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Inspection on 15/09/09 for St Dominic`s Nursing Home

Also see our care home review for St Dominic`s Nursing Home for more information

This inspection was carried out on 15th September 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a detailed and informative Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. Some residents were able to confirm that they were visited by the someone prior to admission to the home and two relatives said they were involved in the admission process. The menus evidence a well thought out balanced diet with a varied choice of food in line with residents preferences. Quality assurance systems are in place which enables the service to monitor and improve their service and ensure that the home is run in the best interests of residents. There is an open-house policy which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents finances. Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The Comments received from visitors and families regarding the care received included: ` Very good care, they are very supportive of us and always keep me updated`. Comments from residents regarding life in the home were generally positive and included `I have been here for a long time and like it`, `I havent been here long but its quiet and peaceful`, `I am comfortable`.

What has improved since the last inspection?

At the last key inspection there were no requirements made. Improvements mentioned in this section are commented on from information received about the service, the site visit and from the AQAA completed by the home. The AQAA states that training has improved and that in the last twelve months: 5 staff have gained an National Vocational Qualification in care. All care staff are being offered the opportunity to achieve ASET Level 2 in Dementia Care. All domestic and kitchen staff are being offered the opportunity to achieve NVQ Level 2 in Support Services. The head cook has attended Safer Food Training and has worked with the trainer in-house to ensure processes and documentation meet standards. Regular refresher/introductory sessions on a range of topics to meet the changing needs of residents. Infection control measures are now more robust and therefore promote the health and well being of the residents.

What the care home could do better:

The care documentation needs to demonstrate that a full needs assessment has been undertaken and provides a clear person centred plan of action for staff to follow to meet in meeting individual care needs. This will ensure that residents needs are met in a clear, safe and consistent manner. Wherever possible the plan of care should be discussed with the resident and/or their representative. The residents would benefit from a programme of activities that meets their social and recreational interests and needs. Feedback from residents and their families included, `I do get bored` ` The residents need more mental stimulation` `Trips out would be good` ` I would enjoy more attention`.

