Care Home: Abbey Court (West Kingsdown) Nursing Home Limited

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What the care home does well Residents were seen to be well groomed, and several residents said that the staff are very good at carrying out personal care, and pay attention to detail. One said "I am more than happy with everything at Abbey Court home". Relatives stated that staff are welcoming and friendly to visitors, and they are usually offered a drink. Residents and staff commented on survey forms that the standard of food is good, and they are offered sufficient choice. The home is kept clean in all areas, and there are no offensive smells. Staff training records show that a high percentage of care staff have completed NVQ 2 training (or higher); and the management are aiming for 100 per cent of care staff trained to this standard. What has improved since the last inspection? The residents` guide has been amended, so that it is easier to read, and contains clear information for enquirers and new residents. The management are more proactive in taking residents` views into account, and hold residents and relatives meetings, and coffee mornings to provide additional forums for feedback. There has been an increase in the range and amount of activities available for residents. There are increased levels of staff training, and these include additional subjects to mandatory training, such as tissue viability training, dementia care, and understanding the Mental Capacity Act 2005. What the care home could do better: The care planning system has been altered into a new format, but not all nursing staff are completing the assessments and charts and keeping these up to date. They need to ensure that all relevant information in regards to residents` care is fully documented. Medication management is generally satisfactory, but there are some areas which need more attention; such as ensuring that any handwritten entries are checked and signed by two nurses. Although there has been an increase in the number of activities, more activities (e.g. some at weekends) and more one to one input, would be of further benefit to residents. The registered manager and matron need to ensure that they familiarise themselves with the ongoing changes in regulatory processes, including the requirements for providing comprehensive data on the AQAA form. Key inspection report Care homes for older people Name: Address: Abbey Court (West Kingsdown) Nursing Home Limited School Lane West Kingsdown Kent TN15 6JB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Hall     Date: 1 4 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 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Abbey Court (West Kingsdown) Nursing Home Limited School Lane West Kingsdown Kent TN15 6JB 01474854136 01474855223 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Abbey Health Care Limited care home 22 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 maximum number of service users to be accommodated is 22 The registered person may provide the following category 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 category; Old age, not falling within any other category (OP) Physical disability (PD) Date of last inspection Brief description of the care home Abbey Court Nursing Home is a large, detached building, set in its own grounds, and is situated just off the A20 in the village of West Kingsdown. The property comprises an original period house, and additional wings which were built over twenty years ago. It is managed and owned by Mrs. Persand, who is a trained nurse with experience of caring for older people. She is assisted by the matron, who oversees all clinical care. Accommodation is provided on two floors, and there are sixteen single and three shared bedrooms. Eight of the single rooms have en-suite facilities. All rooms Care Homes for Older People Page 4 of 26 Over 65 22 0 0 22 Brief description of the care home can be easily accessed via two passenger lifts in different parts of the building. As this home includes nursing care, there is a registered nurse on duty throughout the twenty-four hour period. The home has communal areas on the ground floor, and pleasant gardens with lawns and flowerbeds. The current fees range from £564.08 to £653.70 per week, depending on the assessed needs of individual residents. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The home is assessed as having a rating of good, 2 stars. This was a key inspection, which includes assessing all the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us (i.e. CQC) about ongoing developments in the home, and any changes. We received the AQAA back within the specified timescale, and it was adequately completed, providing some basic information about the development of the home. We discussed this with the manager at the end of the inspection visit, as the Commission will require greater detail in future. Care Homes for Older People Page 6 of 26 The Commission sent out survey forms to residents, staff and health professionals, and received ten completed surveys back. These all contained positive comments, and were helpful in assessing how the home is running. The visit to the home commenced at 08.45, and lasted until 2.45 pm. The registered manager and the matron were present throughout the day. During the visit, we talked with four other staff, four relatives, and five residents (some in the lounge, and some individually in their own rooms). We also met several other residents briefly, and observed staff interaction with residents and with each other. We examined documentation such as admission information, care plans, medication charts, staff recruitment and training files, and some servicing and maintenance records. We viewed all areas of the home, and it was clean and generally well maintained. The home had one safeguarding alert investigated by Kent Social Services during the last year, and fully co-operated with the investigation process. One complaint was made to the the home during the year, and this was dealt with appropriately by the management. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The care planning system has been altered into a new format, but not all nursing staff are completing the assessments and charts and keeping these up to date. They need to ensure that all relevant information in regards to residents care is fully documented. Medication management is generally satisfactory, but there are some areas which need more attention; such as ensuring that any handwritten entries are checked and signed by two nurses. Although there has been an increase in the number of activities, more activities (e.g. some at weekends) and more one to one input, would be of further benefit to residents. The registered manager and matron need to ensure that they familiarise themselves with the ongoing changes in regulatory processes, including the requirements for providing comprehensive data on the AQAA form. Care Homes for Older People Page 8 of 26 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 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Enquirers are provided with sufficient information to assist them in making a choice about moving into the home. Pre-admission assessments could include more details. Evidence: The statement of purpose and service user guide have been altered during the last year, so that they are now two separate documents instead of one large document as previously. We viewed the service users guide, which is kept on display in the entrance hall, and available for anyone to read. It is produced in large print, and contains helpful information for enquirers and new residents. Information includes details of the registered provider and manager; a residents charter; arrangements for meals, and meal times; hairdressing and chiropody; visiting times, and the call bell system. Residents are able to retain their own GP if they previously lived locally; or can join the West Kent Medical Centre, from which a GP visits at least once per week. Residents are encouraged to bring in their own items to personalise their rooms. The guide also contains information about residents and relatives meetings; the homes Care Homes for Older People Page 11 of 26 Evidence: complaints procedure; and how the home meets religious needs. All residents have a pre-admission assessment, to check that the home will be able to meet residents individual needs. These assessments are usually carried out by the matron. We viewed three assessments. Two contained satisfactory information, but one contained little information. However, the matron had obtained a joint assessment from health and social services, and this was very comprehensive. There is a trial period of four weeks, after which a review is carried out to decide if the placement will be permanent. All residents are provided with a contract, which includes the terms and conditions of residency. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents expressed their confidence in the standards of personal care provided by the staff. Some further attention is required to improve documentation. Evidence: Individual care plans are implemented after admission, and these follow the Ropers twelve activities of daily living. These include items such as personal care, skin integrity, mobility, nutrition, communication and socialising. We viewed three care plan files, for residents who had been recently admitted. Some assessments had not been completed, but there was relevant and up to date information on the care plans, which are reviewed monthly. It was noted that information which should have been included on assessments or charts, had sometimes been written in the daily keyworker reports instead (e.g. blood pressure readings). Residents have nutritional food and fluid intake charts in their care plans, but the three viewed did not show good nutritional intake. This was either because the intake is poor, or that the charts had not been properly completed. We discussed this with the matron during feedback at the end of the visit, and she was said that it was due to poor completion of the charts, and that she would take the necessary action to improve them. Consent forms Care Homes for Older People Page 13 of 26 Evidence: for the use of bed rails do not clearly show the risks associated with their use, such as entrapment, and need to be amended. We did not see any falls risk assessments included in care plans. The matron stated that a new care planning system had been implemented the previous month, and nursing staff were still familiarising themselves with the new system. Wound care was found to be well documented, with clear information about the type of dressing to be used, and a separate record for each time a wound is redressed. Referrals are made to other health professionals as needed, including dietician, speech and language therapist, physiotherapy and the tissue viability nurse. Medication is stored in a clinical room which has suitable storage cupboards and a drugs fridge. It is administered via a monitored dosage system; and with packets or bottles of medicine for as necessary medication. Some of these items had been dispensed in 2007 or 2008, and while they were still within the expiry date, this does not show good control of stock rotation. We viewed all of the Medication Administration Records (MAR charts) and noted one or two gaps for signatures. There were also some handwritten entries which had not been signed for by two nurses. The controlled drugs register was seen to be well maintained. During the course of the visit we talked with five residents and four relatives, and received only positive comments about the standards of care. Comments included I am always looked after very well; the staff are excellent; and the care is very good, the staff keep me very clean, and my bed linen is always clean. Residents were seen to be well groomed, with attention to detail such as matching clothes and jewellery, and manicured hands. The nursing staff try to obtain residents wishes in regards to death and dying, but some are reluctant to talk about this. Some records showed if residents prefer burial or cremation, and other funeral wishes. The staff have a resuscitation form to complete, after discussing with residents or their authorised representative if they would wish to be resuscitated in an emergency. The form does not clearly show the details of the discussion points, and needs to demonstrate more clearly that the Mental Capacity Act 2005 has been applied. The staff will spend time sitting with residents who are ill or dying, and try to ensure that they are kept as comfortable and pain free as possible. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged to pursue their preferred activities. Food is well prepared and is of good quality. Evidence: The home has a programme of activities provided on week day afternoons, which includes items such as reminiscing, singing, ball games, flower arranging and bingo. There are two part-time activities co-ordinators; and two volunteers who assist with spending time with residents on one afternoon per week. The homes ethos is to arrange activities according to individual wishes and residents abilities. The activities co-ordinators spend time with residents on a one to one basis (e.g. carrying out nail care), but one relative expressed their wish that this could be increased. The home has planned celebrations for special days such as pancake day, and Christmas parties and bazaars; and also has bring and buy sales, garden parties, and coffee mornings. These are attended by families and friends as well as residents, and their input is appreciated. There has been an increase in social interactions with the local community, and this includes an increased number of church services which are interdenominational; and monthly Holy Communion for residents who wish to take part. Care Homes for Older People Page 15 of 26 Evidence: The manager said that there are plans to provide more training for care staff in the coming year on the importance of enabling residents to take part in social events and activities. Residents are encouraged to share their views, and can discuss ideas at coffee mornings as well as at residents and relatives meetings. The home produces a newsletter every two months, which contains ongoing information to help residents and their friends and relatives to keep up to date with changes in the home. Visitors are always made welcome, but are discouraged from coming at mealtimes (which may distract residents who need assistance with eating), or late evening. One relative commented that the home always has a friendly and homely atmosphere. Residents are encouraged to bring in their own items to personalise their rooms; and are invited to choose colours for the decor when redecoration is planned. Care plans had some good examples to show that residents individual wishes are taken into account e.g. they are asked for their preferred times for getting up and going to bed; and how often they like to have a bath or shower. Residents who we talked with were unanimous in their praise of the food, and said that there is always a choice of main meals, and that food is of good quality. Most meals are home cooked, and home made cakes are provided in the afternoons. The kitchen was seen to be clean and well organised. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns and complaints are taken seriously, and are responded to appropriately. Training courses ensures that staff are aware of how to recognise and prevent abuse towards residents. Evidence: The complaints procedure is clearly displayed in the entrance hall, and states that there will be a response to any complaint within seven days. The home keeps a record book for complaints, and this showed one complaint had been received during the past year, and had been dealt with appropriately. the record in the book was not very easy to follow, and the registered manager and matron agreed that records could be written more clearly in the future. The manager and matron have a daily presence in the home, and are well known by the residents and their families. This means that most matters of concern brought to their attention can be dealt with quickly before the matter escalates into a complaint. Residents feel able to express their views, and are encouraged to do so as individuals, and at meetings. Training records confirmed that staff are trained in the protection of vulnerable adults at induction, and have updates on a yearly basis. This was also confirmed in conversation with two staff. Recruitment records showed that checks are carried out for POVA first and Criminal Record Bureau (CRB) checks, which promotes safety for the residents. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained, and provides a comfortable and homely atmosphere. Evidence: The home is a large, detached building, and is made up of an original old building, and new wings which were added some years ago. It has a large front porch, which is attractively presented with tubs of flowers and plants. The home is surrounded by gardens, and these have mature bushes and trees, and provide pleasant areas for residents to sit outside. A gardener is employed to maintain the gardens. There is a large lounge and dining room on the ground floor, and this is divided into different areas, so that residents have a choice of where to sit. One area has the television available, but other areas are left quietly without this. There is also a small quiet area in one of the new wings, and this includes a payphone for residents use. Accommodation is provided on two floors, with two passenger lifts providing access between floors. The bedrooms are of differing sizes, and some have en-suite toilet areas. There are three shared rooms, for people who wish to share. There is an ongoing programme of redecoration, and bedrooms were seen to be well presented, and fitted with suitable furniture and soft furnishings. The home currently has three bathrooms and one shower, but one of the bathrooms is Care Homes for Older People Page 18 of 26 Evidence: not usually used, as it does not include an assisted bath, and is too difficult for residents to get in and out. The Providers are considering altering this into another shower area in due course. The current shower cannot be used by many residents, as it has a raised base, and is difficult for using with moving and handling equipment. The providers have already put a programme of alteration into place for this shower. The other two bathrooms have assisted baths, including one with a Parker bath, which has been fitted during the last year. There are a sufficient number of disabled toilet facilities available. The home has three mobile hoists, and there is always one hoist kept available on each floor. Other equipment includes pressure relieving mattresses and cushions; raised toilet seats, and grab rails. There is a good storage space on the ground floor for wheelchairs and other equipment. There is a sluice room on each floor. We viewed some of the maintenance records, and these included weekly temperature checks for hot water outlets accessible to residents; emergency lighting checks; PAT testing for all portable electrical items; and lift and hoist servicing checks. The routine checks such as hot water temperatures are carried out by a maintenance person; and other servicing is contracted out to specific companies. The home usually has two domestic cleaning staff on duty each day, and they have routines in place to ensure that individual rooms are Spring-cleaned every few weeks. The home was seen to be clean in all areas, and there were no offensive smells. One resident said that they always keep the home very clean. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has suitable recruitment procedures in place. Residents are confident of the staffs abilty to care for them. Evidence: The home has one nurse on duty throughout the twenty-four hour period, and this is often the matron, who carries out all of the clinical care oversight. Staffing rotas showed that there are usually four care staff in the mornings, three in the afternoons and evenings and one at night. The night shift starts at 9pm, and the manager said that the current residents all prefer to go to bed early. This means that residents are usually all in bed by 9pm, and only a few require hoisting during the night for toileting purposes. This means that one nurse and one carer are currently adequate at night. However, the manager said that if the dependency levels change, she will alter the staffing levels accordingly. There is a cook and kitchen assistant on duty each day; two cleaning staff and a laundry assistant; a part-time administrator; and a maintenance man on three days per week. There are also two part-time activities assistants. Most of the care staff have completed training up to NVQ level 2 or beyond this, with the current level at 88 per cent., which is excellent. Other care staff are continuing to train for NVQ levels 2, 3 or 4. Care Homes for Older People Page 20 of 26 Evidence: We viewed three staff recruitment files, and these are well put together, and include the required checks. One application form did not show a complete employment history, although this was requested on the form. Other application forms viewed were well completed. Applicants have a POVA first and Criminal Record Bureau (CRB) check; and provide two written references; confirmation of training; proof of identity, and a current photograph. Nurses Pin numbers are checked. All new staff go through an induction programme which they complete within the first six weeks. This includes all mandatory training. Two members of staff who completed survey forms for us, stated that the induction was very good. The induction is followed by a six month foundation training programme. Training records showed that there are ongoing programmes for mandatory training and other subjects. The last six months included training courses for infection control, basic food hygiene, first aid, health and safety, wound care, the role of the nurse, pessure sore prevention, and the Mental Capacity Act. All staff have yearly updates in the Protection of Vulnerable Adults. Residents and relatives spoke highly of the staff, and survey forms contained positive comments. A health professional wrote that the staff always assess residents needs holistically, always follow a code of confidentiality, and care for residents privacy. Staff surveys included comments such as the trained staff and carers work as a team. There are good standards of communication; and I am very happy working in this home. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has suitable administration and management procedures in place. Evidence: The manager and matron both have many years of experience in caring for older people, and are familiar with the illnesses that occur later in life. They both have appropriate levels of training. The matron oversees all of the clinical care, and the manager oversees all other aspects of the day to day running of the home. It was noticed that the managers hours are not included on the staff rota, and these should be evidenced, to confirm the hours that she is working in the home. Staff meetings are held at regular intervals. We read the minutes for a trained nurses meeting which had been held the previous week, and this showed that staff have the opportunity to share ideas, and suggestions for changes in the home. There had been a recent change in care planning as a result of listening to the staff. Residents are asked for their views on a day to day basis, and feedback is obtained Care Homes for Older People Page 22 of 26 Evidence: through informal coffee mornings as well as residents and relatives meetings. Questionnaires are sent out once or twice per year, and this gives residents the opportunity to voice their feelings anonymously if they wish. The manager stated that the views and wishes of the residents are paramount in monitoring the performance of the home. There is no facility in the home to look after pocket monies for residents. If residents are unable to maintain their own finances, an authorised representative is arranged, who can do this on their behalf. Staff have one to one supervsion sessions every two months, and have yearly appraisals as well. The matron carries out the supervision for nursing and care staff; and the manager carries out the supervision for other staff. Policies and procedures are kept available for staff, and are reviewed yearly. We viewed servicing records for items such as lift servicing, gas certificate, and hoist checks; and also viewed fire training attendance records, and fire drill records. These were up to date. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The registered person must ensure that residents assessments and charts are properly completed. For example: bed rail assessments, falls risk assessments, and nutritional charts. In order to demonstrate that proper provision is being made for residents health and welfare. 31/08/2009 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 To improve medication practices in the following areas: Ensure that all handwritten entries on Medication Administration Records are signed for by two nurses; Ensure that good stock rotation is carried out. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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