Inspection on 29/04/09 for Sunrise Operations Tettenhall Limited (Assisted Living)

This inspection was carried out on 29th April 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.

Other inspections for this house

Sunrise Operations Tettenhall... 10/04/08

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Sunrise Operations Tettenhall Limited (Assisted Living) 73 Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN     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: Rosalind Dennis     Date: 2 9 0 4 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 26 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 26 Information about the care home Name of care home: Address: Sunrise Operations Tettenhall Limited (Assisted Living) 73 Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN 01902774100 01902774101 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sunrise Operations Tettenhall Ltd care home 70 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 70 The registered person may provide the following category of service only: Care Home with Nursing (Code 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 othr category (OP) 70 Date of last inspection Brief description of the care home Sunrise Operations Tettenhall Ltd was first registered with the Commission in October 2007 and incorporates an Assisted Living and Reminiscence neighbourhood-these are registered with the Care Quality Commission as two separate services and are available as two inspection reports. Both services work closely together and this is reflected in the content of the inspection reports. The purpose built service provides spacious accommodation of a high standard. The Assisted Living service is registered to provide accommodation, personal and nursing Care Homes for Older People Page 4 of 26 Over 65 70 0 Brief description of the care home care to seventy older people and the Reminiscence service is registered to provide care to twenty-five older people with dementia. Accommodation is provided in apartment style rooms and each apartment is very well-equipped with its own spacious hallway, kitchenette and en-suite shower and toilet facility. Some of the apartments are shared in that people have their own private bedroom, but they share bathroom facilities, kitchenette and hallway areas. The service is surrounded by well-kept gardens and patio areas, which are easily accessible for people who may have mobility difficulties. There is level access to the main reception area on the ground floor and a lift provides access between the ground and first floor. The home is near the village of Tettenhall which has an assortment of shops and community facilities such as a library. There is car parking at the rear of the building and a local bus service stops nearby. Information on fees is included within the Residents handbook. Prices vary according to the type of apartment, services and level of care required by the person. The reader is advised to contact the home to obtain up date information on the fees charged. The last key inspection of this service was undertaken on 10th April 2008. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out mainly over one day, but we also met with people and staff on a second day whilst we were inspecting the Reminiscence service which is in the same building. The home did not know we were going to visit. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about events that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment. (AQAA). This is a document that Care Homes for Older People Page 6 of 26 provides information about the home and how they think that it meets the needs of people living there. Four people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive , discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. A sample of care, staff and health and safety records were looked and we also looked around some areas of the home to make sure it was warm, clean and safe. Some people who live at the home were able to comment on the care they receive and their views have been included in this report. Other people were not able to fully communicate their views and we observed how staff interacted with them. We obtained feedback from visitors and spoke with the manager, Ms Bev Turner and staff on duty. Three staff completed surveys for us during the inspection and provided their views on the home, what has improved and what could be done better. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? 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 8 of 26 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 9 of 26 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. People can be confident that when they move into the home they will have all the information they need about the home and that their needs will be met. Evidence: Since the last inspection, the home has registered with us to provide nursing care this means people who have nursing needs can be admitted to the home. We spoke with three people who have nursing needs, and they confirmed to us how their needs are met at the home, they also described how a representative from the home had been to meet with them prior to their admission. We looked at their care files which showed that the manager and a nurse had conducted a pre-admission assessment of their needs. For another person, due to be admitted on the day of inspection, we saw that the executive director, who is a nurse had been to conduct an assessment of their needs whilst they were still in hospital. Observation of these preadmission assessments demonstrates that the service seeks information to ensure that peoples needs can be met at home. We saw that the information which is obtained is then Care Homes for Older People Page 10 of 26 Evidence: used to plan peoples care. There is a range of information available, including a statement of purpose, which provides clear information on the aims and objectives of the service and a Resident handbook which is informative and easy to read. Both documents can be made available in alternative languages or formats, such as large print so that people with different communication needs can access information about the home. Information on how Sunrise structures its fees and care packages is included within the Resident handbook as well as information on services which incur additional cost. People confirmed to us their awareness of the fee structure and they had a contract with the home. One person spoke with us about how it appears some people are receiving more care input than others, but recognised that this could because people are receiving different packages of care. The home does not provide intermediate care, a form of intensive rehabilitation, but does provide care to people who need assistance to recuperate and improve their independence prior to returning home. The home continues to provide care to people who may only need a minimal amount of care input and we spoke with two people who described how they enjoy maintaining their independence, but like the security of knowing staff are around if they need them. The manager spoke