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Inspection on 03/06/09 for Stonecross Nursing Home

Also see our care home review for Stonecross Nursing Home for more information

This inspection was carried out on 3rd June 2009.

CQC 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.

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

Stonecross provided good written information about the services they provide, and the admission procedures were thorough and helped new people settle into the home quickly. People told us they were well looked after and received all the help and support they needed. We saw that people had been helped with their personal care and looked clean and comfortable. The staff worked well with other professionals including doctors and specialist nurses who visited the home. We received positive feedback from them in our surveys. There were good arrangements in place for people to access other health services such as the dentist, optician and chiropodist. Medicines were safely managed and staff were aware of any special precautions they needed to take with certain medicines. People told us they were able to make choices in their daily lives, to get up, go to bed, and spend the day as they wished. There was a range of activities and entertainment provided by a part time activity organiser and by visiting entertainers. There were regular visits from the clergy. People told us they enjoyed the quality and choice of meals served, and said that any special requests were catered for. There was frequent discussion with people about menu choices and their preferences. The home was clean and comfortable and was kept in a good state of repair. There was a choice of communal rooms for people to use and seating and sunshades were provided for the patio. The laundry was well organised with good infection control procedures in place and people said their clothes were nicely laundered. Staffing levels were sufficient to meet peoples` needs and additional staff were brought in for extra duties such as escorting people to appointments. Staff received regular training and were supported to gain National Vocational Qualifications in care and to complete distance learning study courses. People told us they liked the staff and that they were friendly and helpful. The manager had implemented quality assurance checks that included sending out satisfaction surveys to people and their relatives, and completing monthly audits of the homes` performance in key areas. Comments raised in the satisfaction surveys had been acted on and some improvements had been made to the building in accordance with peoples` suggestions. There were also residents and relatives meetings where people could voice their opinions and make suggestions.

What has improved since the last inspection?

Since the last inspection the manager and staff have worked on improving the quality of the care planning process, to make sure plans are detailed and up to date to guide staff in what people need and want. They have also improved wound care records, so they give clear instructions on the current treatment prescribed. Some environmental improvements have continued, with the two shower rooms completed and some further decoration. New towels, sheets, pillows and duvets had been purchased, and some new curtains and tumble driers were on order. A new security light had been fitted outside and the driveway repaired.Staff files had been re-organised, and new processes were in place to make sure that all checks on new staff were undertaken before they started work in the home. The number of care staff with a National Vocational Qualification had increased. Training for all staff had improved, and staff were being supported to complete distance learning courses through colleges of further education.

What the care home could do better:

The policies and procedures for the management of medicines should be updated to reflect current practices in the home. This is particularly in relation to how waste medicines are disposed of, and how people are supported to look after their own medicines if they wish to. There were some worn bedrooms carpets that should be replaced. Staff supervision should be more closely monitored to make sure all staff receive regular supervision sessions.

