service users come from considerable distances, and not all are registered with a local GP. The Manager said that if a resident needed to be cared for and was not well enough to join the day care activities, she would be able to call in an extra staff member to ensure they had the attention they needed. The Director informed us that local GPs are not always prepared to register people as temporary residents when they come to River View for short stays, but they ensure that all service users have access to medical treatment if necessary as the local GP service has made a formal agreement to provide a service to respite residents. Advice to service users about the need to bring any medication in the original containers is included in the Service Users Guide. There is a suitable policy for the safe administration of medication, and a recognition that service users have the right to look after their own drugs, though none are currently assessed as able to do this safely. There is secure storage for medication, and the records kept were seen to be satisfactory. District Nurses had attended when invasive procedures were necessary (eg insulin injections). Care Homes for Older People Page 14 of 27 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. A good variety of creative and enjoyable activities are available, shared with service users coming for day care. Good meals are provided, with choice and variety. Evidence: The daily routine at River View is unusual in so far as the group of 1 - 6 people staying in the residential suite are joined every morning by up to twenty other people coming to the Centre for day care. Staff told us that the majority of the residents rise early of their own accord, but that all other residents are woken by Night Care staff, and taken a cup of tea. The team should consider each persons morning routine, in consultation with their family carer, and only wake them if there is a reason. During this inspection, staff told us they were unhappy that residents needed to be out by 8.30am when the cleaner finished the day care area, and moved to the residential suite. The Manager confirmed that the residential area does not need to be emptied for this purpose, and she would ensure that respite users would in future vacate their room at the time of their choice, or as agreed within their care plan, in accordance with the person centred values of this service. Residents have breakfast in the upstairs lounge/diner, then go downstairs to join social activities for the day. Service users are invited to join groups of 4 - 6 with a member of staff. They may stay in the lounge, sit Care Homes for Older People Page 15 of 27 Evidence: in the garden, or walk around the premises if they do not want to join a group, or are unable. Care staff may lead quizzes and word games. One Carer showed us a quiz which had been written by staff specifically for the residents, as they knew their interests and knowledge. Craft activities are broken down into small achievable stages to enable service users to produce quality work and raise their self-esteem - quote from the AQAA produced by the former Manager. There is an active and supportive Friends of River View group, who have provided materials and equipment for activities. Awards have been received for arts and crafts at the Skilled Hands Exhibition. Artwork produced by service users was included in a calendar produced by the Journal of Dementia Care. We saw artwork by service users displayed in the day care area, and consider that service users who stay in the residential part of the service should be consulted as to whether they would like art displayed there as well. Other groups have included toffee-making, a Light Bite Club, Seasonal Awareness, making gifts, and Getting to know you. A service user who was having a prolonged stay, told us that staff had taken him to see his wife in hospital. He also said he had enjoyed various activities, including skittles, during his stay. The main midday meal is brought in a hot trolley from a neighbouring Plymouth Age Concern establishment. A choice is offered. During this visit there was a choice of chicken or sausages. Staff asked people what they would prefer, and phoned their order through at 11.30am. They wrote the menu on a white board in the lounge, with drawings, to remind people of what they would be served. Soup is served every day, pea and ham on this occasion, with a choice of brown or white bread. Trifle was served for dessert. It was popular, and we did not see anyone offered or asking for anything else. We saw that fresh fruit and cheese and biscuits were available upstairs in the kitchenette. Staff told us that, Since the new Manager has arrived, meal times are less rushed. She saw that staff were spending time during the meal washing the soup bowls ready for pudding. This is a vital period when staff are needed for helping residents with their meal. Extra bowls were purchased so that washing up could wait till after lunch. We saw residents sitting comfortably with staff in the late afternoon when the busy day was over and most day care clients had gone home. We were pleased to see that there was no television in the lounge in the day care area, so people were encouraged and able to talk to each other. Staff told us that residents enjoy quizzes and dominoes, and sing-a-longs in the evenings, and in summer may sit in the garden and enjoy a picnic tea. We heard staff asking a resident what they would like for tea. Upstairs in the respite lounge, there is a television, and also some games. Care Homes for Older People Page 16 of 27 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. Service users are protected by the staffs skills of observation, and good communication between staff, service users and their families. Evidence: The Service Users Guide advises service users to bring any