with us about some of the challenges which initially occurred when admitting people with nursing needs and how the service has adapted accordingly, for example people who are more independent generally now live on the ground floor and people needing nursing care are cared for on the second floor. A survey completed by a member of staff for us commented the introduction of nursing into the home is beginning to come together and another staff member commented there can be difficulties of residential and nursing mixing, this has been addressed where possible due to residents differing needs but could progress further. This identifies that the service needs to keep under review its provision of nursing and residential care. Care Homes for Older People Page 11 of 26 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 are pleased with the care they receive and care plans provide staff with the information they need to ensure peoples health and personal care needs are met . Evidence: People we spoke with gave positive feedback about how they are cared for and viewed their needs are met at the home. We looked at a selection of care files which shows people have care plans and risk assessments in place, which provides staff with information on how people want their needs to be met taking into account any risks to the individual. The people we spoke with confirmed their awareness of their care plans that either they or their significant other had signed to provide confirmation that their care plan had been drawn up and agreed with them. Care plans provided a good amount of detail, for example for two people who need assistance to move, their care plan described the equipment and techniques needed by staff to move them safely. We later saw staff using the equipment safely and as described in the care plan. Another care plan we saw described how the person has a specific need regarding their diet, and we observed that their lunchtime meal had been prepared to take account of this. In each care file was detailed information about the person before Care Homes for Older People Page 12 of 26 Evidence: their illness, their lifestyle and factors which are important to them such as their cultural and religious needs and care plans incorporated this information. Discussions with staff demonstrated their awareness of this information, which helps to ensure people are treated as individuals. For people who do not need nursing care, we saw documentation which shows that the home seeks advice from community nursing professionals, such as District Nurses when needed. In all files we saw that the home contacts health professionals including GPs when there are concerns about peoples health and well-being. Two visitors we spoke with confirmed that the home keeps them informed of any changes to their relatives condition and they are pleased with this regular contact. We observed that, for people assessed as being at risk of developing pressure sores they had specific mattresses on their beds which are designed to reduce the risk of pressure sores occurring. Care plans were in place to describe the care needed, however we found that assessments of one persons pressure sore risk score had not been reviewed for several months and we brought this to the attention of the lead nurse. It is expected that the risk score is updated on a monthly basis or as conditions change, so that staff can see if a persons risk of developing pressure sores has altered. The home had completed risk assessments for people at risk of falling out of bed and we saw that written permission had been sought for the use of bed rails, and we observed that bed rails had been fitted in accordance with relevant guidance regarding their safe use. A staff member had commented in a survey that less paperwork would be beneficial and our discussion with senior management during the inspection confirms that the home is in the process of reviewing and streamlining care documentation so that it is more applicable to people with nursing needs, easier to use and thus reduce the time taken to complete it. We looked at a selection of medication administration records (MAR) charts, these showed that medication had been recorded accurately with all medication signed and accounted for. Peoples care plans contained information on medication and any sideeffects, so that staff know what to look for and take action. If people are assessed as being able to administer their own medication then the home has robust processes in place to enable this to be carried out safely, including secure storage in bedrooms. We found that staff monitor the temperatures of the medication storage room and medication fridge to ensure that medication is stored at the correct temperature. All people spoken with confirmed their privacy is maintained and that staff treat them as individuals. Staff were seen throughout the inspection checking if people were comfortable and needed anything. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in activities and events which meet their needs, capabilities and preferences and they are supported to maintain their independence as far as possible. People are offered an excellent choice of meals which meet their dietary, cultural needs and preferences. Evidence: People confirmed that regular activities and events take place at the home, which they can take part in if they choose. One person spoke of how they are a member of the Domino club and had enjoyed playing dominoes on the morning of the inspection, they also spoke about how they prefer to listen to music in their own room and that staff respect the choices they make. We saw people enjoying sitting in the garden after lunch, with staff supporting people who needed assistance to walk. During the afternoon of the inspection a Residents Council meeting took place which was well attended by people living at home, relatives and members of staff. These meetings take place on a regular basis and provide a forum for people to make suggestions for improvement and observation of written minutes for these meetings show that activities and meals are discussed, with action points produced so that people can see how the home will introduce any change. Specific staff are employed by the home to Care Homes for Older People Page 14 of 26 Evidence: organise and provide activities and we saw training records which demonstrate that all staff attend a training session as part of their induction so that they are aware of the importance of meeting peoples social care needs. The home aims to offer a choice of at least five activities a day and an activities plan is displayed in the reception area which provides an overview of the activities intended for that week. This includes opportunities for exercise, baking, computer activities, arts and crafts, religious and spiritual observance, as well as opportunities for visits to the wider community. A computer with full internet access is available for people to use. There is an inclusive atmosphere within the home, which enables people with varying skills and abilities to try out and be involved in activities if