Care Home: Anley Hall Nursing Home

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What the care home does well Admissions are well planned and managed. People`s needs are properly assessed before they move into the home and they are assured their needs will be met. One relative told us, "We looked around and were told everything about the home. It has lived up to our expectations." A healthcare professional said they thought the home is an excellent service and it achieves this because they make sure the right people move into the home. We talked to people who live at the home and they are very happy with the care they receive. One person said, "They look after us here". Another person talked about getting good support to access healthcare services and said, "Staff organise and get the right help for us if they can`t do it." We spoke to eight visitors and they told us people receive good care and the home is well organised. One person said, "People have freedom around the home. It`s very good." Another person said, "Staff know what mum wants." Staff record important information about people and what they have been doing. The records are detailed and show that people`s needs are being well met. People are supported by a skilled and caring staff team. People who live at the home, visitors and healthcare professionals were very complimentary about the staff and management. People described them as `very nice`, `caring`, `professional`, `helpful` and `kind`. Staff told us the home has a friendly atmosphere. One staff said, "It`s a friendly home. People are well looked after and not rushed." Another staff member said, "All aspects of care are delivered to the highest standard." People enjoy the meals and the activities. One person said, "We have planned activities. The best one is baking." People who live at the home, staff and visitors were very complimentary about the activities organiser. The home is very well managed. The high standard of care that is provided in the home is strongly influenced by the management team. What has improved since the last inspection? The living environment has greatly improved. They have increased the number of special beds and mattresses, redecorated lounges, dining rooms, most bedrooms, corridors and hallway, provided a new ceiling bath hoist, converted a bathroom to a shower room, and replaced kitchen equipment. At the last inspection we recommended that there should be suitably qualified nurses employed to help improve the quality of life of people suffering from dementia and mental illness. The home has employed two Registered Mental Nurses (RMN). Staff and the management team said the home has benefited from having staff with more expertise, and they hope to continue developing this specialism. What the care home could do better: Care staff could have more involvement in the care planning process. This will help make sure people`s needs are consistently met. Staff could make sure they follow medication policies and procedures when administering medication so people always receive the right medication. People who enjoy wandering around the home could have access to an outside area of the home. This will improve people`s quality of life. Staff could receive some refresher safeguarding training to make sure they understand safeguarding policies and procedures. This will help protect people who live at the home. There are plans for improving the environment further to make sure people`s individual needs are fully met. Timescales for the programme of building work could be agreed, and people who live at the home and other interested parties could be informed of these. The home could have an up to date staff training and development plan. This will make sure staff have the right skills and knowledge to meet people`s needs. Staff could receive more regular formal supervision. This will help staff development. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Anley Hall Nursing Home Anley Hall Skipton Road Settle North Yorkshire BD24 9JU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Carol Haj-Najafi     Date: 0 8 0 5 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 30 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 30 Information about the care home Name of care home: Address: Anley Hall Nursing Home Skipton Road Anley Hall Settle North Yorkshire BD24 9JU 01729822268 01729822123 matron@anleyhall.co.uk 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) : Mr Malcolm Haigh care home 47 Number of places (if applicable): Under 65 Over 65 0 0 47 0 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability terminally ill Additional conditions: Age Range 45 years upwards 47 47 0 47 47 Service Users to include up to 47(OP), up to 47(PD), up to 47 (DE), up to 47 (MD) and up to 47 (TI) up to a maximum of 47 Service Users Date of last inspection Brief description of the care home Anley Hall is a care home providing nursing care for up to 47 people who are elderly and may suffer from Dementia, Physical Disability or be Terminally Ill. It is a Georgian, circa 1830, stone built country house, previously a private dwelling Care Homes for Older People Page 4 of 30 Brief description of the care home and is situated in a rural setting on the outskirts of the market town of Settle in the Yorkshire Dales. There are two floors including ground floor and a vertical lift provides level access to the first floor. It retains many of its original features including high ceilings and chandeliers and has extensive gardens, which are well maintained. It was converted for its present use in 1986 / 87. The registered manager told us the weekly fees for the home range from £580 to £700. Information about Anley Hall, including the last inspection report is available at the home. The h5mes Statement of Purpose and Service User Guide is available on request. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection was carried out in May 2007. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before this visit we reviewed the information we had about the home and the manager completed an annual quality assurance assessment (AQAA). The AQAA provides us with information about the home and tells us what has happened in the last twelve months. We used this information to help us decide what we should do during our Care Homes for Older People Page 6 of 30 inspection visit. Surveys were sent out to people who live at the home and other people who have an interest in the service. We received surveys from nine people who live at the home, six staff and six health and social care professionals. Comments from the surveys have been included in the report. An inspector was at the home for one day from 10:15am to 6:30pm. We spoke to six people who live at the home, eight visitors, four staff and the registered manager. We looked around the home, and looked at care plans, risk assessments, daily records and staff records. We spent a total of 8.25 hours at the home. Feedback was given to the registered manager at the end of the visit. What the care home does well: What has improved since the last inspection? The living environment has greatly improved. They have increased the number of special beds and mattresses, redecorated lounges, dining rooms, most bedrooms, corridors and hallway, provided a new ceiling bath hoist, converted a bathroom to a shower room, and replaced kitchen equipment. At the last inspection we recommended that there should be suitably qualified nurses employed to help improve the quality of life of people suffering from dementia and mental illness. The home has employed two Registered Mental Nurses (RMN). Staff and the management team said the home has benefited from having staff with more expertise, and they hope to continue developing this specialism. Care Homes for Older People Page 8 of 30 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 7535. Care Homes for Older People Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are well planned and managed. Peoples needs are properly assessed before they move into the home and they are assured their needs will be met. Evidence: We talked to one person who had recently moved into the home, and two relatives of people who had moved into the home. The person who moved in said the manager told her all about the home. Relatives said they thought the admissions were well planned. One relative said, We looked around and were told everything about the home. It has lived up to our expectations. Another relative told us they received all the information they required which included a brochure. In the AQAA the manager explained the procedure when people move into the home which includes, providing relevant information about the home, completing proper assessments and arranging visits. They said, Our brochure includes, introduction to Care Homes for Older People Page 11 of 30 Evidence: Anley Hall, services provided, dining and refreshments, residents charter and aims of the Home, fees and charges and philosophy of care. Also available on our web site. We talked to members of the management team who are responsible for completing pre admission assessments. They said they always gather enough information about each person before they move in, and encourage people to visit the home. The manager said they always make sure they can meet the needs of the people they admit, and will not offer a service to people who are aggressive towards others. A healthcare professional said they thought the home is an excellent service and it achieves this because they make sure the right people move into the home. We looked at two peoples assessment records. They had pre admission assessments that were completed before the person moved into the home. The assessments contained good information about the type of support they required. Surveys from people who live at the home said they received enough information to help them decide if they wanted to move in and written information about the homes terms and conditions. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are treated with dignity and respect, and their individual needs are recognised and well met. Safe medication procedures are in place but these are not always followed and this could result in medication not being administered correctly. Evidence: We talked to people who live at the home. They are very happy with the care they receive. One person said, They look after us here. Another person talked about getting good support to access healthcare services and said, Staff organise and get the right help for us if they cant do it. We spoke to eight visitors. They told us people receive good care and the home is well organised. One person said, People have freedom around the home. Its very good. Another person said, Staff know what mum wants. Care Homes for Older People Page 13 of 30 Evidence: We asked the staff what the home does well and they all said provide good care and most talked about the friendly atmosphere. One person said, Its a friendly home. People are well looked after and not rushed. Another staff member said, All aspects of care are delivered to the highest standard. In the AQAA the registered manager said, All staff are trained to respect the residents privacy and dignity. For example staff will always knock on a residents door before entering the room. We always ascertain how a resident wishes to be addressed. Healthcare professional surveys told us peoples privacy and dignity is respected. Staff also talked about privacy and dignity and gave us good examples of how they do this. Much of the day was spent talking to people and observing the care being given to people. This included how staff interact with people at the home. Everything was done at a relaxed pace. Staff treated people with warmth and respect and they were kind and