Key inspection report Care homes for older people Name: Address: Stonecross Nursing Home Milnthorpe Road Kendal Cumbria LA9 5HH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jenny Donnelly     Date: 0 3 0 6 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 28 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 28 Information about the care home Name of care home: Address: Stonecross Nursing Home Milnthorpe Road Kendal Cumbria LA9 5HH 01539721673 01539730752 stonecrosscare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Stonecross Care Limited care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing: Code N, to people 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: Code OP (maximum number of places: 38). Dementia: Code DE (maximum number of places: 5). The maximum number of people who can be accommodated is: 38. Date of last inspection Brief description of the care home Stonecross is registered to offer general nursing care for up to 38 older people, including 5 people with dementia cared for in a separate unit. The home tends to run at 36 places as double bedrooms are generally let singly. Stonecross Care Ltd operates the home; the registered manager is Mrs Susanne Edmondson who came into post in February 2008. The building is a three storey Victorian town house, set in the outskirts of Kendal. It has been adapted for its current use by the installation of a passenger lift, grab rails, and an extension to the rear. The home now has 34 single, Care Homes for Older People Page 4 of 28 Over 65 0 38 5 0 Brief description of the care home and 2 double bedrooms. There is a large lawned garden to the rear of the home, but as this has a steep gradient, it is not easily accessible to people, but is pleasant to look at. There are patio areas with seating and sunshades where people can sit out. The weekly fees at the time of this inspection ranged from £422.00 to £600.00, plus any registered nursing care contribution entitlement from the primary care trust. The home had information for prospective residents and their families, in the form of a statement of purpose, service user guide previous inspection reports. Care Homes for Older People Page 5 of 28 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: This was the main or key inspection for the year. The lead inspector Jenny Donnelly asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the the last inspection and for the plans for the coming year. This was returned to us by the date we asked. We also sent surveys to some of the people who live in the home, their relatives, the staff and health care professionals who visit the home. The information we gathered from the surveys is included in this report. Jenny Donnelly made an unannounced visit to the care home on 3rd July at 08.30 hours. During this visit we (the Care Quality Commission) toured the building, spent time in the lounges, and dining room where we watched breakfast and lunch being served. We spoke with people living in the care home and their visitors. We also spoke with the manager and the staff on duty. We looked at files and documents that backed up what we were told and what we saw. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? Since the last inspection the manager and staff have worked on improving the quality of the care planning process, to make sure plans are detailed and up to date to guide staff in what people need and want. They have also improved wound care records, so they give clear instructions on the current treatment prescribed. Some environmental improvements have continued, with the two shower rooms completed and some further decoration. New towels, sheets, pillows and duvets had been purchased, and some new curtains and tumble driers were on order. A new security light had been fitted outside and the driveway repaired. Care Homes for Older People Page 8 of 28 Staff files had been re-organised, and new processes were in place to make sure that all checks on new staff were undertaken before they started work in the home. The number of care staff with a National Vocational Qualification had increased. Training for all staff had improved, and staff were being supported to complete distance learning courses through colleges of further education. 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 28 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 28 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. There was good written information about the services and facilities provided by the home, and admission arrangements were thorough and helped to make sure new people settled in quickly and that their needs were met. Evidence: Stonecross had a written statement of purpose that tells people about the services and facilities they provide. We saw a copy of this was on display in the home and found it included all the information required by the care home regulations and this was a good resource for people interested in finding out about the home. The manager told us this had been updated recently to include some improvements to the environment. We also saw copies of a welcome pack in peoples bedrooms, which contained a summary of the same information. We looked at the arrangements for admitting new people to the care home, and found these to be thorough. Staff completed an initial enquiry form, and then arranged to Care Homes for Older People Page 11 of 28 Evidence: visit the person to carry out a detailed assessment of their health, personal and social care needs. We saw copies of these pre-admission assessments and found they were detailed and informative. These assessments were used to draw up an initial care plan for the person, so staff would know what they needed, and any necessary equipment could be ready for them. We also saw that the manager obtained copies of assessments by other professionals where appropriate, such as the persons social worker, the hospital or community nurse. People were welcome to come and look around the care home and on the day of our inspection, some people contacted the home to arrange such a visit. Care Homes for Older People Page 12 of 28 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. People felt well looked after and were receiving a good standard of personal and health care support delivered in a way that was acceptable to them. Evidence: People told us they felt looked after at Stonecross, saying, They take good care of us, I am quite happy here, this is a good home, and I get all the help I need. We saw that people had been helped with their personal care and were smartly dressed before coming out of their bedrooms to the lounge areas. People told us they were treated well and said staff were considerate when providing personal care, such as helping them to shower or use the toilet. Following the last inspection we made requirements that care plans needed updating, and wound care records and instructions for as required medicines needed improvement. We looked at a number of care plans including people who were new to the home, a person who had lived there for a long time, and someone in receipt of short term respite care. Some of these people also had wound care needs. We found that care plans had been kept under regular review and accurately described the care Care Homes for Older People Page 13 of 28 Evidence: and support people needed at that time. Risk assessments for nutritional needs, skin care and moving and handling had also been updated monthly. Where people had wound care needs, we saw that dressing plans were up to date and there was evidence of involvement by the tissue viability (wound care) nurse specialist, who told us that staff listened to and acted on her advice. We also saw