Care Home: Albany Nursing Home

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Inspecting for better lives Key inspection report Care homes for older people Name: Address: Albany Nursing Home 11-12 Albany Road Leyton London E10 7EL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Illes     Date: 1 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Albany Nursing Home 11-12 Albany Road Leyton London E10 7EL 02085567242 02085560550 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Topcare Limited care home 61 Number of places (if applicable): Under 65 Over 65 61 0 old age, not falling within any other category physical disability Additional conditions: 0 17 The Registered Person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Physical Disability - Code PD (maximum number of places: 17) The maximum number of service users who can be accommodated is: 61 Date of last inspection Brief description of the care home Albany Nursing Home is a purpose built care home owned and operated by Topcare Limited. The home is situated in a residential area of Leyton in the London Borough of Waltham Forest and is close to shops and public transport. The home can accommodate up to 61 people and is registered to provide nursing care to older people; and younger adults with physical disabilities. There is one double room and the remainder are single rooms with ensuite facilities. Accommodation is over three floors and each floor has at least one lounge and a separate dining room. On the day of this inspection the range of fees for the home was from £650 per week depending on Care Homes for Older People Page 4 of 31 Brief description of the care home peoples needs. A copy of the Statement of Purpose, Service User Guide and a copy of the most recent inspection report arelocated in the reception area and can be made available on request. 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: 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 last key inspection of this service took place on 8th May 2007. This key inspection took approximately 11 hours over 2 days and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken by the Commission. The registered manager was available to assist throughout this inspection and 59 residents were living in the home at that time. The inspection activity included: meeting and speaking with a number of residents on each floor of the home although conversation with some was limited due to their communication needs; discussion with a number of relatives; detailed discussion with Care Homes for Older People Page 6 of 31 the registered manager; discussion with the provider organisations area manager; independent discussion with the head of care; independent discussion with 3 nursing staff; independent discussion with 5 care staff and independent discussion with a number of other staff including an activities coordinator, chef, person in charge of the laundry and administrator. An independent discussion by telephone also took place with a social worker from L.B. of Waltham Forest. Further information was obtained from a tour of the building, documentation kept in the home, survey forms sent to us by residents, some filled out with the assistance of relatives and survey forms from staff. Information was also gathered from an Annual Quality Assurance Assessment (AQAA) that the registered manager sent to the Commission prior to this inspection. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 8 of 31 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. The home has a range of information available to help people and their representatives decide if it can meet their needs. Peoples needs are properly assessed before they move into the home to make sure that the home can meet these. Once living at the home peoples needs continue to be monitored to help staff meet any changing needs. Evidence: Since the last inspection the home has built an extension, which includes six additional bedrooms and additional storage facilities, and this has been successfully registered with the Commission. The home has an up to date Service User Guide and Statement of Purpose, both of which were seen displayed in the entrance of the home for people to look at. Both documents included details of the change to the accommodation, were clear and up to date and seen to have been reviewed in February 2009. The files of eight people living at the home were looked at. Five of these had been Care Homes for Older People Page 11 of 31 Evidence: admitted to the home since the last key inspection in 2007 and three had lived at the home for a longer period. The homes Annual Quality Assurance Assessment, (AQAA), states that Pre-admission assessments are done using all the available information to confirm the home suitability of the home for the prospective resident. All the files seen had a range of assessment information that was available to the home before the person moved in. This included assessment information on the persons nursing needs, their social and leisure needs and their moving and handling needs. Some files also contained assessment information from the persons placing authority and detailed medical assessment information where appropriate. It was also noted that the majority of files had a Life History section that included information on the persons interests and things that were important to them before they were admitted to the home. Some of these had more information than others and we were informed by staff spoken to that work was continuing to develop these further. Soon after being admitted to the home a further assessment is undertaken and those seen included information on peoples cultural and equality needs. These gave information areas such as religious requirements regarding diet and their preference regarding the gender of staff that provide them with personal care. Evidence was seen that after this peoples needs and preferences are reviewed on a regular basis to make sure that staff are aware of any changing needs and can meet these properly. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and preferences are recorded on their care to assist staff in meeting these. People also benefit from having their healthcare needs addressed by a range of healthcare professionals. The homes medication policy generally assists safeguard people although recording of medication entering the home is needed to improve this. Staff are working hard to treat people with respect and dignity, which is appreciated. Recording of peoples wishes in relation to end of life care needs improving to help reassure them that these will be respected. Evidence: At the last key inspection a requirement was made that care plans be made more specific, including with regard to recording how peoples needs about skin and hair care are to be met. At this inspection the care plans for eight residents were looked at and evidence seen that staff are working hard to make the plans sufficiently detailed to give clear guidance on peoples needs and preferences. The plans seen included sections on nursing needs, personal care, skin care, daily living needs and mobility. The plans seen were appropriately detailed including regarding skin and wound care Care Homes for Older People Page 13 of 31 Evidence: where needed. Each element of the plan had a section on the identified need, the expected outcome and nursing action needed to achieve this. Nurses and care staff spoken to were able to describe how they supported individuals and appeared knowledgeable about the persons needs, likes and dislikes. Evidence was seen on the files looked at that they are reviewed at least monthly by the nurses on each unit. The homes Annual Quality Assurance Assessment, AQAA, states that Residents are assisted for their appointments regarding their health. Transport is provided and escort arranged by the home. The AQAA goes on to say that Regular referrals are made to the GP for residents who are unwell and need home visits. At this inspection evidence was seen on residents files to support this. This included records of appointments with a GP; dentist, optician, dietician, chiropodist and a tissue viability nurse. The home also employs a part time physiotherapist who is involved in initial assessments of residents and in monitoring their ongoing and changing needs. Residents and relatives spoken to confirmed that residents were supported with their health care needs. Many residents have complex health care needs and nurses on each floor were able to describe how these were addressed by the home. At the last key inspection a requirement was made that records regarding food and fluid intake are accurately maintained and kept up to date. At this inspection the records seen indicated that the requirement was being complied with. Medication is stored properly on each floor and the home has a satisfactory medication policy and procedure. Medication and medication administration record (MAR) charts were sampled for nine residents, three on each floor. Although the charts recorded that people were being administered the medication that was prescribed to them there was not always a clear record of medication being recorded when it was received into the home. This meant that for some people it was not possible to check an audit trail of the remaining medication currently in stock for that person. The registered manager stated that the home had recently changed the system for receiving medication into the home and acknowledged that this needed to be improved. A requirement is made regarding this. Some people are prescribed controlled drugs and records of this were sampled and were satisfactory. The controlled drugs (CD) sampled were properly stored separately in a CD cupboard, one on each floor, the record of it being administered was accurate and there was a proper audit trail. Staff were observed interacting with residents throughout the inspection in a generally kind and appropriate manner. Two staff were observed transferring a resident from an armchair in one of the lounges to a wheelchair. This was undertaken gently with the staff talking to the resident and reassuring them throughout the process. Staff were also observed helping people with their midday meal in a generally relaxed and appropriate way although it was noted that lunch time is a busy and sometimes Care Homes for Older People Page 14 of 31 Evidence: stressful time for staff. Residents and relatives were asked about how staff treated them generally. One resident told us, Staff are very nice and accommodating, I can have my supper in my room if I choose. However, the same resident did raise an issue regarding one member of staff and we subsequently discussed this with the registered manager. As a result of this we were satisfied that the issue raised was being properly addressed and appropriate support for both the resident and the member of staff had been put in place. A relative of another resident told us that their spouse had been living in the home for nearly a year and stated that The staff are first class, cannot be faulted. We received questionnaires from eight residents and these indicated that they were generally happy with the care and support they received. The homes Annual Quality Assurance Assessment, AQAA, states under one section, What We Could Do Better , To continue to improve End of Life Care Planning by incorporating the documentation giving the residents instructions in the event of serious illness or death. Although the files inspected had a section for peoples wishes in the event of serious illness and death, a number of these had minimal or no information recorded. Given that the home is registered for nursing care and many of the people have complex needs we regard this as important and a requirement is made for the home to improve its records in this area. 