Inspection on 20/07/09 for Wychdene

This inspection was carried out on 20th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wychdene 16/12/08

Wychdene 19/02/08

Wychdene 26/02/07

Wychdene 13/07/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Wychdene 19 Callis Court Road Broadstairs Kent CT10 3AF     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: Geoffrey Senior     Date: 2 0 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Wychdene 19 Callis Court Road Broadstairs Kent CT10 3AF 01843865282 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mylan Ltd Name of registered manager (if applicable) Miss Lisa Robinson Type of registration: Number of places registered: care home 28 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 who can be accommodated is: 28 The registered person may provide the following category/ies of service only: Care home only - 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 - OP Date of last inspection Brief description of the care home Wychdene residential home is owned by a private company. It is a large detached property situated close to the town of Broadstairs. At the present time two of the bedrooms are being used as a double and all other bedrooms are used as singles. Seven of the bedrooms have ensuite facilities. The home has a lift facility. The home is located in close proximity to local amenities. 1 6 1 2 2 0 0 8 0 Over 65 28 Care Homes for Older People Page 4 of 28 Brief description of the care home Wychdene is registered to provide personal care and support for up to 28 older people, who require varying degrees of assistance. The home has a registered manager. The fees range from £320 to £500. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This report takes into account information gathered since the last inspection on 16/12/2008 and includes a visit to the home. The visit to the service was an unannounced key inspection which took place over one day. Two inspectors were involved in the visit. we arrived at 10.10 am on 20th July and stayed until 16.00. The registered manager was not on duty or present. The homes Head of Care, four members of staff and twelve of the service users were involved in the inspection. We used the homes annual quality assurance assessment, known as an AQAA, for short. This is a document that all homes have to send us once a year to tell us how they think they are meeting the national standards, how they have improved in the previous year, what they aim to do and lets us know when they have completed important environmental safety checks. This was received after the visit had been made. Prior to the visit we sent survey questionnaires to the home to be distributed to 10 service users, 10 members of staff and 10 relatives. Most were completed and returned to us in the two weeks following the visit. The responses were noted and contribute to this Care Homes for Older People Page 6 of 28 report. At the time of the visit there were 23 service users living at the home. We spoke with 12 of the service users and had discussions with the Head of Care and the staff on duty. We observed how staff interacted with service users during the day when offering care support. We looked at some of the service users individual support plans and risk assessments. We also looked at and discussed the homes training records and quality assurance. In May 2009 a safeguarding alert was raised at the home. The local safeguarding team have subsequently undertaken investigation and monitoring visits. Care Homes for Older People Page 7 of 28 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some existing service users have not been fully assessed and care plans developed. Future residents will now have plans of care based on full pre admission assessments. Service users receive enough information to help them decide about moving in to the home. Service users are offered the opportunity to visit the home before moving in. Evidence: We were told that the management and staff recognise that moving into a residential setting is a big step and they want to put peoples minds at rest. People are invited to visit, to find out about the home and ask any questions they like. There are also written documents that say about the home in some detail. These are called the Statement of Purpose and Service User Guide. The home is quite happy for them to take a copy to read at their leisure. In our questionnaire we asked 10 people who live in the service, did you receive enough information about this home before you moved in so you could decide if it was Care Homes for Older People Page 10 of 28 Evidence: the right place for you. Everyone said always. Relatives commented usually or sometimes when asked if they get enough information to help make decisions. We were told that the Manager and, or, the head of care asks people who are thinking of moving into the home what support they need and want. They also talk with family members, care managers and medical staff. The head of care informed us that when she gets the information she shares it with the care staff so that they know in advance what support they will need to provide. We spoke to care staff who said that they are told about people who are going to move in. They then discuss as a team how they can best support the person in the first few days while they get to know them better. We looked at the written information that has been collected for people who have recently moved into the service. We found that one assessment had not been dated or signed and although it contained adequate detail in some areas it was incomplete. We were told that this had been done on the day of admission. Another persons assessment had been completed by the Manager the day before admission. This also gave a reasonable picture of the persons needs but, a plan of care for daily living had not been developed because, we were told, the manager had said that they do not have to be completed for service users on respite care. We understand that this has been changed following a recent visit by care managers and would expect that all service users will now have a plan of care for daily living and longer term outcomes, based on the care management assessment and the homes own needs assessment. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users cannot be sure that all their needs will be identified and met and that all risks are minimised. The homes medication administration needs to fully protect the safety of service users. Evidence: We asked to see a sample number of care plans and looked at four. Each persons plan of care and support is important because they are one of the ways that people can say what assistance they need and how they want it done. The plans also give information and guidance to care staff so they know what to do. As noted earlier some care plans were either not in place or had only recently been initiated. The care plans were seen to contain 11 different sections. Daily records mainly refer to the personal care given and that they sat in the lounge and if they had visitors. Some of the daily records provided a reasonable picture of each day and night. Personal profiles contain some useful info about them as a person, their background and past life and family. Under Behaviour Section in one plan it was noted by staff that a service user is getting more impatient and attention seeking.There was nothing in the plan to guide staff about Care Homes for Older People Page 12 of 28 Evidence: what, if anything, they should do to resolve the matter. The entries were written in a way that saw the service user as the problem, rather than looking at why the behaviour exists, and how they could help the person more. Overall the care plan does not give enough information to understand the service user as a person, her needs and what support is required. Each section of the care plan is kept in an individual plastic sleeve in the file but with other papers behind the front one, the daily records are all kept in one sleeve and have to keep taking the papers out to follow the audit trail. Overall the care plan files need to be looked at and rearranged to make them more easily accessible. We asked staff about what all the written information means in practice and is it used. We were told that the information is good for reference if they are unsure or need reminding about something. Much of their work however is based on good team communication and exchange of information. Some staff felt they need to be given time to talk to people, to listen to them and learn about their experiences. We were told that this had been discouraged as staff felt they needed to be seen to be engaged in tasks. In our questionnaire we asked people who live in the home, do you receive the care and support you need. six said always and four said usually. Five questionnaires were received from relatives. They were asked whether they felt the home meets the needs of their relative. Four said, usually and one said, always. Accompanying comments include, I have been visiting my mother for nearly 10 years and have never seen anything but kindness to the residents. With the staff available they look after my mother very well. Another said that the care staff are really good within the limits they have been set. When asked what the service could do better one stated Listen. Also Wychdene has an extremely caring ethos. My relative is not the easiest person to look after but the staff are always excellent. When we were in the home we talked with people about this. They were generally positive about the care staff. They said that the care staff are helpful and caring, generally do fairly well, Take care of me. Others felt that there are not enough staff. We used to have more staff on duty when they first came to the home. Do not have a choice of when to have a bath but falls in with them. Days vary according to what staff are on duty. People who said that Overall its OK, nothing special. just ordinary and Its bearable here declined to expand on their comments. When considering privacy and dignity we found that one service user we spoke with in the lounge said that she wanted to change her position in her chair. The call bell was on the wall opposite. Asked how she gains attention she said, just shout. She has to call out if she needs to go to the toilet. Another service user was visited by her GP. The service user, her daughter and the GP stayed in the lounge and talked. She was Care Homes for Older People Page 13 of 28 Evidence: not seen in her bedroom or somewhere more private. When staff were able to respond to the service users needs and calls for attention they were seen to be polite, helpful and patient. Involvement in other tasks caused some delay but things like removing breakfast tabards, cleaning food spillage and finding someones false teeth were attended to eventually. Steps are taken to keep people safe from any avoidable accidents. For example staff accompany people if they are a bit unsteady on their feet. Staff said that they were aware of risks associated with individuals and kept an eye out. The absence of some care plans and omissions in others meant however that the risk assessment process was not complete and formalised in all cases. Risk assessments must be included in all service user plans. This includes when oxygen is stored and used in the home. We were told that only the staff who have received appropriate training give out medication. We watched a member of staff giving out some tablets. She checked the medicine was the right one for the person concerned. After she had given it she recorded that this had been done. Samples of the records were seen to be complete and up to date. During observation there was a query regarding the correct dosage and accurate measuring of some liquid medication, also how it was being recorded. The MAR sheet stated the solution and how much to give, as required. Two different symbols were being used; one for refusal and one for not required. We discussed with the head of care that this is confusing as it is prescribed for use when necessary, so, should be recorded as not required rather than a refusal. That indicates a drug prescribed to be given at set times has been refused. The head of care took immediate steps to clarify and address the issue with the pharmacist. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Family links are encouraged and maintained and visitors are welcomed to the home. People are able to make some choices regarding their daily lives and routine. The home provides a choice of meals for the service users. Some people told us the quality is not consistent Information from people tells us that the home needs to make sure service users are offered regular and interesting things to do. Evidence: We wanted to know what goes on in the home to occupy and interest the people who live there. We spent time in the lounge with some service users and their visitors. We also spoke with staff and service users in other parts of the house. We saw there was a weekly activities planner on the dining room notice board which listed things like; arts and craft on Monday, hairdressing on Tuesday, nails and hand massage on Wednesday. Our visit was on a Monday but we did not see any activities taking place. There were twelve service users in the lounge, five were asleep. the others were unoccupied. The television was on, there were no staff in the lounge. In