courteous. The general appearance of people who live at the home was good, they were dressed appropriately and attention had obviously been given to their personal care. For example, peoples hair had been brushed and their glasses, shoes and clothing were clean. Staff record important information about people and what they have been doing. The records are detailed and show how peoples needs are being met. This is good practice because peoples health, welfare and lifestyle can be properly monitored. Staff had good knowledge about the people who live at the home. They understood peoples current needs and knew about their past. They were able to talk about peoples family members. Care staff told us they sometimes read the care plans but generally they get information from the qualified staff. One qualified staff said they tell care staff what support people need. Other qualified staff said they try to involve care staff in the care planning process. It is important that all staff use the care plans so they know the care they provide is the right care. We looked at four peoples care plans and assessments. These were well organised. Information in the care plans was good and gave sufficient information about potential risks and how individual needs should be met. A new life history section has been introduced. The care planning system is quite complex and has many different sections. It is Care Homes for Older People Page 14 of 30 Evidence: completed by qualified staff but care staff are being encouraged to get more involved. When asked what the home can do better and how they plan to improve, in the AQAA the registered manager said, To continue to review the care plans to increase the focus on person centred care and to encourage and support care staff in their contribution to the care planning and documentation process. People told us the home was good at meeting healthcare needs. Healthcare professionals, management and staff told us the home works very well with healthcare professionals. We received six healthcare professional surveys and spoke to one healthcare professional. We received very positive feedback. Surveys told us peoples social and healthcare needs are properly monitored, reviewed and met, and the care service seeks advice and acts on it to meet peoples needs. One survey said, Senior staff know residents well and appropriate care is tailored to needs and wishes. Another survey said, A friendly and family like atmosphere. Records showed us peoples health and welfare is properly monitored. Assessments, care plans and reviews identify needs, any changes in needs and any significant events. Healthcare appointments are clearly recorded. We looked at medication systems. Medication is generally well organised and the records were completed correctly. We checked antibiotics that had been prescribed. The number of tablets corresponded with the number of tablets that should have been administered and the signatures on the medication administration records. We looked at medication administration records (MAR). These are generally printed by the dispensing pharmacist although when people have just moved into the home the records are handwritten. Medication guidance says if a handwritten MAR is the only available option, there must be a robust system to check that the MAR is correct before it is used. Only one staff had written and signed the instructions. A second signature to confirm these had been checked would make the system more robust. One handwritten MAR had instructions to administer two types of medication that had not been prescribed, and staff had signed to confirm these had been administered. They were being given with prescribed medication. Full instructions that were on some prescribed medication had not been transferred to the MAR, and one prescribed medicine had the dosage altered but it was not clear who had changed this. The manager said they had a clear policy for household remedies and administration of medicines but on these occasions the policy was not followed. Care Homes for Older People Page 15 of 30 Evidence: Staff were mixing one persons medication with their food, without their knowledge or consent, although it was in agreement with the family and recorded in the care plan. This is called covert administration and should only be done when it has been agreed with the persons GP. The manager said they have a clear policy for this and on this occasion the policy has not been followed. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy living at the home and feel well cared for. Everyone works hard to make sure people have a stimulating and varied lifestyle. Evidence: In the AQAA the registered manager said, We create a happy homely inclusive atmosphere for residents and their families. Our inspection found that the home successfully achieves this. People who live at the home said they are very happy with the level of activities. One person said, We have planned activities. The best one is baking. People who live at the home, staff and visitors were very complimentary about the activities organiser. From these discussions it is clear she enhances peoples lifestyle at the home. One person suggested the home could offer more activities on a morning. People told us it is a relaxed home. One person said, I can get up early or decide to sleep in, and sometimes I chose to go to bed late. A visitor said people who live at the home can wander around different rooms and areas of the home, and this gives a feeling of freedom. Care Homes for Older People Page 17 of 30 Evidence: When asked what the home could do better, several people suggested having an outside area that people can access. Several people we spoke to at the inspection and six surveys suggested this as the key area for improvement. The manager explained this will be provided as part of the on-going refurbishment but did not have any idea of timescales. The