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. People benefit from an activities programme within the home and from staff working hard to meet peoples needs and preferences. Families and visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. People are also served a range of appetising meals that they enjoy. Evidence: The homes Annual Quality Assurance Assessment, AQAA, states An activity programme is in place to suit all residents depending on their abilities. The home employs three part time Activities Coordinators who between them cover the home for the working day from Monday to Friday. We were given a copy of the homes activities programme for a four week period that covered the period of the inspection. This showed that each morning five residents were offered 1/2 hour one to one sessions with an Activities Coordinator and each afternoon a group activity was undertaken by an Activities Coordinator on one of the three floors. We were told by an Activity Coordinator that she felt that individual activities were particularly helpful for people that spent significant amounts of time in their rooms. She went on to tell us about some reminiscence work that she had undertaken with one resident that morning. Care Homes for Older People Page 16 of 31 Evidence: Group activities include bingo, soft ball games, crafts including card making and films, we were told that the film Mamma Mia had been shown earlier in the week and that people enjoyed this. Evidence was also seen of occasional outings, the home is registered with the L.B. of Waltham Forests community transport to facilitate this, and of external entertainers visiting the home. Feedback from residents regarding the activities were generally positive although a few people told us that they would like more to do. The home is registered for both older people and for younger people with a physical disability. The homes Service User Guide states that Our residents all have identified nursing needs and therefore age groups are mixed on all floors. We feel that this reflects community living. Younger people talked to during the inspection stated that they were happy with their living arrangements. However, one social worker spoken to independently felt that in their opinion younger people may benefit from a separate unit. We feel that it is important for this to be explored by those concerned when a younger person is referred to the home. The residents in the home come from a range of ethnic communities and the home works hard to meet peoples religious and cultural needs. We were told that the home supports people to attend their preferred place of worship. The Annual Quality Assurance Assessment, AQAA states that We have Church contacts for (people who are) Evangelist, Roman Catholic and Church of England. Other residents are taken by family members to attend the Mosque or Temple or Church. (People) are also offered a quiet lounge on the first floor to undertake religious observances within the home. Records seen, residents, relatives and staff spoken to all indicated that the home is working hard to meet peoples individual needs and preferences in relation to equality. Relatives and friends are encouraged to visit the home at any time during the day and evening. A number of relatives that visited the home were spoken to independently during the inspection and expressed satisfaction with the home. The home has satisfactory systems for dealing with peoples finances. Residents are encouraged to manage their own finances as much as they can with relatives or placing authorities being appointee for people when required. People are encouraged to bring their own possessions when they move into the home. The home has a four week menu that was seen with a choice for all meals. We spoke to the weekday chef who stated that if people did not like the choices on the menu he would prepare an alternative if possible and gave examples of having done this recently. The home is able to cater for people with special diets, such as for people with diabetes. The home also provides meals to meet peoples religious and cultural Care Homes for Older People Page 17 of 31 Evidence: needs and preferences including Halal and vegetarian meals. We were invited to join one unit for lunch and chose the fish option available on the day, which was very enjoyable. Other residents in the unit were enjoying other options and one person had their meal pureed, and this was presented attractively. Feedback generally from residents was that they enjoyed the meals provided by the home. Care Homes for Older People Page 18 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. People living at the home, and their relatives, can raise complaints or concerns and have these acted upon appropriately and in a timely manner. The home has clear policies and procedures for protecting people from abuse that staff are aware of. However, staff may benefit from the provider organisations whistle blowing policy being made more readily available to them. Evidence: The home has a clear and up to date complaints procedure with a copy seen in both the service User Guide and displayed in the home. At the last key inspection a requirement had been made that the homes complaints procedure showed the then current address of the local Commission office. This was to assist any interested party to contact the Commission if they wished to and this requirement had been complied with. The homes complaints log was looked at and showed that the home had recorded four complaints since the last inspection. Records of these were sampled and indicated that they were dealt with promptly and in accordance with the homes policy. An anonymous complaint had also been received by the Commission since the last inspection and this had been referred to the Provider organisation to be investigated. No evidence was found to substantiate the complaint. The home also has a concerns book in the entrance hall of the home for anyone to write comments in. This also indicated that minor concerns or queries were promptly Care Homes for Older People Page 19 of 31 Evidence: dealt with. Questionnaires returned from residents and relatives indicated that those people knew how to make a complaint if they needed to. Residents and relatives spoken to during this inspection also stated that they felt comfortable raising any concerns if they felt the need to. The home had a copy of the latest LB of Waltham Forest Safeguarding Adults (adult protection) policy and procedures and a satisfactory in-house policy. There had been three safeguarding allegations made since the last key inspection and these had been properly investigated under the local authority procedures. At the last inspection a requirement had been made that all ancillary and administrative staff receive training in safeguarding adults, in addition to nursing and care staff who had already received this training. Evidence was seen from records and talking to staff that this requirement had been complied with. Staff spoken to during this inspection were able to