conversation Care Homes for Older People Page 15 of 28 Evidence: with service users and some visitors the following comments about having things to do were made; One said that she had nothing to occupy her time except the TV. She used to like reading but there is nothing to read. Another said that they were fairly new but it was hard to find something to do as, most people sleep as there is nothing to stimulate them. One visitor who said she calls regularly and tries to occupy her relative feels the home could do more to stimulate the service users. We asked, in our questionnaire, does the home arrange activities for you to take part in?. Four service users said regularly and three said always. A staff member said that people enjoy the music and movement sessions. She added that it is sometime difficult to get people to join in but they do like to just sit and chat if the staff have the time. Comments from staff and relatives as well as some of the service users suggested that things could be improved by offering more outings and activity and allowing staff time to sit,listen and talk with the service users. People said they are given some choice in regard to their daily life. They said that they could usually get up and go to bed when they liked, access their rooms when they wanted and choose what to eat and where to eat their meals. Generally they were happy with the choices they were offered. One person said that the home was alright for a temporary stay and it had been a reasonable experience. He found that one or two staff were a bit hasty and although he could usually go to bed when he wanted sometimes they were asked to go to their rooms at 6:30 pm. it makes it a long night. In our questionnaire we asked people do you like the meals at the home? Two said always, two said usually and two said sometimes. Additional written comments were; need better food and need better quality, better variety and sometimes better cooked food. In conversation with the service users we were told variously that the food was excellent, alright, nicely cooked and we have a choice, we are asked one day what we want for dinner on the next day. The home employs two cooks. Staff and service users said that the amount eaten or wasted depends on which one is on duty.We observed a lunchtime meal and saw that a range of meals had been prepared and served in response to peoples choices. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment procedure ensures staff are suitable to work with vulnerable adults. A complaints procedure is in place and available to service users. Staff have had training in the protection of vulnerable people. Evidence: We were told that people have been informed about their right to make a complaint or raise a concern. Written information about the complaints procedure is available to the service users and visitors and is on display in the home. We asked in our questionnaire, is there someone you can speak to informally if you are not happy and do you know how to make a formal complaint? All of the people who replied (8) said yes to both questions. Staff members have attended training on the protection of vulnerable adults and were aware of the homes procedures and the service users rights. We asked about how the home deals with complaints. The head of care said that she was not aware of any formal complaints received or of a record book being available. The homes Annual Quality Assurance Assessment (AQAA) which had been completed by the manager and was received after the visit indicated that two complaints had been received and resolved and the details recorded. This is an internal communication issue that needs to be resolved. The route for raising a concern in a residential home needs to be open and available for all to use. Providers should promote that they are supporting and acting in the best Care Homes for Older People Page 17 of 28 Evidence: interests of the people who live there, encouraging them to feel confident to use it. Information was shared with us that some service users and staff did not feel confident to approach the manager with concerns, talking instead with other staff or the owners (Directors) who, it was said, will talk to people, have a chat and listen to any complaints. The homes recruitment process includes undertaking formal checks to make sure that potential employees are suitable to work with vulnerable adults. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service continues to improve and maintain the environment to provide people with a comfortable, homely and safe place to live. Service users benefit from a clean environment. The home needs to ensure that peoples privacy is not compromised by the use of CCTV. Evidence: We were informed that a number of alterations have taken place with a view to making the home a better place to live and work. Some areas have yet to be finished and decorated but are part of the ongoing plan. We asked people in our questionnaire is the home fresh and clean? six said always and two said usually.In conversation people said that they were generally satisfied with their surroundings. Most have single bedrooms which they can personalise with familiar items and ornaments.. Some people share a room and when we were looking round the home we saw that a ground floor room, which is shared, had no screening or curtain between the beds to offer some privacy for the occupants when they are getting dressed or undressed or are being cared for in bed. People who need it are helped to get about. Hoists and frames are there for assisting Care Homes for Older People Page 19 of 28 Evidence: people in the toilets and bathrooms. There are also mobile hoists that can be used in the bedrooms and communal areas. One relative has queried why they were asked to pay for some safety equipment and a hoist sling when they should be available for loan locally. Another said that she had bought a wheelchair and two hoist belts because she was told to by the management. The home needs to make clear to service users and their representatives, in the statement of purpose and the service user guide, what services and equipment will be provided by the home and those that the service user may be expected to provide from their own resources. The day of the visit was warm and sunny. No one was using the front or rear gardens. There was little in place to encourage people to go and enjoy sitting outside. There was a table and chairs near the car parking area but this was used only by staff taking their break. A written comment received in the questionnaires suggested that the gardencould be more organised. There are CCTV cameras in use in the home. If it is considered necessary for them to be used for security, this information should be included in the homes statement of purpose and service user guide. They impact on everyones privacy and this should be made clear. The Registered person also needs to ensure that any legislation that applies to their use is complied with. For example The Data Protection Act. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users would benefit from additional staff on duty at peak times and for social care, attention and activities. Staff have attended training courses and have been encouraged to attain NVQ to at least level 2. Staff training needs to be further developed so all the support and safety needs of the residents can be understood and met. There are recruitment systems in place to protect the service users from the risk of harm. Evidence: Records show that mandatory training such as first aid and moving and handling has been received by a number of staff. They said that they valued training opportunities. The training record showed us who had completed what, and although a number of subjects had been well attended, there were significant gaps in the fire training, infection control and coshh training record. We were told that all staff had attended a dementia awareness training day. The staff information section in the AQAA was not complete, however, the separate training record indicated ten staff have attained NVQ at level 2 and five are at level 3. Staff were aware of their roles and of their responsibilities to the service and its users. They felt that they were a mostly strong team of dedicated people who truly care and who the service users trust will care for Care Homes for Older People Page 21 of 28 Evidence: them. They said that the service users would tell them if they were found wanting. It was expressed by some of the service users, relatives and staff, that there are times when more staff are needed on duty to assist. One said that it has always been a lovely home, carers are good and devoted but morale is not good. There are more and more domestic tasks to do rather than time to care and support the service users. The manager needs to ensure that the tasks are not to the detriment of service users care nor does it compromise the opportunities for choice. We acknowledge that the staff were engaged in responding to the inspectors on the day but limited staff to service user interaction was observed. Feed back suggested that improvements in general social contact would be welcomed. Staff records show that the recruitment practice includes obtaining police checks and references prior to commencement of duties. There are staff supervision and appraisal sessions. Staff were asked in a questionnaire whether their induction training covered everything they needed to know when they started the job, and are they given training relevant to their role. All answered,very well or mostly on induction and yes for training. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is qualified and experienced in the provision of residential care and accommodation. Service users need to be sure that the home is run in their best interests. Interaction, communication and relationships between the manager, staff and residents needs to be improved to reflect trust, respect and confidence. The registered providers need to ensure that staff training and safety measures are sufficient to protect the health, safety and welfare of the service users, staff and visitors to the home. Evidence: There is a manager in post at the home. She is registered with us. This means that she has the formal qualifications we expect and has satisfied the fit person process. She has a number of years experience in residential care provision and has previously been a registered manager in another home. A head of care shares in the management and administration duties in the home. The registered manager was not available on the day of our visit. We were assisted by the head of care. The manager Care Homes for Older People Page 23 of 28 Evidence: had completed the homes AQAA which we received a few days after the visit. People who live at the home, relatives and staff should be confident in saying how they would like the service to be run and make suggestions for further improvements. Information was shared with us that some service users and staff did not feel confident to approach the manager and the relationship between her and service users, staff and some relatives was not entirely harmonious. Some felt that they were not always listened to or have their views considered. Two other service users inferred that they were not entirely happy but declined to comment further. The responsible individual (Director) is, we were told, a frequent and regular visitor to the home. We saw from records that he or someone else from the organisation, undertakes a formal visit once a month and produces a report of the findings. Service users said that the owners are very nice, talk to you, have a chat with us, listen to any complaints. Staff said also that they are happy to approach the provider if they need to talk about anything. We were told that a quality assurance questionnaire had been sent out by the provider to residents and their families and to staff. The head of care was not sure whether the results had yet been collated and made available but she and some staff felt that some positive changes were occurring. We were told that a number of residents manage their own financial affairs, others have their affairs dealt with by family, representatives or advocates. The home maintains records of any expenditure made for or on behalf of a service user and submits invoices for payment. All transactions are receipted. The AQAA indicated that the homes equipment and installations have been serviced and tested as recommended. As noted earlier , some safety related staff training courses need to be attended. We discussed with head of care the need to consult with, and seek advice from, the relevant agency regarding the comments on the fire service engineers report. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person 31/10/2009 shall...prepare a written plan as to how the service users need in respect of health and welfare are to be met. Not all service users had care plans and risk assessments completed in respect of their support needs. 2 16 17 A record is kept of all complaints made and includes details of investigations and actions taken. Head of care not aware of record. Itwas therefore not made available for inspection 30/09/2009 Care Homes for Older People Page 26 of 28 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 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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