Inspection on 25/03/09 for Sutton Lodge Care Home

This inspection was carried out on 25th March 2009.

CSCI found this care home to be providing an Excellent 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

Sutton Lodge Care Home 12/06/06

Sutton Lodge Care Home 04/01/06

Sutton Lodge Care Home 10/11/05

Sutton Lodge Care Home 01/11/04

Sutton Lodge Care Home 05/07/04

Sutton Lodge Care Home 24/07/02

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sutton Lodge Care Home Priestsic Road Sutton In Ashfield Nottinghamshire NG17 2AH     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Richards     Date: 2 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Sutton Lodge Care Home Priestsic Road Sutton In Ashfield Nottinghamshire NG17 2AH 01623442073 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashmere Care Homes Name of registered manager (if applicable) Emily Smith Type of registration: Number of places registered: 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: Ashmere Care Homes is registered to provide accommodation and personal care at Sutton Lodge Care Home for a maximum of 39 people whose primary care needs fall within the following categories and numbers :- Old age, not falling within any other category (OP) 39 Dementia (DE) 24 - No person falling within category DE may be admitted into Sutton Lodge Care Home where there are 24 persons of category DE already accommodated within the home Dementia over 65 years DE(E) 24 - No person falling within category DE(E) may be admitted into Sutton Lodge Care Home where there are 24 persons of Category DE(E) already accommodated within the home No person falling within category PD may be admitted into Sutton Lodge Care Home where there are 4 persons of category PD already accommodated within the home Care Homes for Older People Page 4 of 29 care home 39 Over 65 0 39 0 24 0 4 No person under the age of 55 years who falls within the category of DE may be admitted to the home Physical Disability (PD) - No person under the age of 45 who falls within the category PD may be admitted to the home Date of last inspection Brief description of the care home Summary section of this report. 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: three star excellent 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 three stars. This means the people who use this service experience excellent quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service, including our last key inpsection report. And our annual quality assurance assessment questionnaire (AQAA), which we ask the home to complete on an annual basis in order to provide us with key information about the service. We also received survey returns from eight people who use the service, three people who visit there and five staff who work there. These provided us with overall positive feedback, which tells us that people are satisfied with the care and services they, or Care Homes for Older People Page 6 of 29 their relative receive. And that staff are suitably supported and trained to perform their role. Comments we received from people who use the service, included, A enjoy living here. I am happy here and my room is lovely. Staff always have time for you and with a smile. The food is good. We have a choice of activities. There is always something to do. I like the trips out to garden centres and to Matlock. At this inspection there were thirty people accommodated, including eleven people with dementia. We used case tracking in our methodology, where we looked more closely at the care and services that three people receive. We did this by talking with them, observation of staff interactions with them, looking at their written care plans and associated health and personal care records and by looking at their private and communal accommodation. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the manager, who has managed the home for a number of years, about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian religion. As at the date of this inspection, the range of fees charged per week is: 404 to 432 pounds, with a negotiable top up fee payable directly to the home, for those funded by way of local authority arrangements. 442 to 535 pounds for people whose funding is by way of private arrangements. Fees charged are determined in accordance with individuals assessed needs and the type of private accommodation chosen. There are no additional charges to private funding arrangements and those who are funded by their local authority and who pay a privately negotiable top up fee directly to the home. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 29 We have made a small number of quality recommendations in this report relating to medicines policy and practise, the provision of food menus and publishing the results of any satisfaction surveys they undertake. However, the registered persons are well able to demonstrate their continuous commitment to ensuring the ongoing monitoring, review and development of the services they aim to provide, in consultation with people who live at the home, or who have an interest there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported and informed throughout their admission to the home and their needs are very effectively accounted for. Evidence: At our last key inspection of the service we found effective admission and assessment arrangements ensured that peoples needs could be met from the home. Since that inspection the Commission has approved a major variation to the homes registration. This enables them to provide for the category of dementia within a separate dedicated unit in the home, accommodating up to twenty four people, known as the Extra Care Unit. As well as continuing to provide personal care and support for older people, they can also accommodate up to four people under the category of physical disability. With a total overall maximum number of 39 service users. Care Homes for Older People Page 11 of 29 Evidence: In our annual quality assurance