tell us the actions they needed to take if an allegation or disclosure of abuse was made to them. The home had a satisfactory whistle blowing policy that was seen although was not immediately to hand when requested. A good practice recommendation is made that this should be made more readily accessible to help staff know the provider organisations procedures should they wish to use these. Care Homes for Older People Page 20 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. People live in a modern, purpose built home that has sufficient equipment, is being properly maintained and that meets their needs. The home was generally clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors. Evidence: Accommodation for residents is provided on three floors, all of which provide nursing and personal care. An integral extension to the building has been built and registered since the last key inspection increasing the capacity of the home from 55 places to 61. Accommodation is currently provided as follows: the ground floor has 19 single ensuite bedrooms and 1 double en-suite room, the first and second floors have 20 single en-suite rooms each. In addition each of these three floors has an additional assisted bathroom, 2 shower rooms, a dining room with drinks making facilities and two lounges, one larger and one smaller. The smaller lounges on the ground and second floor are designated smoking areas that meet the Environmental Health requirements, as required at the last inspection. The home has a third floor that accommodates the homes main kitchen, laundry and staff facilities. In addition the ground floor contains the reception area with the registered managers office and administrators office being adjacent to this. There are also two pleasant gardens for residents and visitors to enjoy. Care Homes for Older People Page 21 of 31 Evidence: During a tour of the building it was noted that their were appropriate aids, adaptations and equipment such as hoists on the three main floors and that the bath, shower and toilet facilities were sufficient to meet the needs of people living there. Bedrooms seen had been personalised by the person living in them and were light, airy and comfortable. People spoken to throughout the inspection indicated that they were satisfied with their bedrooms and other facilities within the home. The homes Annual Quality Assurance Assessment, (AQAA), states that improvements to the physical environment in the next twelve months will include to redecorate bedrooms, replace identified flooring and provide new curtains and soft furnishings where required. During this inspection new soft furnishings were being fitted. At the last inspection a requirement was made that suitable arrangements were made for storage so that stored equipment and goods did not impinge on individuals space, comfort and privacy. This had been complied with in large part as a result of the new extension that provides a range of storage space in addition to the 6 extra bedrooms. The home was generally clean and tidy throughout during this inspection although feedback from a social worker who had recently reviewed a resident told us that he felt that the residents bedroom was not as clean as it could have been at that time and he raised this with the home. The home has laundry facilities that meet the needs of a large home that provides nursing. The person in charge of the laundry was spoken to independently, presented as being competent and was able to describe how infection control was managed in regard to the laundry. Care Homes for Older People Page 22 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 benefit from a staff team that work on each floor in sufficient numbers and who are properly trained. Residents are also protected by the homes robust recruitment procedure. Evidence: The home allocates 1 registered nurse and 4 care staff to each floor on the early shift, 1 registered nurse and 3 care staff to each floor on the afternoon shift and 1 nurse and 1 care staff to each floor at night. The registered managers hours are in addition to this. The home also employs a head of care who takes overall management responsibility for the home when the registered manager is on leave. The head of care works half her hours as the allocate nurse on one of the floors and the other half undertaking management and related professional tasks. The home also employs a range of ancillary staff to meet the non care needs of people living at the home. Staff rotas were inspected and were accurate for the time of this inspection. It is our judgement that their are sufficient staff and skill mix to meet the needs of the current residents. The homes Annual Quality Assurance Assessment, (AQAA), showed that over 50 of the care staff had achieved at least National Vocational Qualification (NVQ) level 2 in care, which meets the required standard. Evidence to support this was gathered from Care Homes for Older People Page 23 of 31 Evidence: staff training records sampled and discussion with individual care staff. We were informed that the home does not use agency staff, which promotes continuity of care for residents. Records also indicated that residents benefit from relatively low staff turn over generally. We were told that no new nurses had been employed at the home since the last inspection. We chose at random and looked at the files of three care staff that had been appointed since the last inspection. These indicated that the home operates a robust recruitment procedure with the necessary documentation and recruitment checks in place before the person starts. This included on each file a completed application form, proof of identity, proof of eligibility to work in the UK, 2 references that had been verified by the home and the proper Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. In addition staff questionnaires returned to us indicated that staff had not stated work before the recruitment checks had been completed. A staff training programme was seen that showed that regular training, including refresher training, is provided to staff on a regular basis. This included in the last three months training on: resuscitation, infection control, promoting continence, care of pressure ulcers, managing colostomys, managing PEG feeding; and safeguarding adults. Registered nurses are also supported to keep up to date and are offered 2 paid training sessions per year to assist with this. Each staff file sampled had an up to date individual training record, however, there was no overall training matrix or other overview to show managers when individual refresher training for individual staff was needed. The registered manager stated that the system worked well and evidence from records and staff spoken indicated that staff training is ongoing. However, given that the home employs in excess of 70 staff a good practice recommendation is made regarding this. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from the service being managed by a competent and qualified registered manager. People accommodated and other stakeholders are regularly consulted to promote and monitor the quality of the service they receive. Peoples financial interests are safeguarded while living in the home. Staff supervision is provided to support staff meet the needs of people accommodated and to assist in their own development. A range of effective health and safety procedures protect people living in the home. Evidence: The registered manager of the service was registered with the Commission in May 2008 having been the deputy manager prior to that date.The registered manager is a registered nurse, presented as being knowledgeable about the needs of the residents and as having the managerial skills to undertake her role competently. Feedback from both nurses and care staff was very positive and it is clear that staff spoken to felt well supported. The head of care, who deputises when the registered manager is away for Care Homes for Older People Page 25 of 31 Evidence: any length of time, is also a registered nurse who presented as knowledgeable and competent and shares the supervision of the nursing staff with the registered manager. The home has a number of systems in place to monitor the quality of care it provides. An annual questionnaire is sent out to residents and relatives and an annual evaluation report compiled by the registered manager from these. The last evaluation report was seen and recorded a high degree of satisfaction from people that returned the questionnaires. In addition to this the home holds residents and relatives meetings every 4 months. Notes of the last meeting in December 2008 were seen and notices displayed in the home informed people that the next meeting was planned for later in April 2009. A series of quality audits are undertaken including: a monthly health and safety audit for each floor, a separate accident audit for each floor, a monthly overall audit and an annual audit using all the information available throughout the year. Copies of these were sampled and seen to provide useful information for managers to develop the service further. Monthly unannounced visits are undertaken by the provider organisation and reports of these were seen to evidence this. The provider organisation has recently appointed a new area manager, who was visiting the home at the time of this inspection. The Area Manager informed us that it was the provider organisations intention for her to become the responsible individual for the home in due course and that the Commission would be informed when that is to be implemented. Evidence was seen that the new area manager had started to undertake a review of care documentation in the home with signatures to that effect seen on some of the documentation we inspected. We were informed that neither the registered manager nor other staff at the home acted as appointee for residents finances. The majority of residents are assisted with their finances by relatives or other representatives although the home holds an individually agreed personal allowance for most residents. The individual records and systems for peoples personal allowances were sampled and found to be in order. One person is currently managing their own finances with some assistance from the home. We were informed that 5 residents were subject to Receivership by the L.B. of Waltham Forest and 3 monthly statements of these peoples expenditure were sent to that Authority. Evidence was available, including from staff spoken to independently, that staff receive supervision at least every two months. Staff spoken to felt that this was useful. A range of satisfactory health and safety documentation was seen. This included: gas safety certificate, electrical installation certificate, portable appliance certificate and Care Homes for Older People Page 26 of 31 Evidence: water tank maintenance to minimise the risk of legionella. Evidence was seen that the Fire Officer had visited the home in May 2008 and we were informed that recommendations made at that visit had been complied with. The homes fire log was inspected and showed: up to date servicing of fire fighting equipment, a record of monthly fire drills being undertaken and an up to date fire risk assessment. Care Homes for Older People Page 27 of 31 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 28 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 9 13 The registered persons must 29/05/2009 ensure robust arrangements are in place for the recording, handling, and administration of medication. This must include a robust audit trail for all medication entering and stored in the home, including date of receipt and a record of the person receiving it. This requirement is made to maximise the safety of residents who are prescribed medication. 2 11 12 The registered persons must 29/05/2009 continue to endeavour to seek, record and respect peoples wishes and preferences in the event of serious illness or death and, where it has not been possible to obtain this information, this should also be recorded on the persons file. Care Homes for Older People Page 29 of 31 This requirement is made to show evidence to the person and other stakeholders that their wishes are known will be respected. 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 18 The home should make the Provider organisations whistle blowing policy and procedure more readily available to staff so they are aware of how to implement these if they feel the need to. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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