that people received input from other health professionals such as their doctor, optician and chiropodist. One person attended a dental appointment on the day of our inspection and we saw that an extra member of staff was brought in to accompany her there. One of the doctors who visits Stonecross commented, excellent nurses that treat patients with respect. People, or their relatives, had signed their plan of care showing they had been consulted on its content. We inspected the management of medicines and found this to to be safe. Staff were knowledgeable about the medicines in use and understood when extra monitoring or precautions were needed. For example the nurses had put a lot effort into chasing up blood test results for a new person, as they were concerned about the amount of blood thinning medicine they were taking. Staff showed good practice in their handling of medicines and the medicines records were good. Where people needed as required medicines there was better information for staff about what this was for and when to give it. We noted that some of the medicines policies and procedures needed updating to reflect current practice in relation to the disposal of unwanted medicines and self administration of medicines. The manager said that all policies were due for review. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were able to spend the day as they wished, enjoyed the range of activities and entertainment, and were happy with the choice and quality of the meals provided. Evidence: People told us they were able to spend the day as they liked and could get up and go to bed as they wanted to. We arrived in the home at 08.30 am and there were a few people up and dressed in the lounge watching the morning news. They told us they liked to be up at this time and were looking forward to breakfast. We saw breakfast being served from 9 am onwards in the lounge and being taken up to people in bed. We saw an activity programme for the month was on display and this detailed the planned activities for three days each week, as well as religious services and visiting entertainers. There were photograph displays of recent events including a music hall event, a communion service, a darts championship and some animal visits. The activity organiser was on duty and we saw she spent time chatting with people outside on the patio, discussing favourite things and later ran a what the papers say discussion in the lounge. People told us the hairdresser visited regularly. People we spoke with said the meals at Stonecross were very good. We received one Care Homes for Older People Page 15 of 28 Evidence: survey that said, the food is good and wholesome, but I dont find it stimulating to one with a relatively small appetite. The chef told us that the nurses spoke with new people about their dietary needs and told the kitchen what was required. We saw that the chef had a list of peoples food preferences and any special needs. The chef said they were able to accommodate special requests and had recently purchased a particular brand of soft drink for a new resident. There was a four week menu in operation and this was on display in the lounge and dining room. There was a choice of two main courses at each meal and people ordered one day in advance. We saw that people chose where to eat their meals, using the dining room, the lounge, the patio or their bedroom. Visitors were also able to have a meal for a small charge. There were two new vending machines in the home, which the manager says were mostly used by staff and visitors. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People told us they felt happy and safe in the home and said that staff listened to them. Evidence: There was a copy of the complaints procedure on display that advised people to write to the manager or to the registered provider at the address supplied. It also gave people contact details of the Care Quality Commission and Social Services department. The manager had told us about four complaints made in the last year and we saw the records relating to these. The complaints included staff grievances and a care related complaint that the manager had investigated and responded to accordingly. People who completed our surveys said they knew how to raise concerns if they needed to, and people we spoke with on the day told us they had no complaints. Since the last inspection there had been a safeguarding investigation about an allegation of physical abuse against a resident by a member of staff. The manager had not referred this to the safeguarding team in accordance with local guidance, but conducted an internal investigation, after which no robust action was taken. Once the allegation came to the attention of the safeguarding team, via a member of staff, a police investigation was launched. At the time of this inspection a court case was awaited. During the safeguarding investigation the alleged abuser was suspended from duty, and no longer works in the home. Further to this investigation the Care Homes for Older People Page 17 of 28 Evidence: safeguarding team made a number of recommendations to the provider about their procedures. The local council temporarily suspended funding new admissions to the homes, until they were satisfied these recommendations had been met. This suspension has now been lifted. The manager and staff have received updated training in safeguarding procedures and at this inspection were able to explain correctly how to make referrals to the appropriate authority. Care Homes for Older People Page 18 of 28 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. People lived in a clean, comfortable home that was being well maintained. Evidence: Stonecross is a three story Victorian town house, set in the outskirts of Kendal. It has been adapted for its current use by the installation of a passenger lift, grab rails and an extension. There is a large lawned garden at the back of the home, but this has a steep gradient and is not easily accessible. There is a patio area with seating and sun shades where people can sit out. The home has a large entrance hall with a sofa and armchairs where people can sit. There is also a large lounge, a small lounge, a dining room and a conservatory. The conservatory is not much used, as its too hot in the summer, and has no heating or lighting for winter use. Soft drink and snacks vending machines had been installed in the small lounge and dining room. There is a further lounge on the top floor of the home. There are five bathrooms providing two large showers and three ordinary baths, two of which have a fixed bath seat. The two showers were being installed at the time of the last inspection and have proved very popular. The manager hopes to replace one of the baths in the near future. Bedrooms are situated on all three floors of the home and vary in size, shape and outlook. New curtains had been provided in two rooms and the manager said another Care Homes for Older People Page 19 of 28 Evidence: another four pairs were being made up. A number of carpets had been replaced over the last two years, but we saw three bedrooms still had poor carpets that need replacing. Laundry arrangements were good with sound infection control procedures in place, and we saw that peoples clothes had been nicely laundered. We were told two new tumble driers had been ordered and some new towels, sheets, pillows and duvets had been purchased. There were two domestic staff on duty and we found the home was clean, tidy and fresh throughout when we arrived in the morning, and stayed that way throughout the day. People told us they were comfortable living at Stonecross, and said the home was always clean. A new