they choose. Each person has an activities record, which details the activities they have participated in. These indicated a range of activities on offer for people if they wish to participate in them. The manager confirmed to us that the home is continuing to look at ways of developing activities for people who are less mobile. The home has its own minibus, although it is not currently used because there is not a suitably qualified driver. This was raised and discussed with the Executive Director who confirmed that alternative transport arrangements, such as taxis are used so that people are able to access events in the wider community. The manager described how people are encouraged to invite visitors and during the inspection visitors were seen coming and going and all confirmed that they are made to feel very welcome. A Bistro area is located near the entrance to the home, where refreshments are readily available, as well as a selection of newspapers and magazines and people were regularly seen meeting up to chat with their visitors and other people who live at the home. A very high standard of restaurant style dining is provided. The meal served on both days of inspection was well presented and people spoke of their satisfaction with the standard and quality of the food. A menu is displayed to enable people to make an informed choice and alternatives to the menu are always available. If people are less able to make choices than the home seeks to establish individual likes and dislikes and keeps records so that staff are aware of these. From observations and discussions with people it is apparent that the home places great emphasis on ensuring people receive well-balanced and highly nutritious meals. The home is able to cater for special diets for cultural or medical reasons. We observed staff using good approaches with people who need help with eating and drinking and staff were observed providing people with regular drinks throughout the day. Care Homes for Older People Page 15 of 26 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 complaints procedure, which provides people with information so they know how to complain and ensures concerns and complaints are acted upon. Staff are provided with training to equip them with the skills to safeguard adults from harm. Evidence: All people spoken with during the inspection confirmed they would feel comfortable in raising any concerns with the manager or other staff and felt confident their concerns would be dealt with quickly. The complaints procedure is displayed in the reception area and is also available within the service user guide (Residents Handbook), copies of which we saw in peoples rooms. People also receive a copy of the procedure on their admission and sign to confirm receipt, which provides clarity to ensure everyone receives a copy. The procedure provides people with clear information on the process to follow and who to contact if people want to complain. The manager confirmed that no complaints have been received by the home. We have not received any complaints. People living at the home stated they feel safe and staff are kind in their approaches with them. On commencement of employment staff receive copies of relevant procedures and policies to safeguard adults from the risk of abuse and to support staff to report poor practice (whistleblowing). Information was also available to show that staff receive training in adult protection and abuse awareness so they know their role in keeping people safe. The manager demonstrates a good knowledge of safeguarding adults and in the past twelve months has made two referrals to the local safeguarding Care Homes for Older People Page 16 of 26 Evidence: adults team for investigation under local area procedures. The home has a copy of the local area multi-agency adult protection policy, so that staff have guidance to follow in the event of an allegation of abuse. Care Homes for Older People Page 17 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides excellent accommodation, which fully meets the needs and abilities of the people who live there and provides people with the opportunity to maximise their independence wherever possible. Evidence: There are different types of apartments, which vary in size and cost and this flexible approach means that people can choose the apartment type best suited to their needs. Each apartment is very well-equipped with its own spacious hallway, kitchenette and en-suite shower and toilet facility. Some of the apartments are shared in that people have their own private bedroom, but they share bathroom facilities, kitchenette and hallway areas. People who choose to share can use their living space as they wish, for example some people may want to use just one of the bedrooms and use the other bedroom as a lounge area. A partial tour of the home was undertaken and we looked at a selection of bedrooms, bathrooms and communal areas, relevant to the people we case tracked. We found that the furniture, fixtures and fittings in all parts of the home is of an excellent quality and promotes a homely atmosphere. The home is fully accessible to people in wheelchairs: corridors and doorways are wide, a lift provides access between floors and on the ground floor there is level access onto the garden and patio areas. People spoke of how they like the fact they can choose where to spend their day, for example Care Homes for Older People Page 18 of 26 Evidence: some areas are quieter than others and there are plenty of different places to sit and relax. As at the last inspection there was opportunity to speak with people living at the home and their visitors and all spoke of their satisfaction with the environment. People are encouraged to view the home as their own and are able to have a key to their apartment if they wish and dependant on their capabilities. Some people have chosen to personalise their rooms with their own furniture and pictures to help make their rooms as homely as possible. The home has a good range of specialised equipment to meet individual assessed need. There are sufficient toilets and bathrooms including spa baths-the frequency of accessing this facility may incur additional cost. The home is surrounded by well-kept gardens and patio areas, which means that people are able to walk around the grounds. Observation of training records demonstrates that staff receive training in infection control and observations made at the time of inspection shows that staff put training into practice during everyday activities. All parts of the home were very clean. Care Homes for Older People Page 19 of 26 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 are supported by staff who have the skills and knowledge to meet their needs and who are suitable to work with vulnerable adults. Evidence: The people we spoke with confirmed their needs are met during the day and night and if they need assistance staff are around to help them. People commented that the staff are good and know how to help them with their care in a way they prefer. We observed the staff working in different parts of the