Inspection on 15/07/08 for Signature at the Miramar (Operations) Ltd

This inspection was carried out on 15th July 2008.

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

Similar services:

Springfield House

The Shelley

Thorndene

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Signature at the Miramar (Operations) Ltd 165-173 Reculver Road Beltinge Herne Bay Kent CT6 6PX Lead Inspector Lisbeth Scoones Unannounced Inspection 15th July 2008 09:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Signature at the Miramar (Operations) Ltd Address 165-173 Reculver Road Beltinge Herne Bay Kent CT6 6PX 01227 374488 01227 749837 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wellbeing.Miramar@signaturesl.co.uk Signature at the Miramar Operations Limited Ms Lorna Lois Jennifer Pollock Care Home 82 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age - not falling within any other category (OP) Nursing physical disabilities (PD) The maximum number of service users to be accommodated is 82. 2. Date of last inspection N/A: This is a new registration Brief Description of the Service: The Signature at the Miramar is a newly built, large, detached and innovative project providing flexible person-centred full-time or respite care. As stated in the Statement of Purpose, “it is a modern, revitalizing, high quality alternative to a traditional care home. The Miramar is a wellbeing community with residents living in their homes and having real choices about the home care services and communal activities they choose.” The website states: “The modern alternative to a care home. Signature. Quality Care with all the comforts of home. Even your own front door”. The choice of accommodation comprises 10 en-suite rooms with showers, 17 one-bedroom apartments and 14 two-bedroom apartments. Accommodation is provided on three floors served by a passenger lift. Many rooms have spectacular sea views. The complex is surrounded by landscaped gardens and includes a sensory garden at the rear. It is situated by the sea in Beltinge village, close to Herne Bay, and is within easy access of the local village amenities. There is a main line railway station in Herne Bay and Beltinge is on several bus routes. The home is also easily accessible by car. Ample car parking is provided at the front of the property. The home is built adjacent to the old Miramar Nursing home, which is now closed. In due course the old building will be demolished and the current care complex extended. On completion, the new complex will be registered for 82 people. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 5 Weekly accommodation charges range from £660 to £ 935 for a shared apartment. Care is charged separately from the accommodation to reflect individual peoples’ needs. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Key Lines of Regulatory Assessment (KLORA) have informed the judgements made based on records viewed, observations made and written and verbal responses received. KLORA are guidelines that enable The Commission for Social Care Inspection (CSCI) to make an informed decision about each outcome area. The visit was carried out over two days and was the first inspection of the Signature at the Miramar. It comprised information gathered and received about the home since its registration on 25th March 2008. This included an AQAA (annual quality and assessment) completed by the registered manager prior to the visit. Comment cards were sent to residents and staff working at the home. Information thus received is incorporated in the report and was discussed at the visit. Discussions were held with the registered manager, the deputy manager, General Manager, Finance Manager, Administrative Manager, Care Administrator, nursing and care staff. Eight residents were met in private to discuss their views on the service provided. An accompanied tour of the building was carried out and documentation examined. The documentation included the Statement of Purpose, care plans and risk assessments, medication charts, policies and procedures, financial records, accident and complaint records and staff employment and training files. The CSCI has been made aware of one safeguarding vulnerable adults referral. This was investigated and has now been concluded. Three complaints have been received. The outcome of the home’s investigation was discussed at this visit. Residents who transferred from the ‘old’ Miramar are referred to as ‘residents’ while residents admitted to the apartments since registration are called ‘members’. For the purpose of this report all people who use the services are referred to as “residents.” Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: A Service User Guide is being prepared providing residents with information of the home’s services and facilities. Pre-admission assessments should clearly state identified risks and any adaptations needed to ensure resident’s safety and independence. The home should be proactive in making adaptations as soon as the need for these is identified. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 8 Care plans would benefit from audit to ensure that every resident has a comprehensive care plan. All current information in relation to care should be recorded. Minor changes in the recording of the administration of medication would ensure clarity. The home is planning the installation of a second clinical room. On-going difficulties with the nurse call system should be addressed. The home should ascertain why some residents and some staff say that there are not enough staff on duty. A resident said,” At times there appears to be a shortage of available care staff resulting in long delays in response to personal alarm call.” The home is in the process of updating staff training records and individual training profiles. The manager must ensure that the frequency of staff supervision complies with the National Minimum Standards. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is in the process of finalising its Service User Guide, which would provide residents with clear and detailed information. Every resident is provided with a contract or licence agreement setting out the terms and conditions. No resident is admitted to the home without a comprehensive pre-admission assessment thus ensuring that the home can meet their needs. EVIDENCE: The Statement of Purpose contains comprehensive details about all aspects of the running of the home. This includes details of the management structure, provision of medical care, facilities, meals and hospitality, visiting Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 11 arrangements, activities and accommodation. It includes a section on quality assurance and a copy of the complaints procedure. A Service User Guide is being prepared. Residents have access to the website. A high quality brochure is available. Residents who transferred from the ‘old’ Miramar are referred to as ‘residents’ while residents admitted to the flats since registration are called ‘members’. Residents’ original contracts continue to apply. New members are provided with a licence agreement stating the terms and conditions. Weekly fees quoted for members relate to the license agreement. Additional fees are charged for personal and nursing care. Pre-admission assessments are carried out by the registered manager or the deputy manager. Whist these provide detailed information, it was recommended that any environmental risks or shortfalls are identified and addressed prior to admission. A resident said that the home was not wheel chair friendly and related this to toilet facilities access and door handles that were too high. The registered manager is aware of these issues and has taken action. Another resident said that the new carpets make pushing a wheelchair difficult. See also standard 19. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Every resident who needs care is provided with a care plan setting out their health, personal and social care needs. Residents’ health care needs are met. Residents are protected by the home’s medication policy and procedures. Residents are treated with respect for their privacy and dignity. EVIDENCE: A sample of 5 care plans was viewed. Admission assessments included good information about all aspects of residents’ health needs, relevant social history and preferred activities. Care plans have a signed sheet at the front, showing that the plan of care had been discussed and agreed with the resident or their representative. As some of these dates go back some considerable time, it Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 13 was recommended that residents are also involved in care plan review and sign accordingly. Care plans are underpinned by a series of risk assessments such as pressure area care, nutrition, continence, mobility, pain management and communication needs. Risk assessments are completed for the risk of falls, use of bed rails and mobility risks. Life stories are included to demonstrate an awareness of previous work history, hobbies, family details, likes and dislikes, special memories, and religious preferences. Wound assessments and records of professional visits are stored in separate folders at the nurses’ station, with the daily reports. This enables quick access for ongoing care when doctors or other health professionals visit. Records of visits are well maintained, and show input from e.g. GPs, dentist, chiropodist, optician and physiotherapist. The registered manager said she is trying to access regular physiotherapy and NHS dental services. Wound assessments are well completed. Daily records had been satisfactorily completed. Whilst it is the home’s policy that care plans are reviewed monthly, there were some gaps in such reviews. One resident who had been at the home for over a month only had a care summary rather than a care plan. One resident’s care needs had changed and the care records not updated. The home has good policies and procedures for the safe storage, recording, administration and disposal of medication. Residents are encouraged to self medicate for as long as they can. Medication is stored in a locked clinical room. Staff reported that the space is very small. The registered manager acknowledged this and said that a second clinical room will be installed in the next few months. The home uses three trolleys, one for each floor. Three sets of medication charts were examined and had been well maintained. However, recommendations were made for clearer recording of staff initials, double signatures for all handwritten entries and to ensure that residents’ photographs are of a good likeness. The deputy manager said this would be addressed. Residents said that staff treat them with respect, and consider their privacy and dignity. Staff interacted with the residents in an unhurried and respectful manner. The home is able to meet palliative care needs. Many nursing and care staff have undergone specific training in this area such as syringe driver training, and use of drugs in palliative care. The registered manager is working towards a Master’s degree in palliative care. The home has taken on board specific pathways for management of end of life care. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home provides a very good range of varied and imaginative activities. There is a good choice of wholesome and varied meals. EVIDENCE: The home has two activities co-ordinators providing a wide range of ongoing activities for the residents to attend if they wish to do so. Residents spoken with said they were impressed with the range of activities available even though they did not always want to join in. A resident said she liked scrabble and old films. Another resident said she had enjoyed the Jazz event recently organised. Details of forthcoming events are displayed on notice boards around the home and in individual bedrooms. A Summer Fete is organised for 2 August 2008. On the day of the visit, several residents were entertained with ball games. The home has different activities available every day such as quizzes, bingo, Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 15 armchair exercises, cookery, games etc. Shopping trip and outings are organised. The home has an air-conditioned minibus. A hairdressing and beauty salon is provided on the ground floor. The Home makes its grounds available for the local community for activities such as fetes and flower shows. Visitors are made welcome at any time. The home has a kitchenette area and relatives/friends who visit frequently are advised that this is available for their use. Residents are encouraged to bring their own items of furniture and personal possessions. Care plans contain a property list to identify their own belongings. Residents are encouraged to manage their own finances if possible. For some residents the home manages small amounts of monies at their request. Good records of such transactions are maintained. See also standard 35. The kitchen was not visited on this occasion. Residents reported only positive views on the food provided. “The food is excellent.” “I like the cakes”. Menus were seen confirming choice and variety. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home takes all complaints seriously and acts upon them. Residents are protected from abuse. EVIDENCE: The complaints procedure is on display in the entrance hall and included in the Statement of Purpose. The procedure clearly states the pathways to follow for anyone who wishes to make a complaint. The complaints file was examined and demonstrated the action taken following a complaint. Currently there is one complaint not yet resolved which the registered manager is trying to conclude. Residents spoken with said they knew who to raise concerns with if that were necessary. The AQAA states that the Human Resources Manager will organise complaints management training for all staff that fully encompasses issues relating to gender, age, sexual orientation, race, religion or belief and disability. The registered manager is a qualified trainer for safeguarding vulnerable adults and delivers this training to all staff at induction. Updates for existing staff are provided on an ongoing basis. Staff have access to the Kent & Medway protocols for prevention of adult abuse. The home has made one referral to Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 17 the safeguarding vulnerable adults team and the investigation has been satisfactorily concluded. Staff have POVA and enhanced CRB checks carried out prior to employment, and confirmation of employment is dependent on 2 satisfactory written references. See also standard 29. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides a modern, spacious, light, clean, safe and well-maintained environment for the people who live there. The home provides sufficient equipment and facilities to meet their needs. EVIDENCE: The home is newly built and furnished to high specification. A tour of the home and grounds was undertaken. The people spoken with said they were very happy with their environment. Issues in relation to wheelchair users have already been referred to in standard 3. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 19 The entrance hall (concierge) and bistro area provide a welcoming feel. There is an adjoining lounge and restaurant where people have their meals. A private room is also available for people to use for parties and celebrations. The home has a sun lounge and landscaped gardens with raised beds. These provide a pleasant and tranquil environment including patio areas with outdoor furniture and a sensory garden. All are accessible by wheel chair users. The single rooms are furnished and equipped to a high standard. People who prefer to live in an apartment will need to provide their own furniture. They can choose to live alone or share with a partner or friend. Many rooms have sea views and a private balcony. The home provides two fully equipped assisted bathrooms For those residents requiring a high level of nursing care, profile beds have been purchased, which are designed to raise/lower the head/feet of the bed, or the whole of the bed. Other items such as pressure-relieving equipment are available. All residents have access to a nurse call system. The system is connected to a main computer and to all staff on duty via individual handsets. There have been some teething problems with the system, which the registered manager is trying to address. These relate to a high pitched sound and some residents’ perception that calls at times take a long time to answer. See also standard 27. The home employs a full time maintenance team who are responsible for repairs, maintenance and environmental checks. The home provides a clean and bright environment. Good clinical waste disposal systems are in place as noted in a clean sluice room. The registered manager represents care homes (nursing) on the PCT’s Infection Control Committee. The Housekeeping Manager said on a comment card, “ My role involves dealing with all aspects within the home to make a resident comfortable and welcome and ensure that every provision is made for that particular person’s needs.” A laundry service is provided and located on the ground floor. The AQAA states that a second sluice room will be installed in the next few months and an improved laundry included in Phase 2 of the redevelopment of the Miramar’s site. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The registered manager endeavours to ensure that staffing levels are adequate at all times. Residents are cared for by well-trained staff. Residents are protected by the home’s employment procedures. EVIDENCE: On the day of the visit, the home cared for 36 people. Staffing levels for the morning shift comprised two nurses and 9 care staff. For the night shift there are 2 nurses and 3 to 4 care staff. Whilst these numbers appear to be satisfactory, several residents and staff said that at times these levels were inadequate. Residents related this to the length of time they had to wait for their calls to be answered. The registered manager acknowledged that there have been teething problems with the nurse call system. A resident said, “ They turn it off without coming.” A staff member said, “The call system leaves a lot to be desired.” See also standard 22. A resident suggested that the home has “stand by” staff for when shortages occur. The registered manager said that she would like to enlarge the flexi Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 21 bank. The issue of adequate staffing was discussed at length and it was agreed that this would be further investigated. The role of support worker was discussed. Support workers are senior carers who support and monitor the care staff and undertake some nursing duties for which they have received training. A support worker said she enjoys her role and has achieved a NVQ level 3. A carer commented, “I was fortunate to have two weeks induction with a senior carer.” In addition to the nursing and care staff there are catering, activities, administrative, housekeeping, maintenance, gardening and reception staff on duty. The home is an accredited placement centre for student nurses from Christchurch University in Canterbury. Currently there is one student on placement. Each student nurse has a trained nurse as a mentor. Three staff files were examined and discussed with the Administrative Manager who is in the process of updating these and providing staff with a new contract and redesigned staff handbook. These contained the required documentation, including a full work history, 2 written references, NMC check for nurses PIN numbers, health questionnaire, and previous training records. Enhanced CRB (Criminal Record Bureau) checks are carried out prior to an appointment being offered. A copy of the comprehensive Training Directory 2008 compiled by the newly appointed Head of Human Resources was presented. The manager said that staff training records are currently being updated and that a training matrix is in place. Each member of staff will discuss their professional development with the Human Resources Manager and an individual staff profile devised. All new staff receive Skills for Care compliant induction. All staff attend all mandatory training. The company is committed to NVQ training and actively encourages staff to pursue further training. Recent training includes palliative care, wound care, infection control, PEG feeding, male catheterisation, venepuncture, continence assessments and peritoneal dialysis. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the people who live there. Residents’ financial interests are safeguarded. Staff are supervised though some supervision has been delayed. The home promotes the health, safety and welfare of the residents and staff. EVIDENCE: Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 23 The company provides a management structure with clear lines of responsibility and accountability. The registered manager is a level one registered nurse with a Diploma of Higher Education (Nursing) and is studying for a Master’s degree in palliative care. She has extensive nursing experience in a managerial role and was the Clinical Nurse Manager at the “old” Miramar. She is soon to start the RMA (registered managers award) training. In the AQAA, the registered manager said, “ we are adjusting to the new philosophy of care and we hope to constantly review and enhance this over the coming year.” It is evident that the registered manager has an open and inclusive management style. She is supported by a deputy manager who has a joint management/clinical role. Quality Assurance is high on the agenda. The home is keen to ensure that the residents’ views on the service are ascertained and a recent quality assurance survey (June 2008) has been carried out. Residents’ meetings are held regularly, chaired by the deputy wellbeing manager and minuted. Information is disseminated to staff through staff meetings and staff newsletters. The registered manager and deputy have a visible presence in the home, and obtain further feedback via one to one conversations. Monthly visits are carried out by the Responsible Individual, who is involved in the general management and oversight of the home. There was evidence of regular review of policies and procures and regular audits are carried out. These audits include medication, nursing care and pressure ulcers. Some residents have requested that their personal allowances are managed in house. The Finance Manager demonstrated that these are stored separately and safely. Records of any transactions are maintained and audited. Staff are formally supervised although for some staff there has been a delay. Nursing staff receive additional clinical supervision. They are delegated to manage supervision for care staff. The home provides a safe environment. Maintenance certificates were not inspected at this visit as these were all in order at registration. Accident records are well documented and audited. Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 3 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Signature at the Miramar (Operations) Ltd DS0000071735.V368659.R01.S.doc Version 5.2 Page 27 - 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. 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