home plans to divide the home into two separate areas as part of the refurbishment programme. A concern was raised that some of the freedom for people who live at the home could be lost as a result of this. The manager said people would still have freedom in the home when they make the changes. We received very positive feedback from relatives and friends. They told us they can visit anytime and are always made to feel welcome. One visitor said, They are always very helpful. Another visitor said, They ring and tell me about any changes. Im kept informed. In the AQAA the registered manager said, A choice of menu is available at each meal time. Our food is home made on the premises with fresh produce being used where possible. Tea, coffee, snacks, cakes and biscuits are freely available to both residents and their friends and family. Special diets are catered for. Six surveys from people who live at the home said they usually enjoy the meals. Three people said they always enjoy them. One person said, The meals are very, very good. The menus are on the wall so we know what we are having, and we are asked what we want before tea. Care Homes for Older People Page 18 of 30 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 who live at the home are safeguarded. They will be listened to and appropriate action will be taken when necessary. Evidence: Surveys from people who live at the home told us there is someone they can talk to if they are not happy and they know how to make a formal complaint. Staff also told us they know what to do if someone has concerns about the home. In the AQAA the manager said, Residents and their relatives are made aware of the complaints process through written information included in the brochure. The procedure is also displayed prominently in the hallway of the Home. Relatives confirmed that they have received information about how to make a complaint, and the complaints procedure was displayed when we looked around the home. The safeguarding policy and procedure is kept in the office. People said they feel safe. One person said, There is nobody here that is physically aggressive so I dont get worried. Staff cover safeguarding as part of their induction and some have received abuse awareness training although most have not done safeguarding training for a number of years. This training should be refreshed to make sure everyones knowledge is up to Care Homes for Older People Page 19 of 30 Evidence: date. Staff we spoke to were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They said they would report any concerns to the management team and they were confident they would deal with them promptly and appropriately. Since the previous key inspection visit there has been no safeguarding referrals. Care Homes for Older People Page 20 of 30 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 clean, safe and comfortable environment. The living environment has greatly improved and planned refurbishment will make sure peoples individual requirements are fully met. Evidence: People told us the home is fresh and clean. One person said, Ive visited many homes and this is very good. It feels fresh. When we looked around the home it was clean and tidy. At the last inspection we noted the provider had plans for major work to improve the environment. At this inspection we found that some very good improvements have been made but there is still work to do. In the AQAA the registered manager said they plan to commence major refurbishment of the whole home in the next 12 months, and provide another sluice, two new baths, a loop system, internet connection in all bedrooms, and a safe outdoor space. They told us they have already made many improvements and said they have increased the number of profiling beds and the number of nimbus mattresses, refurbished lounges and dining rooms, decorated several bedrooms, corridors and hallway, provided a new ceiling bath hoist, converted a bathroom to a shower room, and replaced kitchen Care Homes for Older People Page 21 of 30 Evidence: equipment. People who live at the home, visitors, staff and management said the environment has greatly improved in the last year, and everyone was aware of future development plans for the home. Some people did raise concerns that they do not have a timescale of when all the work will take place, and thought it would be helpful if they received this. Many bedrooms have been decorated and only approximately 25 still need decorating. Bathrooms are being refurbished and at the time of the inspection one bathroom was being converted to a wet room. The home is set in very pleasant grounds and these are kept in a good condition. As stated in the lifestyle section of the report, people who who live at the home would benefit from safe access to an outdoor area. The home was awarded a good hygiene certificate following an environmental health inspection of the kitchen in January 2008. Clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who live at the home. Staff have received training in infection control. Care Homes for Older People Page 22 of 30 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. People who live at the home are supported by a skilled and caring staff team. Evidence: People who live at the home, visitors and healthcare professionals were complimentary about staff. People described the staff as very nice, caring, professional, helpful and kind. People told us in the main they were happy with staff levels. One person who lives at the home said, There is plenty of staff, you dont have to wait. A regular visitor said, If the alarm goes staff turn up very quickly, Im impressed with the speed they respond. Four staff surveys said they usually have enough staff; one survey said they sometimes have enough staff and one survey said they always have enough staff. We received six staff surveys and spoke to six staff. We received positive