home, looked at staffing rotas and discussed staffing levels with the manager, this indicated that sufficient skilled care and nursing staff were on duty to meet the needs of the people currently living at the home. The manager described to us how meetings are held on a weekly basis where individual needs and requirements are discussed to ensure that the staffing levels remain appropriate to meet individual needs. We were informed that the home used agency staff to supplement its own staff for a while but has now successfully recruited more permanent staff. A staff member viewed the service had improved in the past six months through an increase in staffing, including nurses. In addition to care and nursing staff the home also employs kitchen, domestic, laundry, maintenance and administrative staff to ensure that all aspects of peoples needs are met. The home has recently increased the availability of laundry staff, which will alleviate care staff from their previous assigned duties of laundering peoples clothes. Care Homes for Older People Page 20 of 26 Evidence: We looked at two personnel files for staff, one employed on the Assisted Living Unit and one on the Reminiscence Unit. This demonstrated that required pre-employment information, such as references, POVA First checks (Protection of Vulnerable Adults) had been sought prior to the staff starting work at the home. A full CRB disclosure (Criminal Records Bureau) had been obtained for one of these staff members before they started work. The other member of staff started work prior to their full CRB disclosure being obtained, the staff member and the executive director confirmed to us that they are working in a fully supervised capacity until their CRB is obtained-we observed them in their work and saw that they did not attend to people unsupervised. We saw that the home had sought confirmation from the Nursing and Midwifery council (NMC) to ensure that nurses have current and effective registration. We saw documents, which demonstrate the home provides staff with a comprehensive induction. A member of staff recently appointed confirmed they had received an induction and they spoke positively about the support they had received since starting at Sunrise. Almost all staff have attained a recognised qualification in care (National Vocational Qualification) at Level 2 and some staff have attained Level 3, which should ensure that care staff have the skills and knowledge to meet peoples care needs. We looked at individual staff training records and the homes training matrix which shows that a wide range of training is provided, this includes training in safe working practices such as fire safety as well as more specific training related to different illnesses and conditions people living at the home may have. A training session took place during the inspection to update staff on a medical condition. Staff provided us with their views that training opportunities at the home are good. Care Homes for Older People Page 21 of 26 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 management arrangements ensure that the home is safe and run in the way that the people living there want. Evidence: Since the last inspection the manager, Ms Bev Turner has completed her registration with us. Ms Bev Turner has considerable experience in managing care services for older people and management experience is supplemented by supporting qualifications. Staff confirmed to us that Ms Turner encourages staff to work as a team to benefit people living at the home. The new executive director is nurse qualified and the home has recently appointed a nurse to lead the nursing team and ensure good clinical practice is maintained. During the inspection we were informed of changes to the management structure and the executive director is to oversee the service as an interim measure. There are processes in place to monitor quality within the home. Regular meetings take place with people who live at home and their significant others. Quality assurance Care Homes for Older People Page 22 of 26 Evidence: questionnaires are sent out to people and staff to obtain their views on different aspects of the service and the information is then collated into a report, for action to be taken if necessary. We looked at documents which show meetings are held for staff to keep them informed of changes within the service, implementing good practice and where changes to practice are needed. A representative of the company also monitors quality at regular intervals with monthly unannounced visits, looking at matters including general observations, speaking with staff, checks of medication and whether any complaints have been received. A report is then formulated with the findings of the visit. Staff are provided with access to formal staff supervision sessions, which provide opportunity for them to reflect on their practice and to discuss training and development needs. For the purpose of this inspection Ms Bev Turner had responded to a request by the Commission to complete an annual quality assessment document (AQAA)-this is an opportunity for providers to share with us areas that they believe are doing well, and where they could improve. Ms Turner provided clear, relevant information of what the home does well, improvements which have occurred and plans for future improvement. We looked at records relating to the management of small amounts of personal monies and the process used by the home appeared robust with receipts kept to show spending and transactions checked by two people, which should ensure peoples money is held safely. Information was provided within the AQAA to confirm servicing and maintenance of equipment is undertaken and policies and procedures are reviewed. Observation of maintenance and servicing records shows a very well organised process to ensure all parts of the home are safe and equipment consistently well-maintained. We saw documentation which showed that a Health and Safety Executive inspector had recently visited the home and was satisfied with how the home protects people through its health and safety arrangements. The manager keeps us informed of the occurrence of accidents or incidents. The bed rails we saw were fitted correctly, one staff member is currently advising other members of staff on their safe use. We advised that it would be good practice to record when this training has taken place and ensure that staff who deliver the training are deemed competent to do so. Care Homes for Older People Page 23 of 26 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 24 of 26 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 38 Training in the safe use of bed rails should be recorded, ensuring that staff who deliver the training are deemed competent to do so. This should ensure that all staff receive the same training based on relevant guidance, delivered by a competent trainer. Care Homes for Older People Page 25 of 26 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 26 of 26 - 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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