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Inspection on 28/04/09 for Whitestone Lodge Residential Care Home

Also see our care home review for Whitestone Lodge Residential Care Home for more information

This inspection was carried out on 28th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

Residents were positive about many aspects of the home. Resident`s comments included `The staff are good and they look after us well` and `the place is always spotless`. Residents said that they felt respected by staff and that their privacy was upheld when they were being supported with their personal care. New residents are only admitted to the home following an assessment of their needs. This is to ensure the home has sufficient information so as to determine if the person`s needs can be met appropriately. The catering arrangements are well organised and residents gave good feedback about the quality and choice of food and meals. The home is well presented, well maintained, comfortable and spacious. Aids and adaptations are in place to promote the independence of residents and to ensure staff carry out safe practices when assisting residents with moving and transferring. Resident`s bedrooms are nicely presented and furnished with many of their personal belongings. Staff were seen to interact with residents with warmth, familiarity and courtesy. Staff turnover is low and therefore staff get to know the residents well and visa versa. A good percentage of staff have attained a relevant qualification for example a National Vocational Qualification (N.V.Q) in care. Staff feel well trained and well supported in their role. When asked about care staff one resident said `they`re very good`. Another resident said `staff are lovely, they`re very kind and helpful`. The home is run in the best interests of the residents. Health and safety policies, procedures and practices are in place and checks are carried out regularly so as to safeguard residents, staff and visitors.

What has improved since the last inspection?

There have been improvements to the home environment since the last inspection visit. There is a continous programme of maintenance and upgrading of the home. This has included re landscaping of the garden at the rear of the home to make it more accessible and service user friendly and one of the lounges has been refurbished. A higher percentage of staff have attained a relevant qualification and there has been further staff training. There has been minimal staff turnover since the last inspection visit. The manager has reported further improvements in the Annual Quality Assurance Assessment (AQAA) including; `We now have a manager`s assistant to compliment the role of the manager so that more time can be spen on training, guiding and developing the staff and their skills` and `All staff have been provided with adult protection training`.

What the care home could do better:

Resident`s care plans need to be reviewed and updated to ensure that they include an appropriate level of information on the person`s health needs and medication support needs. There was no information in resident`s care plans which gives an overview of a person`s health and how to support them to remain healthy. Some of the records relating to the health of residents, i.e Gp or nurse visit notes, were not being kept in sufficient detail and there was evidence to indicate that some appointments or health issues were not being recorded at all. Risk assessments were in place in relation to diet and nutrition. However, there were examples whereby these had not been completed correctly and therefore did not reflect the person`s current state and relevant information as determined by the risk assessment was not recorded in the person`s care plan. Some of the medication practices were poor and this may leave residents at risk. One resident had not been administered their medication but their records showed that their medication had been signed as administered. There is some room for improvement to the level of information and guidance in the homes complaints procedure and adult protection procedures.

Key inspection report Care homes for older people Name: Address: Whitestone Lodge Residential Care Home 56 - 58 Church Road Roby Knowsley Merseyside L36 9TP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Debbie Corcoran     Date: 2 8 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 31 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 31 Information about the care home Name of care home: Address: Whitestone Lodge Residential Care Home 56 - 58 Church Road Roby Knowsley Merseyside L36 9TP 0151-480-4237 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: whitestonelodge@btconnect.com Mr Caulton,Mrs V Caulton care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability, over 65 years of age Code PD(E) The maximum number of service users who can be accommodated is: 20 Date of last inspection Brief description of the care home Whitestone Lodge is located in the Roby area of Liverpool, close to Huyton Village. Mr & Mrs Caulton own the home and the registered manager is Ms Paula Allen. The home is situated in a residential area within access to public transport to surrounding areas, Prescot and Liverpool. The home can have up to twenty residents who are of old age or with a physical disability. The home is pleasantly decorated and is situated over two floors. Single accommodation is provided and there are two double bedrooms for couples or for those who wish to share. There are three bathrooms, which are Care Homes for Older People Page 4 of 31 Over 65 20 20 0 0 Brief description of the care home equipped with aids to assist less independent residents. There is a large enclosed garden to the rear of the home with a ramp and handrail and car parking space to the front. The fee rate for accommodation is £418.00 a week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The visit to the home was not announced beforehand. During the visit the majority of residents were met and a number were spoken