Key inspection report Care homes for older people Name: Address: St Dominic`s Nursing Home 71 Filsham Road St Leonards On Sea East Sussex TN38 0PG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Calveley     Date: 1 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: St Dominic`s Nursing Home 71 Filsham Road St Leonards On Sea East Sussex TN38 0PG 01424-436140 01424460767 stdominics@asterhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: St Dominic`s Ltd care home 91 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 91. The registered person may provide the following category/ies of service only: Care home with nursing - (N) 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) Physical disability (PD) Dementia (DE). Date of last inspection Brief description of the care home St. Dominics Care Home is a large property in a residential area of St. Leonards-OnSea. It is registered to provide personal and nursing care for up to ninety-one older people, including those with physical disabilities and dementia. The home is arranged over four floors. A large passenger lift enables access to all floors. The residents accommodation is currently arranged over the upper three floors Care Homes for Older People Page 4 of 29 Over 65 0 91 0 91 0 91 Brief description of the care home and each floor has its own lounge. Many of the rooms have lovely views, either towards the sea or over the surrounding countryside. Outside there are parking facilities to the front of the home and a large garden to the rear. There are plans to landscape the gardens so as to improve access for the more physically frail people who use the service. The weekly fees range between £500 and £650. Fees are based on the assessed needs of the prospective resident. The fees do not include items such as hairdressing, newspapers and telephones in the rooms of residents. Further information in respect of fees can be obtained from the home on request. 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: one star adequate 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at St Dominics will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with residents representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 15 September 2009. There were 47 residents living in the home on the day of which five were case tracked and spoken with. During the visit eight other residents, both male and female were also spoken with. The purpose of the inspection was to inspect all key standards and talk to the people who use the service. A range of documentation was viewed Care Homes for Older People Page 6 of 29 including the Service Users Guide, Statement of Purpose, care plans medication records and recruitment files. Four members of care staff, two registered nurses and the cook were spoken with in addition to discussion with Mrs Stratford who is the registered managher of the service. Telephone contact was made with visiting professionals following the visit and two relatives were spoken with during the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment (AQAA) was received from Mrs Stratford, completed in the main competently and in full prior to this key inspection. The information received in the AQAA was measured against the information gathered on the site visit. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? At the last key inspection there were no requirements made. Improvements mentioned in this section are commented on from information received about the service, the site visit and from the AQAA completed by the home. The AQAA states that training has improved and that in the last twelve months: 5 staff have gained an National Vocational Qualification in care. All care staff are being offered the opportunity to achieve ASET Level 2 in Dementia Care. All domestic and kitchen staff are being offered the opportunity to achieve NVQ Level 2 in Support Services. The head cook has attended Safer Food Training and has worked with the trainer in-house to ensure processes and documentation meet standards. Regular refresher/introductory sessions on a range of topics to meet the changing needs of residents. Infection control measures are now more robust and therefore promote the health and well being of the residents. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home its facilities services and the costs involved The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission however little information is documented thus not evidencing their needs can be met Evidence: There is a comprehensive Statement of Purpose and Service Users Guide which contains clear information about the home the facilities and the services it provides. These are given to prospective residents and a copy is placed in all bedrooms. These documents give prospective residents and their families the information they need to make an informed choice about where to live. The documents do need to be updated to reflect the correct details of the commissioning body, the management structure of the home and the recently registered beds for people who have a dementia type illness. Care Homes for Older People Page 11 of 29 Evidence: It was confirmed whilst talking to residents that the contract arrangements were clear and understood. A review of the care documentation confirmed that pre-admission assessments are completed by the manager or senior nurse. The format of the pre-admission document was seen to be relevant however more information could be recorded, which will inform the inspection process and ensure that the home can meet the identified needs. The prospective residents are seen either in their home or hospital before admission and it was confirmed that wherever possible the family or representatives are involved. One visitor confirmed that they were involved in the whole admission process. A recommendation of good practice is that the venue and all the people involved in the assessment are documented. The manager was able to verbally demonstrate her knowledge and awareness of the different specialties required in the home. She ensures that carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. The completion of an extension to the home has enabled the home to admit people who have a dementia type illness. The home have not yet employed a registered mental health nurse (RMN) but it was confirmed that all staff have attended training in dementia awareness. Trial visits to the home can be arranged. Mrs Stratford confirmed that residents are invited to a trial period to ensure suitability of the home. This is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Intermediate or rehabilitative care is not provided at St Dominics Care Home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive care plans are needed to enable staff to meet the assessed needs of residents in a structured and consistent manner. Residents are protected by the homes medication policies and procedures. They are treated with respect and dignity. Evidence: The care documentation pertaining to five residents were reviewed as part of the inspection process. These residents were also visited and spoken with. It was found that there was no evidence of a full assessment of needs having been