maintenance man had been employed since the last inspection and he was on site seeing to the general upkeep of the building. Care Homes for Older People Page 20 of 28 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. People were being cared for by staff who had been properly recruited and received appropriate training to help them do their jobs. Evidence: We looked at staffing rotas, spoke with people living in the home, and with the staff on duty. We also observed throughout the day and found that the home was sufficiently staffed to meet peoples needs. With 25 people in residence, there were two nurses and five carers on duty, with a sixth carer escorting someone for an appointment. There were also two catering staff, three housekeeping staff, the activity organiser and maintenance man. A new allocation list was in use, which set out what duties each staff member was responsible for and listed break times. The home also employs a part time administrator who was off that day. The registered manager was on annual leave, but attended for part of the day. We looked at staff training records, which were held in individual staff files, as well as on a central register. Staff also signed an attendance sheet to confirm they had attended the training sessions. The home employs 14 regular care staff of whom eight had completed a National Vocational Qualification (NVQ) in care, a further two staff had told the manager they also had an NVQ but she had not seen any paperwork to support this as yet. Four care staff were being supported by the home to complete an NVQ. Care Homes for Older People Page 21 of 28 Evidence: We saw that a lot of training had taken place over the last year including safeguarding training sessions using an external trainer as well as DVDs with written question and answer booklets. There had also been moving and handing training, fire safety, management of challenging behaviour, food hygiene, nutrition, management of pressure sores, catheterisation and blood taking. One of the registered nurses had been out with the local tissue viability (wound care) nurse specialist, learning more about wound care. We also saw that a number of staff had started distance learning courses in palliative care, medicines and dementia care. One of the staff surveys we received stated, training very rarely happens. The staff on duty told us they had received a lot of training and thought it had been beneficial. This was backed up the records we had seen. Staff we spoke with told us, the home is better organised, the allocation lists are good, the atmosphere is good, and there is good training here. Further to a previous requirement on recruitment practices, we checked the records of new staff members and saw that all checks including criminal records bureau disclosures had been completed, before people had started to work in the home. People told us, the nursing and care staff are very good and always available, Im very happy with home and the staff and, Im quite content and get all the help I need. Care Homes for Older People Page 22 of 28 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. Management of the home had improved following a recent lapse, people were being consulted, and their views about the service were being listened to and acted on. Evidence: The home manager Mrs Susanne Edmondson is registered with the commission and was judged suitably qualified and experienced to manage the service. We were told that staff meetings, and residents and relatives meetings take place regularly, and we saw the minutes of these, which showed what had been discussed. The manager had sent satisfaction surveys to people living in the home, and their relatives, last year and again this year. As a result of peoples comments, a new outside security light had been installed, some pot holes in the driveway had been filled, and the home had a real tree to decorate at Christmas. We looked at the latest questionnaires completed by relatives, and saw the responses were very positive. The manager had continued to complete a detailed monthly audit of the home. This Care Homes for Older People Page 23 of 28 Evidence: included checks on the environment, care and medication records, complaints, accidents, training and activities. The manager said these audits initially showed up some problems in the service, and she had produced action plans to address these. The more recent audits did not highlight any problems. Staff told us the registered provider of the home, Dr Sondhi, had visited twice in recent months, and the manager said he was always available for advice via the telephone. In April Dr Sondhi told us he had appointed an area manager to undertake monthly monitoring visits at Stonecross. We saw a written report of the April monitoring visit, and the manager told us she expected this to happen again shortly. Dr Sondhi had also told us that a nurse manager from another home would provide support and supervision to the manager at Stonecross, but this had not taken place. We saw that staff supervision had begun to take place more regularly, with each of the nurses responsible for supervising a number of care staff. From the records we saw not all the staff had received supervision this year, so this system needs firming up. The manager had not been supervised. Spending money was held on behalf of two people and we saw there were records kept of all transactions and the money was separately held and safely stored. Prior to this inspection the manager completed an annual quality assessment audit (AQAA). This asks for details of what has improved in the home since the the last inspection and for the plans for the coming year, as well as some numerical data. The AQAA lacked detail about these things, and we talked with the manager about how to improve this for next time. The AQAA showed that health and safety checks on the home and equipment had been completed, and during our inspection we noted the hoists had recent service stickers on them. We had became aware in April, through the safeguarding investigation, that the manager had been spending time at one of the owners other care homes, and was away from Stonecross. We do not think this was acceptable whilst there was an ongoing safeguarding investigation at Stonecross. The registered provider told us this would not happen again. Staff surveys we had sent out in March brought in some negative comments about the management of the home, saying, the manager is rarely on the premises, we get no support from the manager only from the deputy managers, and the manager only listens to some people who she likes. Staff we spoke during the inspection gave us different information stating that, the manager is supportive, she is now here every day and is always available and, we have regular staff meetings, supervision and training. The manager stated she was no Care Homes for Older People Page 24 of 28 Evidence: longer spending time in the other home. Care Homes for Older People Page 25 of 28 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 28 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 9 Medicine policies and procedures should be updated to reflect current practice in the home for the disposal of unwanted medicines, and there should be procedures in place for people to manage their own medicines if they wish to. The worn bedroom carpets should be replaced to provide people with a safe and pleasant bedroom. All staff, including the manager, should receive regular supervision to help them do their job well, identify training needs and develop their skills. 2 3 24 36 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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