problem to the attention of the Manager and staff as soon as possible, and tells them that if this does not result in a satisfactory resolution, the Plymouth Age Concerns Complaints Procedure is displayed on the notice board by the entrance. No formal complaint had been received by the service or by the Commission for Social Care Inspection. The home had made efforts to keep open lines of communication with an initiative called carers support call, whereby the keyworker phones the informal carer to keep them up to date with what the service user has been doing in the centre, and to hear any comments, ideas or worries. There is also a monthly Carers Support group, held in the home. The Missing Persons policy had been reviewed, following an episode when a service user was unusually restless, due to a medical condition, and insisted on a bus ride. Community safety procedures were followed during the trip - quote from the report by the Director. Two staff accompanied the person to ensure their safety. The training officer gave us a chart showing staff attendance at training sessions, which showed that twelve of the 18 staff had attended a session on the Protection of Vulnerable Adults during either December or November 2008. A brief introduction is included in the induction training provided to all new recruits. The Manager showed us Care Homes for Older People Page 17 of 27 Evidence: a copy of their policy on Dealing with Abuse. It included the action to be taken in case of an allegation being made, and the Manager agreed to include the contact details of the local agencies who must be contacted, in case this should occur in her absence and have to be dealt with by a Senior Carer. Senior management would be available for support, as their offices are in the same building. Staffs responsibilities with regard to whistleblowing if they become aware of any bad practice, were brought to their attention at a recent staff meeting. The Assistant Director told us that over the next year they intend to provide training and in-house workshops to raise staff awareness of the Mental Capacity Act 2005 including the Deprivation of Liberty Safeguards, linking these to reviews of care plans and risk assessments. Care Homes for Older People Page 18 of 27 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. River View provides clean, comfortable and bright accommodation. It had been well maintained and decorated with the needs of the service users in mind. Evidence: The residential accommodation is on the first floor. There is a kitchenette and a lounge/diner, a toilet and bathroom and a utility room. There are four single rooms and one double, which is used by married couples or same sex people by mutual agreement. All rooms have magnificent views across the River Plym. They do not have en suite facilities. A commode can be made available. The unit was redecorated last summer, and the kitchenette refitted. It has a dishwasher and a microwave. Main meals are taken at lunch time, downstairs with day care clients. The lounge/diner was furnished with a gateleg table that can seat six people, but folds away when not in use. A large screen television and video recorder have been provided. New beds were provided, with colour co-ordinated bedding, duvets, pillows and curtains, and bedside lamps. Lockable storage space has been fixed in each wardrobe, in case residents wish to keep items of value. Red toilet doors and seats had been provided on the ground floor where service users spend a large part of their day, which are easier for people to see and recognise. They had not yet been installed upstairs in the residential suite. There was a small patio and garden area. This is important due to the beneficial feelings given by the fresh air and views across the river. There was free access to a small enclosed area where service users could sit outside in safety.The League of Care Homes for Older People Page 19 of 27 Evidence: Friends have given two garden benches, a pergola and additional plants. A new alarm system for external doors was being researched. The one in place was found to be too noisy, and not useful during the day as it went off too often, and staff did not know which door to go to. It was being used only in the evenings when the day care clients had gone home. The Manager was seeking an alarm that would make a different sound for each door, so that staff would know instantly where to find a resident who might be putting themself at risk. Staff told us thay they foind the current situation difficult, with constant anxiety that service users may leave the premises unaccompanied. They were vigilant to maintain safety, while also engaged in social activities with service users. A former bathroom had been converted into a utility room, with a washing machine. Previously all laundry had been sent to a neighbouring unit. We saw liquid soap and paper towels in the communal toilet and bathroom, plus disposable gloves and wipes, to avoid risk of infection. Care Homes for Older People Page 20 of 27 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. Recruitment practice is sound, so service users can be confident that they will be cared for by suitable people. Staff are well motivated and supported, and the training programme is being further developed to meet the changing needs of the service users. Evidence: We were given a staff rota, which confirmed what we had been told, that there are two staff on duty during the evenings when the day care clients have gone home, and two waking night staff. The Manager comes in at 7.45am, and though generally occupied in the office with the days arrangements, said she would assist with the residents if she were needed. Other staff arrive from between 8.30 and 10.30am, as more service users arrive. During this inspection this was sufficient, but some staff in surveys