with either on a one to one basis or a small group basis. A sample of residents records were looked at. Other records looked at include medication administration records, staff files, staff training records and health and safety checks / records. A tour of the home was carried out which included all areas. We sent surveys to members of the staff team and some of the information provided in these has been used to inform the findings of the inspection. Care Homes for Older People Page 6 of 31 The manager returned a self assessment of the service prior to this visit. The self assessment enables the service provider to inform us of what they do well, where they have improved and where they can improve in the future. It also includes information on how they promote equality and diversity, how they seek the views of residents and includes data on staffing and health and safety. The self assessment is referred to as an Annual Quality Assurance Assessment (AQAA). Some of the information in this has been used to inform the findings of the inspection. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? There have been improvements to the home environment since the last inspection visit. There is a continous programme of maintenance and upgrading of the home. This has included re landscaping of the garden at the rear of the home to make it more accessible and service user friendly and one of the lounges has been refurbished. A higher percentage of staff have attained a relevant qualification and there has been further staff training. There has been minimal staff turnover since the last inspection visit. The manager has reported further improvements in the Annual Quality Assurance Assessment (AQAA) including; We now have a managers assistant to compliment the role of the manager so that more time can be spen on training, guiding and developing the staff and their skills and All staff have been provided with adult protection training. Care Homes for Older People Page 8 of 31 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 31 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 31 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. Residents are provided with the information they need to make an informed choice about moving to the home. Residents are only admitted following an assessment of their needs so at to enaure their needs can be met at the home. Evidence: An information pack was available in each of the residents rooms and this included a service user guide which describes the services offered at the home. The manager stated that these are provided to all residents and would be provided to prospective residents prior to moving it. It was reported in the providers self assessment (AQAA) that prospective residents and their relatives or representatives are invited to visit the home and spend some time there before deciding whether or not to move in. This was confirmed during discussions with residents. We asked residents in our surveys if they had received enough information to help them decide if this home was the right place for them Care Homes for Older People Page 11 of 31 Evidence: before they moved in and if they had been given written information about the homes terms and conditions and all residents who responded felt that they had. The manager reported that when a new resident is referred to the home then the referring agency, for example Social Services, are asked for assessment information. This was confirmed in residents records as they contained a copy of the persons initial assessment or care plan as provided by Social Services. In addition to this an assessment of the persons needs is carried out by a senior member of staff at the home. This was confirmed in residents records. The assessments cover issues such as the persons understanding, hearing ability, eyesight, communication styles, emotional needs, personal care needs, dietary needs, medication support needs, social history and religious observance. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is little evidence to demonstrate that residents are being appropriately supported with their health care. Some of the practices for administering medication are not safe and this may leave residents at risk. Evidence: When a resident requires support with their personal care then this is recorded in the persons care plan. Residents were all well presented which would indicate that they have been well supported with their personal care and it was evident care and attention had been paid to detail. When asked if staff were respectful of their privacy when they were being supported with personal care one resident stated oh yes they are very good. Staff were observed to be warm and respectful in addressing the residents. The care plans for three of the residents were looked at in some detail. The care plans provided information on meeting the residents needs in areas such as; mobility and moving and handling needs, drinking and nutritional needs, eyesight, hearing, speech, personal care, communication, motivation, emotional wellbeing. Whilst the care plans Care Homes for Older People Page 13 of 31 Evidence: cover some health related matters, such as some of those listed, there is no section which gives an overview of a persons health and how to support them to remain healthy. This may include information such as refering to health professionals, support with medication etc. This is therefore an area in which care plans need to be improved. Feedback from residents about their support with their health and their personal care was mixed. We asked residents in surveys Does the home make sure you get the medical care you need? Three people replied that they always do and two people replied that they usually do. There was some evidence of good practice in the care of residents and it was noted that some residents had been referred to relevant health professionals for support, advice and equipment. However, there were also examples whereby it was not possible to determine whether or not residents were being