questionnaire the home completed, they told us about their admission process for people, including the arrangements for their needs assessment. These are comprehensive in approach and include consultation with relevant outside health and social care professionals as necessary and with significant others who have a direct interest in peoples individual care. They told us about their plans to review these to ensure they still meet with peoples expectations and current guidance. And they gave us some statistical information that we asked for about the numbers and needs of people accommodated at the home, which assisted us in our inspection planning. At this inspection we found that people are provided with a variety of information to assist them in choosing the home, by way of a welcome pack. With key service information provided within their Statement of Purpose and Service Guide. Other informaton provided within the pack includes a copy of their most recent home newsletter, which includes photographs of people engaged in activities in and outside the home. And information about financial assistance and advocacy and fees. The home also has a website www.ashmere.co.uk that people can visit to find out further information about the service. People told us that they receive the care and support they need and relatives said they felt that the home met the service users needs. Staff told us that they are given up to date information about the needs of people they support and care for. We saw from looking at peoples recorded needs assessments that these gave a full and comprehensive account, including in respect of any risks to their personal safety. They were person centred, with consideration applied to the Mental Capacity Act 2005 so as to determine peoples individual capacity to make key decisions about their lives and to consent to their care and treatment. For people with dementia who lacked the capacity to provide direct information about themselves and their lives. We found comprehensive social and personal profiles were collated, which promoted their personhood by assisting staff to understand and know them as people in their own right. 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 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 assured that their health, personal and social care needs will be effectively met from staff treat them with respect and maintain their rights to privacy and dignity. Evidence: At our last key inspection we found that peoples individual holistic needs were addressed by a suitable care planning process. That they were protected by the homes medicines policy and procedures and were treated with respect, with their dignity and privacy maintained. In our annual quality assurance questionnaire that they completed, the home told us they promote a personal and inclusive approach in ensuring peoples health needs are accounted for and met. And that staff treat people with respect and promote their dignity and privacy. They told us about some of the improvements they are making and gave us some Care Homes for Older People Page 13 of 29 Evidence: statistical information that we asked for. This indicates to us that they regularly review their approaches to care and care planning in line with national practise developments. At this inspection most people were able to tell us that they receive the care and support they need from staff that treat them with respect and who maintain their privacy and dignity. And that they receive the medical care they need. Relatives told us that the home always keeps them up to date with important issues affecting the service user, such as illness, accidents, or hospital admission. And that the home give their relative/friend the support and care that they expect or is agreed. During the course of our visit we observed staff to be sensitive and courteous in their approaches with people and to uphold their privacy and dignity. And we saw that the home is awarded a certificate as Dignity Champions from Nottinghamshire County Council. Peoples written care plans were comprehensive, person centred and reflective of recognised guidance relating to their respective conditions and risk assessed needs. They had regularly recorded reviews and where necessary included consultation and any specific instructions from relevant outside health and social care professionals concerned with that persons care. Including specialist advice and for the purposes of routine health care screening and monitoring. We also saw that those people whose care we looked at more closely via case tracking were provided with the equipment they needed to assist them with their health and personal care. The individual care plans for one service user that we case tracked with advanced dementia care needs, were innovative and well developed. As well as promoting their personal and healthcare, they provided staff with person centred information to assist them in promoting that service users individual personhood. These included specific care interventions for their inclusion, occupation, stimulation and spiritual wellbeing, focusing on existing and retained strengths and capabilities. We spoke with people about the arrangements for their medicines and found people case tracked had chosen for the home to retain and manage these on their behalf. Where people lack the capacity to make that decision, this is clearly accounted for. There is a comprehensive medicines policy in place, together with associated procedures for practise, including for any person who may wish to manage their own medicines. For any person who may do so, suitable lockable storage is provided in their own rooms. Care Homes for Older People Page 14 of 29 Evidence: We found that there are suitable arrangements in place for the ordering, receipt, storage, administration and disposal of medicines. Although we recommended to the manager that a more suitable thermometer be provided for the medicines refrigerator, ensuring that a minimum and