said they found mornings to be rushed. The need to review morning routines has already been recorded (Section 3, Daily Life). At this time there were no contracts for the provision of 1:1 staffing for any service users. We looked at the files of two recently appointed staff. All documents required to check for safety and suitability had been carried out. Records of their initial induction were on file. Induction training had included a day where new staff are given introductory presentations on Plymouth Age Concern as an organisation, Health and Safety at Work, Managing Aggression, Communicating with Older People, Understanding the ageing process, and Awareness of Adult Protection. These are introductory sessions to Care Homes for Older People Page 21 of 27 Evidence: major topics. One staff member in a survey said they had found it to be information overload. Another said they felt new staff did not have enough time to get to know how to meet the needs of service users. However, staff on respite shifts have ample time to read care plans. Recently recruited staff told us they felt it would be helpful to have time put aside to read care plans and discuss these with senior staff in River View. Although the respite unit accommodates a small number of people at any one time, the staff care for around 90 service users through the week. Day time is very busy with activities for day care attenders, and time to read is not likely to occur without planning. Staff told us they have time during their waking night shift to catch up on reading. The increasing severity of dementia of our clients means we need more training and support in how to deal with difficult situations, said staff who spoke to us and those completing surveys. Staff were keen to engage in training, and keen to learn about best practice in care of people with dementia. Plymouth Age Concern has its own training officer. She told us that staff are booked to attend training in dementia care provided by Plymouth City Council. She is trying to source training in Dealing with Challenging Behaviour, which staff told us they are keen to attend. A newly recruited staff member said they felt unprepared for leading groups in social activities, and would appreciate specific training. Senior staff in the team have the skills to provide this support. The training officer gave us a chart that showed good accomplishment of National Vocational Qualifications in Care at levels 2 and 3, as well as good attendance at First Aid training, and Protection of vulnerable Adults. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service is well managed in the interests of the service users and their carers. Evidence: The new Manager started work at River View on 5th January 2009, and told us she was in the process of preparing her application to register with the CSCI. She had a variety of appropriate experience. the former Registered Manager is now Assistant Director for Plymouth Age Concern, and still involved with the management of the service. Quality assurance is built into the work. When someone has stayed at River View, a letter is sent to the carer, inviting them to express their views on the service and how they benefited from the respite period, we were told in the AQAA. The service had been made even more flexible over the past year in response to listening to the carers. The opportunity of an extended day, by using the twilight service, enables carers to continue in employment, partake in hobbies, socialise, have extended family time and find time to relax and continue to care. Staff meetings had been held, and minutes showed a variety of concerns had been Care Homes for Older People Page 23 of 27 Evidence: aired, and that some staff felt confident in expressing themselves. Small amounts of cash were kept in the office for the convenience of a small number of service users. We checked one and found it to be accurate, though the recording was unclear because the form being used was not designed for this purpose. A column each for date, details, cash in, cash out, balance, and signatures would make audit clearer. The new Manager has started to implement a programme of supervision sessions, meeting with each staff member individually, to listen to anxieties as well as give feedback on performance and make sure they are aware of changes in policies. Safe systems of work were seen to be in place. Water temperatures in baths had been checked regularly. Fire safety equipment had been serviced professionally in August 2008 and the alarm system in October 2008. Professional staff training had been provided in November 2008, and a questionnaire given to all staff to check their awareness and knowledge of fire safety in March 2009. The Training Officer told us that they have in-house trainers for Moving and Handling. They were due to up-date their own training in May 2009, so will provide training to all staff following this. She said that Plymouth Age Concern aim to up-date this training for their staff every year. New recruits probationary periods are to be extended until this is accomplished. Care Homes for Older People Page 24 of 27 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 27 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 2 1 12 The Care Quality Commission should be supplied with a copy of the completed Statement of Purpose. Early morning routines should be reviewed for any resident who does not normally rise early, to ensure that arrangements may be made to suit them. The new door alarm system should be installed as soon as possible, to avoid potential risk of harm to service users. The Manager should review the method of record keeping for residents cash, so that it is easier to see the transactions and the balance. 3 4 22 35 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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