undertaken and there were no clear care plans in place to guide staff in meeting needs in a consistent way. The home use risk assessment tools with comments that highlight certain areas of need and these did evidence monthly review but little room is available to document changes in the residents condition and this could cause confusion and misunderstanding. Care Homes for Older People Page 13 of 29 Evidence: It was a concern that specific care plans had not been put in place for those residents that have a swallowing deficit, communication problems, identified weight loss, continence, aggression, behavioral problems, end of life care and bowel changes. For example: One resident was identified as at risk from tissue breakdown but there was no action plan devised for staff to follow in preventative methods particular to that person. Another resident pre admission mentioned vacant episodes, pacemaker and epileptic fits but the care documentation did not mention any of these and therefore staff are disadvantaged by lack of knowledge of health ailments. These shortfalls do not demonstrate a person centred approach to individual care. The care plans also do not evidence any involvement of resident or with their representative. The staff write daily notes and these were seen to be inconsistently completed and some comments were written in an unprofessional inappropriate manner. The staff spoken with demonstrated an understanding of the individual residents they care for and questions that arose from reviewing the care documentation were answered with insight and from knowing the resident well. However if staff have been away from the home or have just commenced employment the available care documentation would not enable or guide staff to care for the residents in a consistent and safe manner. Relatives and residents spoken with were satisfied with the care provided at the home one saying that the home they are very kind, My husband gets very good care Staff are efficient, courteous and very kind. There are policies and procedures in place for staff to refer to regarding the safe administration, storage disposal and recording of medication. The systems for recording and checking controlled drugs were found to be thorough. Medication Administration Charts were found to be in the main competently completed. The medication round observed demonstrated that staff were aware of the homes policies and residents are protected by safe medication practices. Staff were seen to be respectful and considerate to all residents and visitors whilst attending to their needs. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing and their personal appearance was attended Care Homes for Older People Page 14 of 29 Evidence: to in manner that maintained their dignity. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle and meals experienced by residents at this time does not always meet their expectations choices or preferences. Evidence: The care documentation evidenced some residents past histories and social preferences but they are not linked constructively to a formal activity programme. The home have a selection of lounges throughout the home and some residents were seen to be quite isolated during the morning, with no company and little supervision. Whether residents are offered a choice of lounge was not clear. The AQAA and Service Users Guide stated that twice a week activities are arranged and include yoga and tai chi. Visiting entertainers are invited to the home at certain times of the year. During conversation with Mrs Stratford the registered manager she stated that one to one sessions with the residents takes place regularly but this is not documented. There are plans to employ an activity co-ordinator which will benefit the people who use the service From direct observation on the day of the site visit no activities were planned or undertaken. It was confirmed by staff that the residents are encouraged to attend facilities away Care Homes for Older People Page 16 of 29 Evidence: from the home these include shopping trips church services and visits out with their families. It was not clear from documentation how often these take place. One resident said that I spend my time in the lounge,I prefer the quiet Not a lot happen, would like to spend time outside in the nice weather. Relative feedback included, More mental stimulation is required, not much is arranged unless the person is fit enough to exercise. Activities should be an important part of life to the residents living in St Dominics and therefore it is identified as an area that requires development. This is to ensure that the lifestyle they experience matches their expectations and preferences and meets their interests and needs. This was discussed in full with Mrs Stratford during the inspection. Residents are facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents. Many of the residents have individualised their bedroom with items from home. Residents and relatives spoken with confirmed that they are encouraged to make it homely. It was observed during the inspection that the routines at the home are flexible, residents spoken with confirmed that they were consulted about their normal daily routine. The home has an advocacy policy in place and the information regarding this is available to all residents. There are various dining areas throughout the home and some residents eat from small tables from their chairs in lounge areas and their bedrooms. The staff were seen to assist residents with their meal in a discreet and supportive manner. It was also nice to see residents families joining them for lunch. The menus demonstrated that there is a varied and nutritious menu in place which changes seasonally. The meals provided for residents were seen to be nutritious and attractively presented including the pureed meal. Fresh fruit and vegetables are readily available. Following discussion with residents it was noted that breakfast is limited to porridge, cereal and toast, some residents said that they would like a chance to have a boiled egg or cooked breakfast occasionally. The residents comments included, The food is good, We get a good variety Its really ok. The staff keep fluid/food and stool charts in residents bedrooms, however not all were up to date and correctly completed which then gives an inaccurate picture of their Care Homes for Older People Page 17 of 29 Evidence: nutritional status. From discussion with staff it is said that they do not keep daily records of residents food consumption. This needs to be commenced so as to pick up appetite traits early. The home staff use a nutritional assessment tool to identify any residents with special dietary needs Monthly weights are recorded but some were seen to be inconsistent and there was no evidence of a care plan to monitor and address this. As previously mentioned an action plan needs to be in place for those whom have been identified as at nutritional risk. 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. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. Evidence: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated during the site visit. The home has received two complaints since the last inspection. Residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the protection of vulnerable adults and staff have received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. There has been one safeguarding referral since the last key inspection. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Dominics provides a comfortable, clean and safe environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room and rooms are homely and reflect the residents personalities and interests. Evidence: St Dominics is a large home that has recently had an extension added on, the home is now registered for 91 residents. The layout and location of the home is suitable for its stated purpose. The extension provides single ensuite accommodation for 40 residents, communal areas and a large purpose built laundry. The extension has been built to a good specifications and furnished to a high standard. The older part of the building is quite dated with tired decor. There are plans to follow a refurbishment and redecoration plan now that the building work is completed. The maintenance team is at present depleted and therefore progress is slow. There were some aspects of maintenance that needs to be attended to prevent falls and trips. Some maintenance issues that were outstanding were identified to Mrs Stratford. A recent visit from the Health Protection Agency raised some concerns in respect of infection control measures in the home. These were discussed and followed up during this key inspection Polices and procedures for infection control are in place and have been updated. These include an outbreak policy as requested. Sluice areas have been Care Homes for Older People Page 20 of 29 Evidence: cleared of clutter and old and stained equipment and appropriate soiled laundry bins are in place. Appropriate storage has now been found for incontinence pads. It was noted however that bathrooms are being used as storage areas for mops and buckets( some with used water in) and this practice needs to be reviewed. Rubbish bins are in use without an appropriate lid and these need to be replaced. These shortfalls were fully discussed and attended to so a requirement has not been made at this time. Good practice by staff was observed during the day in the usage of gloves and aprons and these are now stored appropriately to prevent cross infection. The cleanliness of the home was generally good with no malodours. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient suitably qualified staff on duty to ensure that residents receive the level of care they need. Staff training ensures they are aware of their roles and are able to provide the support and care the residents need. Evidence: The staffing rota was viewed and the staffing levels were seen to be sufficient to meet the needs of the residents at this time. However staff were seen to be stretched at meal times and this needs to be monitored. It was confirmed by the manager that there is flexibility of the staffing levels and they are adjusted according to the changing needs of the residents. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. There is an induction programme in place which is in line with Skills for Care. This has been introduced for all staff. Files seen confirmed this. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the manager. Staff and the training list seen Care Homes for Older People Page 22 of 29 Evidence: confirmed that training is in place to enable them to care for the residents competently and safely. The manager has introduced a training matrix which enables the management team to track the training needs. Staff are all encouraged National Vocational Qualification training (NVQ), at present 13 of the 23 permanent care staff have a NVQ. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents financial interests are safeguarded and the safe working practices of the staff promote their safety. Evidence: The manager, Mrs Stratford was registered as manager just under two years ago. She has completed the Registered Managers Award and is a level one registered nurse. She has the necessary qualifications and experience to run the home effectively. Until recently she worked very closely with the nurse director who took the lead in the inspection process. The director has recently left and this is the first key inspection Mrs Stratford has been involved in. The staff spoken with said that they felt supported by the management structure of the home. Residents were aware of whom the manager is and of her role in the home. Mrs Stratford has addressed some of the recommendations made by the Health Protection Agency but as identified there is still considerable work to be done on the care documentation. The quality assurance systems in the home include questionnaires sent out to Care Homes for Older People Page 24 of 29 Evidence: residents and relatives following admission to the home. The formal quality assurance and quality monitoring systems has enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. The quality assurance results have recently been audited and action taken to address any suggestions of improvement. The results are also included in the Statement of Purpose for interested parties. There are no residents at present who are responsible for their own finances. Relatives and solicitors support the majority. The home holds small amounts of residents personal allowances. There are safe procedures in place for managing this which ensures that residents financial interests are safeguarded. Staff supervision was discussed and staff supervision is in place. Staff spoken with confirmed that they receive regular supervision. All staff have received the mandatory training necessary to promote and protect the safety and well being of the residents. The manager confirmed that all staff are appropriately supervised until they have received the necessary training. Good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 That the registered person 29/11/2009 ensures that after consultation with the service user or their representative a written plan of care as to how the service users needs in respect of their health and welfare are to be met. that the service users health, personal and social care needs are set out in an individual plan of care thjat guides staff in meeting their needs consistently. 2 8 12 That the registered person 29/11/2009 ensures that there are appropriate assessments in place with clear guidance to promote the health and well being of the service users. In respect of Swallowing, nutrition, bowel management, behaviour and communication. Care Homes for Older People Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action That service users health care needs are managed safely and effectively. 3 12 16 That the registered person ensures that service users are consulted about a programme of activities that is based on their intrests, preferences and social needs. That services users are offered a lifestyle that meets their intrests and expectations. 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 29/10/2009 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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