maximum temperature range can be determined on a daily basis. The manager agreed to act on this. We also found hand written medicines instructions, that were not signed by the staff member recording these or countersigned by a witnessing staff member, although we could see from looking at other records made in the same way, that this was not routine practise. Regular visits are made to the home from the supplying pharmacy for the purposes of providing information and advice and monitoring medicines systems. Although, the manager advised that there is no internal quality auditing system in place in respect of medicines systems and practise. She advised that this would be developed. Most people were able to tell us that they always receive the care and support they need from staff that treat them with respect and maintain their dignity and privacy. And that they receive the medical care they need. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual variations in in peoples daily living preferences and capacity are effectively considered and accounted for by the home. And their right to exercise choice and control over their lives is promoted. The provision of a balanced, varied and nutritious diet is ensured in accordance with peoples preferences and assessed needs. Evidence: At our last key inspection here we found that people are afforded opportunities and choice to participate in varied and stimulating social activities. And that they were supported to maintain contact with families and friends and the local community as they chose. We also found that people were provided with a wholesome appealing and balanced diet. In our annual quality assurance questionnaire the home completed, they told us that they continue to provide people with ongoing opportunities from a range of daily social activities, entertainments and outings. And to maintain contact with their peoples their families and friends. They also said they hold regular residents meetings and involve Care Homes for Older People Page 16 of 29 Evidence: people in menu planning and reviews. They told us about some ways in which they have developed recreational and leisure opportunties for people, including the purchase of a minibus and computers for people to use with the aim of facilitating access to computer courses for people who choose. At this inspection we found that people are regularly consulted about their daily living arrangements, including for their occupation and leisure. And people told us that there are always activities that they can take part in. One person said they particularly enjoyed going out to garden centres and the trips to Matlock that are organised. Another person said they were suppported to pursue their hobby in electronics. Information about activities and forthcoming events is posted for people in both units of the home, in large print and picture format. And regular meetings are held with people to consult with them about these and about menu planning and reviews. Examples of events include forthcoming Easter celebrations and a summer fayer, church group, singers and entertainers coming into the home. Day trips such as to Sherwood Forest, garden centres, boat trips, shopping, trip to Matlock, clothing show and a visit planned to a local chocolate factory, which a group of residents had recently requested. Residents photoboards are displayed in each unit showing people engaging in activities and events in and outside the home. Some showed residents and their families across the generations, enjoying a Christmas meal at the home. A programme of various daily activities is also provided and there is a lunch club held every Tuesday. On our arrival at the home, some people were engaged in a game of bingo in the main lounge, some reading newspapers and some watching TV or in their own rooms. We saw that the large ground floor lounge is arranged into smaller group seating areas and with a quiet lounge area off, housing three computers with internet access for residents dedicated use. There is also a library bookcase, piano and a range of games and craft materials there and a separate hairdressing room. Film shows are regulary enjoyed by people from the large pull down film screen provided in the dining room and TVs are provided in lounge areas. A residents mail box point is also provided in the entrance where people can collect mail and leave mail for posting out, together with recent editions of the residents newsletter. A variety of information and literatures is also provided for people, Care Homes for Older People Page 17 of 29 Evidence: including independent advocacy groups, outside agencies, such as the Alzheimers Society and regarding access to the hydrotherapy pool at their sister home nearby. We also saw that many people with dementia have their own memory boxes, which contain items that are meaningful to them. Visiting to the home is open and there is a choice of quieter areas that people can use if they wish for privacy. A number of relatives visited people during our inspection and said they are always made welcome and greeted by staff. And are invited to join their relative for key seasonal celebration events. People also told us that they usually like the meals at the home. Comments received include Good home cooking. There is always plenty and a choice. We saw that tables were attractively set for lunch and at tea time, with matching table linen, cutlery and placemats and with cruets and posies set at each table. And people were assisted by staff in a calm and unhurried manner. However, we saw that in the ground floor dining room the menu board was not completed for the day and a group of people that we spoke with said, they could not remember what was for lunch. Menus kept in the kitchen and also in the Extra Care Unit Dining rooms provided choice and variety at each meal and people told us they are consulted about menus. 