feedback and a good range of comments of what the service does well. Staff told us the team work well together. One person said, We offer a good mix of staff- age, experience and diverse backgrounds, which creates a therapeutic atmosphere. At the last inspection we recommended that there should be suitably qualified nurses employed to help improve the quality of life of people suffering from dementia and Care Homes for Older People Page 23 of 30 Evidence: mental illness. This recommendation has been well met. The home has a Registered Mental Nurse (RMN) who is head of the dementia unit, and a second RMN has just been employed. Staff and the management team said the home has benefited from having staff with more expertise, and they hope to continue developing this specialism. Staff told us they receive good training. The surveys told us their induction covered everything they needed to know, and they receive training that is relevant to their role, and helps them understand and meet the needs of people living at the home, and keeps them up to date with new ways of working. We looked at training records. The home has a training matrix and individual staff training files. Some of the records were not up to date so it is not possible to tell if staff had received all the relevant training. The training matrix is a relatively new system and has not been fully implemented. The assistant manager said they were working on the matrix and it would soon be up to date. In the AQAA the registered manager told us, All long term staff are trained to a minimum of NVQ level 2 and all new staff are undergoing training to NVQ level 2. New members of staff are expected to undertake the NVQ 2 programme following their initial probationary period. They are also expected to complete the Skills for Care programme, in house. Staff surveys told us a thorough recruitment process was carried out before they started working at the home. In the AQAA the registered manager told us they have recruitment policies to ensure that proper checks are carried out before starting employment. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed. The high standard of care that is provided in the home is strongly influenced by the management team. Evidence: In the AQAA the manager told us she holds the qualifications RGN, MRM, Dip.HE (Care of the Elderly) and has a Registered Managers Awards NVQ Level 4. She also has over 24 years experience in nursing. People told us the home is well managed. One person who lives at the home said, Its well organised. A visitor said, If you ask the manager for anything. She deals with it and always gets things sorted. A staff member said, The management is good, we all have confidence in the manager. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA gave us some very good information about the service. It gave us Care Homes for Older People Page 25 of 30 Evidence: good examples of what they do well, how they have improved and what they want to do better. They also told us about changes they have made as a result of listening to people who use the service. In the AQAA the registered manager told us the home should encourage and support care staff in their contribution to care planning and further improve the environment. These are areas that we identified at the inspection and show that the manager has a good understanding of how the service could improve. Good systems are in place to make sure the quality of the service is properly monitored. A staff member said, We always ask for opinions. Invite people to have a say and take on board suggestions because we want to keep improving. We looked at a selection of surveys that the home had received. These were generally very positive and many commented on the friendliness of the home. People who live at the home and their relatives attend meetings to discuss the home. One visitor said they are well informed and have opportunities to provide feedback. We looked at personal allowance records. All financial transactions were recorded and receipts were obtained for any purchases made. When we asked staff about supervision and support, staff said they received very good informal and formal support from the management team. Supervision records showed us staff have not always received regular formal supervision. The manager said she works very closely with staff but acknowledged formal supervision could be offered more frequently. In the AQAA the manager told us they have all relevant policies and procedures in place, and equipment has been tested as recommended by the manufacturer. No concerns around safe working practices were seen on the day of the inspection. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 Staff must follow the homes 30/06/2009 medication policy and procedure when administering medication. This will make sure people receive the right medication. 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 7 Care staff should continue to have more involvement in the care planning process. This will help make sure peoples needs are consistently met. People who enjoy walking around should be able to safely access an outside area of the home. This will improve peoples quality of life. Staff should receive some refresher safeguarding training to make sure they understand safeguarding policies and procedures. This will help protect people who live at the home. Timescales for the programme of building work should be agreed, and people who live at the home and other interested parties should be informed of these. This will help make sure people live in a well-maintained and Page 28 of 30 2 12 3 17 4 19 Care Homes for Older People suitable environment. 5 36 Staff should receive regular formal supervision. This will help staff development. Care Homes for Older People Page 29 of 30 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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