appropriately supported due to a lack of information in their assessments and care plans on what their needs were and of how these were being met. It was also noted that some residents records showed that when a person had seen a GP or District nurse this information either wasnt being recorded or wasnt being recorded appropriately. For example, a resident may have seen a GP for a specific issue or test but then there may be no further reference to this or any follow up recorded on the persons notes. Also, staff were not recording the details of a GP or nurse visit in sufficient detail and alongside this much of the most recent information relating to GP visits and nurse visits has been archived. It is not appropriate to archive recent information which is important to the persons current state and which staff need to be aware of. These omissions mean that it is not possible to evidence that health concerns are being followed up. Risk assessments are carried out where a resident is thought to be at risk of harm. These include risks such as falling or not eating a nutritional diet. The risk assessments looked were not always reflective of the persons current state. For example one of the residents had lost a significant amount of weight but this was not reflected in the nutritional assessment or in their care plan. The persons care plan clearly stated that there were no issues with the persons diet. Alongside the lack of information on health needs was a lack of information on medication needs. A sample of medication administration records and medication in stock was checked. These showed that medication is not always recorded and administered appropriately. The medication for one of the residents had been signed as administered earlier in the day. However, this medication had not been administered. The practice of signing medication administration records prior to Care Homes for Older People Page 14 of 31 Evidence: administering medication puts residents at risk. For another residents medication it was not possible to check the stock record against supply and there were differences of opinion from staff as to whether or not this medication was still required by the resident. There was no information available to indicate what residents were taking medication for. On two occasions throughout the day it was noted that the keys to the medication cupboard were left in the cupboard. This leaves residents at risk. This was discussed with the manager and other senior member of staff for immediate address. It was reported that medication is audited on a monthly basis but there were no records to support this. Care Homes for Older People Page 15 of 31 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. Residents have opportunites to get involved in activites and to remain independent and exercise choice. Residents are provided with a choice of good quality food and mealtimes are a relaxed and enjoyable part of the day. Evidence: Residents gave mixed feedback on activites at the home. Some felt that the activities were good and others felt that there could be more. Activities were reported to include board games, dominoes, tea parties, entertainer, exercise and facials. A hairdresser was visiting the home at the time of the inspection. The providers self assessment of the service states We advertise the religious services that take place here for families to participate. We have used the information obtained and inserted in our Story of My Life section in the care plans to provide special moments. A musical resident has been provided with an electric keyboard as he has voiced a wish to return to playing a piano. We have invested in more table pastimes for wet afternoons. As a direct consequence of talking to two particular residents we refurbished the patio and relandscaped the garden to make it more user friendly. Accompanied walks out have been growing in popularity. Activities take place in the afternoon and it is the responsibility of the care staff to Care Homes for Older People Page 16 of 31 Evidence: support the residents with these. A number of residents will choose not be included in group activities and their choice to do this is respected. We asked residents in surveys Does the home arrange activities that you can take part in if you want? Two people responded sometimes, two people responded usually and one person responded always. This indicates that there could be some room to further develop activities. The feedback from residents at the time of the inspection visit was also mixed. Some residents were more than happy with the activities offered whilst others felt they were not appropriate and did not want to join in. Residents records included information on the persons previous experiences of work, leisure, likes, dislikes, history and pastimes. This information was recorded in the residents care plans and was referred to as Story of my life. In essence this provides staff with information on what has been and what continues to be important to the person concerned and how they can maintain their individuality. During discussions with residents they stated that they are free to make their own choices about things such as when to get up, where to spend the day and their own routine. Resident meetings were reported to take place on a regular basis. Residents gave good feedback on the quality and quantity of meals and food provided. It was reported that residents have been consulted on meals and mealtimes. The dinning tables are set nicely so as to make mealtimes more enjoyable for residents. It was reported that residents are given a choice of two hot meals at lunchtime. However, at the time of the visit everbody was having the same meal. Residents appeared to enjoy their meal and those who were aksed said that it was nice. The kitchen was found to be clean, well organised and well stocked. However, one aspect of food hygiene was noted to have not been followed. This was the date labelling of food which has been opened. This was discussed with the manager and must be