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. People may continue to be assured that any concerns or complaints they raise will be taken seriously and acted on. And that their protection from harm and abuse is effectively promoted. Evidence: At our last key inspection here we found that people could be confident that their complaints would be listened to, taken seriously and acted upon. And that people were protected from harm and abuse. In our annual quality assurance questionnaire them home completed. They told us they operate a rigorous and effective approach to the handling of complaints and continue to ensure that staff is suitably trained to recognise and deal with any witness or suspicion of abuse of a person using the service. Information they gave us about improvements tells us that they recognise the value of continually seeking ways in which they could improve, by way of ongoing staff training and staff supervision arrangements and in the monitoring of complaints received. Statistical information they gave us told us that they had received two complaints over the preceding twelve months. Care Homes for Older People Page 19 of 29 Evidence: At this inspection we looked at their record of complaints and found these were effectively recorded, including details of their investigation, outcome and action where appropriate. One of the complaints was anonymous and related to staffing and front of house. This was not substantiated following investigation by the manager. The other related to communication. This was partially substantiated and recorded as resolved, with action to the satisfaction of the complainant. People told us that they usually know who to speak to if they are unhappy and that they know who to make a complaint. And feedback from people told us that any day to day matters they raise are usually dealt with promptly without the need to make a formal complaint. We saw that a suitable complaints procedure was openly displayed and with information also provided within the homes written service guide. Staff were conversant with their individual role and responsibilities relating to the homes policy and procedural guidance, in dealing with complaints and recognising and responding to any witnessed or suspected abuse of any service user. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a clean, homely, safe and well maintained environment, which effectively provides for their collective and individual needs and preferences. Evidence: At our last key inspection we found the environment to be safe, well maintained, pleasant, comfortable and clean. In our annual quality assurance questionnaire that the home completed they told us they ensure environmental health and safety and monitoring for the ongoing upgrade and repair of the home, including the necessary servicing and maintenance of equipment. And provide housekeeping staff that is suitably trained. They also gave us some additional information about their arrangements for the maintenance and servicing of systems and equipment in the home and relating to infection control. Indicating their promotion of safe working practises for these. At this inspection people told us the home is always kept fresh and clean. All areas of the home that we saw were comfortable, fresh, clean and odour free. Well decorated and maintained. With a good standard of furnishings and suitably equipped. A number of bedrooms are large and spacious. The home provides level access with suitable aids Care Homes for Older People Page 21 of 29 Evidence: and equipment to assist those who may have mobility problems and there is a choice of well kept garden areas, with seating provided. Some people told us that they enjoy the gardens in the warmer weather. A good choice of lounge and dining areas is provided throughout the home. With a computer area housing three computers and internet access for people on the ground floor. There is also a library bookcase here and tables for activities here. Quiet lounges are availlable and a separate hairdressing room, which may people said they enjoy with service from a regularly visiting hair dresser. Small library areas are also provided in both units. And the two dining rooms in the Extra Care Unit also have small kitchenette areas. Bedrooms of those people we case tracked, were personalised, providing accessible en suites and suited their needs. And they told us that they were satisfied with their own rooms. They also had close access to suitably equipped and clean communal bathing and toilet facilities. Suitable aids to assist people in their orientation were also provided and with additional sensory developments in the Extra Care Unit, including a wall mural of a park scene with a real park bench and a virtual fish tank. Bathrooms were also developed to promote sensory stimulation. The separate laundry facility is well equipped and clean and staff is provided with suitable hand washing facilities. We also saw that a full infection control audit of the homes systems and environment was recently undertaken via the local primary care trust. And that the overall scoring achieved for this was excellent. An internal quality assurance and monitoring system is operated in respect of standards and safety within the environment, including each persons own room. Care Homes for Older People Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their needs will be met from staff that is effectively recruited, inducted, trained and deployed so as to support the smooth running of the service. Evidence: At our last key inspection here we found staffing arrangments sufficient to meet peoples needs. And that people were in safe hands from suitable recruited and trained staff. In our annual quality assurance questionnaire completed by the home, they told us that they ensure a rigorous staff recruitment process and provide people with written information about their staffing arrangements. They told us about some of their improvements here, which include promoting increased training opportunities for staff arising from their registration with Skills for Care, who monitor and promote national workforce training targets. And also in achieving a personal record for the home in respect of the number of staff having completed NVQs. They also gave us some statistical information that we asked for about staff employed. Care Homes for Older People Page 23 of 29 Evidence: And told us that they aim for continual improvement her by way of ongoing monitoring, review and provision of relevant staff training. At this inspection feedback obtained from people, told us that staff is always or usually available when they need them. Relatives told us that staff is always visible and have time for you. And that they seem to have the right skills to look after people properly. Staff described suitable arrangements for the recruitment, induction, training and deployment and felt that opportunities for their training and development were very good. Associated records that we looked at reflected this and we found that out of twenty four staff, including the manager. That twenty two have at least NVQ level 2 or above in care and with two new staff enrolled to work towards their level 2. Six staff, including all seniors have NVQ level 3 and a further six are working towards this. The manager has an NVQ level 4 and the deputy is working towards this. We could see from speaking with people, looking at records and from discussions with the manager that they ensure that staff receive relevant training that is targeted and focused on improving outcomes for residents. And they have worked to ensure the development of their induction process to meet with Skills for Care Standards, but also to exceed these. Examples of this include a focus on person centred care planning and thinking and training for staff in records and record keeping. We also found that they operate a robust on call system and plan well for known forthcoming staff absences. Staff also described good communication systems, including regular staff meetings that are properly structured. Care Homes for Older People Page 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is proactively managed and run in peoples best interests. And whose their health, safety and welfare is consistently promoted and protected. Evidence: At our last key inspection here we found the home to be well managed and run by a suitable person and in peoples best interests. In our annual quality assurance questionnaire completed by the home, they told us that the home continues to be well managed and run, with suitable staff support and peoples health and safety promoted. They told us about some improvements, which relate to staff supervision arrangements, ensuring up to date policy and procedural guidance for staff. And they gave us the additional information that we asked for about their arrangements for ensuring safe systems and equipment. Care Homes for Older People Page 25 of 29 Evidence: At this inspection staff described suitable arrangements for their support and supervision and for communication and administration systems. We saw that a focused and systemmatic approach to ensuring the ongoing review and development of the service is operated, including for consultation with people who live there and who have a interest there. These include ongoing systems audit linked to the National Minimum Standards for Care Homes for Older People, the development of action plans from those audits, which are regularly reviewed and in turn inform their annual development plan for the service. The manager told us how she maintains and ensures her own professional development. Including by way of formal training, establishing and maintaining good links with outside health and social care professionals and networks. And by acting on recommendations or requirements that may be made by those in the course of their visits to the home for the benefit of service users. She operates an open door policy and ensures that dedicated meetings are regularly held with residents and staff. There are also satisfaction surveys to residents, relatives and staff, linked to the ongoing formal monthly and annual quality auditing of the homes systems and services offered. Results are collated and used to inform the homes development planning. However, there is no formal method of collating the results to share with residents and their representatives. We recommended that the manager consider this. We saw that the home provides a central safekeeping facility for peoples own monies. And that safekeeping facilities are provided for people in their own rooms so they can retain their monies there if they choose. Records that we sampled for the former showed us that these are properly maintained. Staff described satisfactory arrangements for ensuring safe working practises, including in respect of their training, support and the provision of equipment. And during the course of our visit we observed all areas of the home, to be clean, safe and well maintained with no observable hazards to peoples health and safety. Care Homes for Older People Page 26 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 27 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 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 A minimum and maximum range thermometer should be provided for the purposes of determining accurate daily temperature recordings for the medicines refrigerator. An internal quality assurance system should be developed in respect of medicines to confirm that policy is put into practise. Care should be taken to ensure that the menu board displayed is effectively completed at mealtimes in order to assist and inform people. Or alternatively, to consider the benefit of providing people with the daily menu, in a suitable format, on each dining table. Consider formally collating the results of satisfaction surveys and publish these to inform people who use the service, or who have an interest in it. 2 9 3 15 4 33 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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