addressed. Care Homes for Older People Page 17 of 31 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. Policies, procedres and practices are in place to safeguard residents from abuse. These could be tightened up to make sure they are more explicit and provide an appropriate level of guidance. Evidence: The home has a complaints policy and procedure. This is on display in the hallway. This should be reviewed to ensure it includes sufficient details to inform people of the process for acknowledging complaints, timescales for dealing with complaints, investigating them and reporting back on the findings. Residents who were asked about complaints said that they would let staff know if they were not happy about something and that staff would then address their concerns. Information on how to make a complaint is provided to residents in the service user guide or information pack. A log of complaints is maintained. This showed that there have been no complaints made since the last inspection visit. There have also have been no complaints raised directly with the Commission about this service. An adult protection policy and procedure is in place. This should be reviewed to ensure it clearly outlines responsibilities for responding to an allegation of abuse and any subsequent investigations. Contact details for all relevant authorities concerned with adult protection should also be made available for staff to refer to. The home also has a copy of Knowsley Borough Councils adult protection procedures. The manager has reported in the providers self assessment that all staff have been provided with adult Care Homes for Older People Page 18 of 31 Evidence: protection training. Staff recruitment includes checks against the Protection of Vulnerable Adults register and crimininal records bureau checks for new members of staff. Accidents and incidents are appropriately recorded. Care Homes for Older People Page 19 of 31 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. Residents are provided with a clean, safe, well maintained and comfortable home environment. Evidence: The home is a two storey house situated in well maintained grounds. The home is located approximatley 1/2 mile from Huyton Town Centre and is well served by public transport. The home is spacious, clean, well maintained and well presented. There are two lounge areas and a large dinning room. All areas of the home were found to be nicely decorated and furnished to a good standard. This included the sample of residents rooms which were checked. There was one area requiring attention. This was uneven flooring in one of the residents bedrooms. This was disussed with the manager and must be addressed for the safety of the resident. There is a continous programme of maintenance and upgrading of the home. The home has car parking at the front and there is a large well maintained garden at the rear. Residents reported using this and enjoying it in the fine weather. Many of the residents bedrooms were personalised with their own belongings. Care Homes for Older People Page 20 of 31 Evidence: Bedroom doors are fitted with locks. During discussions with residents they were happy with the standard of presentation and cleanliness of the home and their bedrooms. There was a member of domestic staff on duty at the time of the visit ensuring that the home was clean. All residents responses in surveys was that the home was always fresh and clean. It was noted that handwashing facilities are available as appropriate, however the manager must ensure that soap and hand drying facilities are available in all of these areas so as to ensure good infection control practices. The home is fitted with aids and adaptations such as hoists, handrails and bathchairs so as to assist residents to move and transfer safely. Records showed that these are regularly serviced. Care Homes for Older People Page 21 of 31 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. Residents are supported by staff who know them well and who are appropriatley recruited and well supported. Evidence: At the time of the visit there were seventeen people residing at the home. There were three care staff on duty and the manager. There was also one member of domestic staff and a cook. Staff were observed to interact with residents with warmth and familiarity. Residents gave good feedback on the staff team. One resident commented theyre very good another resident said staff are lovely, theyre very kind and helpful. Staff meetings take place on a three monthly basis and these are minuted. Staff files were looked at for the newest members of staff. These showed that staff recruitment and selection practices are in line with protecting residents and checks and references are carried out appropriatley. A sample of staff training records showed that care staff are provided with training in topics such as fire safety, moving and handling, food hygiene, health and safety, first aid, dementia care awareness, medication, mental health. The manager reported that Care Homes for Older People Page 22 of 31 Evidence: she intends to secure some more specialised training for example in dementia care. The care staff team consists of fifteen staff. Of these, ten have attained a relevant qualification or National Vocational Qualification (N.V.Q)and three were reported to be undertaking a relevant qualification. We sent surveys to staff and these ask numerous questions about the home including questions such as Are there enough staff to meet the individual needs of all the people who use the service, Do you feel you have the right support experience and knowledge to meet the different needs of people who use services, Are you being given training which is relevant to your role, helps you understand and meet the individual needs of service user and keeps you up to date with new ways of working. Does your manager meet with you to give you support and discuss how you are working. All answers were positive and one member of staff commented I have done a lot of training at whitestone lodge I have all my certificates. Care Homes for Older People Page 23 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some aspects of the service require development by the manager in order to demonstrate the health, safety and well being of residents. Evidence: The manager, Paula Allen, has achieved a Level 4 National Vocational Qualification (N.V.Q) and the Registered Managers Award. Staff reported feeling well supported by the manager and have made comments including her office door is always open to anybody with any problems or querys. She is an excellent manager who can never do enough for her residents and staff. Our care home has a high standard of care for the elderly where they are treated with respect and dignity. My manager has high standards and values. The manager reported in the providers self assessment The well being, safety and security of the residents is paramount. We have a happy atmosphere and families and visitors find the home an easy experience. Care Homes for Older People Page 24 of 31 Evidence: The manager presents as dedicated to providing a good quality service and she has developed the service in many areas over the past couple of years. However, as identified in the Health and Personal Care section of this report there are areas of practice which need to be addressed in relation to care planning, demonstrating how residents are supported with their health care needs, risk assessment and medication management. The manager must take action to address these areas and ensure that they are monitored regularly and working effectively. The home does have some quality assurance checks whereby the quality of the service is being monitored and this includes surveying residents and their relatives or representatives about the quality of the service. The providers self assessment (AQAA) states Because we involve families in our search for feedback and quality monitoring we receive constructive criticism that we can act upon and they appreciate that we are doing our ever improving best for their relative. A random sample of staff files were looked at in order to assess the fequency of supervision meetings. The records showed that some staff have been provided with regular supervision whilst others have had minimum. The manager should ensure staff have equal opportunities for supervision. It was reported that residents have the opportunity to manage their own money when appropriate and in line with their wishes. However, where a resident needs support with their money then a record of all money received and spent is maintained and receipts are kept wherever possible. It was not possible to check the system for this on this occassion as the person responsible for keeping these records was not available at the time of the visit. Health and safety policies, procedures and practice are in place to safeguard the well being of residents, staff and visitors. Health and safety records were checked. These showed that some fire safety checks are being carried out but the manager could not find the records to demonstrate regular testing of the alarm system and the certificate for maintenance of fire equipment. The manager must forward a copy of these to the commission. Other safety and maintenance certificates which were checked were up to date. A health and safety manual was available and this included numerous policies and procedures for managing home safety. A safe working practice risk assessment is in place but this needs to be reviewed and Care Homes for Older People Page 25 of 31 Evidence: updated. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 (1) (2) (b) The health and personal care 05/07/2008 of the resident must be recorded in a plan of care. This will ensure staff are aware of their current needs and will provide the necessary care and support. Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must include an appropriate level of information on the persons support with health care needs. So as to ensure care staff are aware of the persons needs and how to meet these. 20/07/2009 2 8 13 A clear record must be maintained to demonstrate that residents where necessary are receiving treatment, advice and other services from health care professionals. To enusre that residents are being appropriately supported with their health care needs. 20/07/2009 3 8 13 Assessments and risk assessments must be carried out appropriately and any issues arising from 20/07/2009 Care Homes for Older People Page 28 of 31 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 these be clearly reflected in the persons care plan. So as to demonstrate that appropriate action is being taken and ensure staff are aware of how to support the person. 4 9 13 Medication must be 20/06/2009 managed safely and in line with appropriate policies and procedures. To promote the health, safety and well being of residents. 5 19 23 All areas of the care home must be safe and free from hazards. The flooring in one of the residents bedrooms must be made safe. To ensure the health and well being of the resident. 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 20/06/2009 1 2 15 17 Safe food hygiene practices should be carried out at all times. The adult protection procedure should be be reviewed to ensure it clearly outlines responsibilities for responding to an allegation of abuse and any subsequent investigations. Contact details for all relevant authorities concerned with adult protection should also be made available for staff to Care Homes for Older People Page 29 of 31 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 refer to. 3 26 All areas of the home should be supplied with soap and hand drying facilities so as to ensure appropriate infection control practices. The manager should ensure that all care staff are provided with regular and recorded supervision meetings. The safe working practice risk assessment needs to be reviewed and updated. 4 5 36 38 Care Homes for Older People Page 30 of 31 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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