Care Home: Argyles Nursing Home

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What the care home does well The home assess people very thoroughly before they are admitted to the home, to make sure that they are able to meet their needs. The home develop an excellent plan of care from the assessment so that peoples` needs can be met effectively, by the staff team. People have detailed health care plans to ensure that people are kept as healthy as possible for as long as possible and medical or specialist help is sought whenever necessary. People are helped to have an interesting and rewarding lifestyle for as long as possible. They are able to have as many visitors as often as they choose and are supported to remain part of the local community, even if they do not leave the home. The home support people to remain as independent as they are able for as long as possible and encourage them to make as many decisions and choices for themselves, as they can. The home is very comfortable and well kept to ensure people who live their have a pleasant environment, in which to live. What has improved since the last inspection? No requirements or recommendations were made Arther last inspection in 2007 but the home have identified areas of improvement. The home has adopted a much more person centred approach to assessment and care planning so that the individual needs of those who live in the home are better identified and met. The home has a more varied activity programme, that now runs for six days a week, to ensure that people can be kept as interested in their lives as possible. The home has been refurbished, including new flooring in the kitchen and new garden furniture so that people can be as comfortable as possible. What the care home could do better: The inspection visit did not result in any requirements being made but their were some good practice discussions about issues such as providing guidelines for the administration of medication prescribed to be taken `when required` and the manager applying for registration, as soon as possible. Key inspection report Care homes for older people Name: Address: Argyles Nursing Home Pound Street Newbury Berkshire RG14 6AE     The quality rating for this care home is:   three star excellent 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: Kerry Kingston     Date: 2 7 0 4 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Argyles Nursing Home Pound Street Newbury Berkshire RG14 6AE 01635551166 01635528716 smithsu@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd The registered provider is responsible for running the service care home 57 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 57 The registered person may provide the following category of service: Care home with nursing(N) 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) Date of last inspection Brief description of the care home The Argyles is a care home with nursing run by BUPA care homes. The home can accommodate 57 residents over the age of 65 years of age. The accommodation in the home is provided over two floors. Each floor has access to two lounge areas. There are two passenger lifts between the two floors of the home. The home is very close to the centre of Newbury and is easily accessible by road and rail, as well as pedestrian Care Homes for Older People Page 4 of 30 0 Over 65 57 Brief description of the care home access. The current scale of charges, as at 30.04.10, are from £700 to £1400 per week, dependent on the size of the room and the assessed needs of the individual. Additional charges are made as required for hairdressing, chiropody, toiletries and newspapers. 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 inspection on this service was completed on the 6th June 2007. This is a report for the key inspection, which included a routine unannounced site visit to the service. This took place between 9.45 am and 4.15 pm on the 27th April 2010. The information was collected from an Annual Quality Assurance Assessment, a document sent to the service from the Care Quality Commission and completed by the service manager. Three surveys returned to us by people who use the service, and six surveys completed and returned by staff. Discussions with the manager, the deputy manager, two staff and approximately nine people who live in the home, took place. Limited observations of people and their interactions with staff took place during the visit to the home, which included a meal time. Reviewing records of the people who use the service and other records and procedures Care Homes for Older People Page 6 of 30 was also used to collect information on the day of the visit. All information received by the Commission since the last inspection, about this service was also taken into account when producing this inspection report Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 30 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. The home ensure that people are properly assessed, before they move into the home, so that people who use the service know that it can meet their needs. Evidence: The home is registered for a maximum of 57 but some rooms are doubles and only used for couples so, generally, there are a maximum of 47 people in residence, currently there are 42, with five vacancies. Assessments for four people with diverse needs, were seen. Assessments are completed pre and post admission using an assessment tool called QUEST. The assessments include detailed information about the person which includes, communication, lifestyle, ability, skin integrity, mental state and cognition, maintaining a safe environment which includes physical aids/needs, breathing, eating, eliminating, personal cleansing and dressing, controlling body temperature, sleeping, Care Homes for Older People Page 11 of 30 Evidence: pain, medication and an end of life plan. The manager and deputy do the preassessments including a map of life that describes how people see themselves, what was and is important to them, such as their happiest memories. If an area is identified as a problem such as skin viability it is scored and the score shows how it should be taken forward for instance, risk assessment, Waterlow (a method of showing the likelihood of skin breakdown and how to avoid it if possible) assessment and nutritional assessment. The four pre - admission assessments seen were of excellent quality and had been developed into detailed and effective plans of care, post -admission . People spoken to said that they had been involved in their assessment and especially producing their map of life, which acts as a starting point for activity plans. The Home has one respite bed but do not provide intermediate care. The manager said that the people who use the service enjoy visitors and people looking round the home, they were very communicative and happy to talk to me, on the day of the inspection visit. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has detailed plans of care which include personal, social and health care needs. Peoples needs, as identified in the plans of care, are fully met. People are, generally, treated with respect and people who live in the home have confidence in the staff team. Medication is administered as safely as possible but the home does not always have detailed guidelines for the use of medication prescribed, to be taken as necessary. Evidence: Three further plans of care, for people with varying needs, were seen. The plans of care are developed from the very detailed assessments and included all necessary information to enable staff to care for people in the way that they prefer. Plans of care included what decisions people are able to make for themselves and how they make them. There was a discussion about seeking individuals permission for information to be passed to family and which members people would like it passed to and which perhaps theyd rather not. Family contacts are noted in plans of care, as are any social contacts or friends. All plans of care are monitored monthly and comments are written by the key worker, weekly monitoring is instigated if there are any issues or concerns Care Homes for Older People Page 13 of 30 Evidence: about the individuals health or well being. Regular reviews of peoples health are completed with the support of health professionals, as appropriate, such as the skin viability nurse, sensory and continence specialists. The home generally use two local surgeries but if people are local they can keep their own G.P, if family live in the area the home try to arrange for them to register with the family G.P , if the person wishes. The home keep excellent health care records and have very robust health care plans including weight charts, breathing, pain, medication records, which are all kept as necessary, with regard to the individual and the assessment of their needs. There have been approximately 24 deaths in the past year, the number of deaths are rising as people are being admitted in a frail condition and for end of life care. Only registered nurses administer the medication, all medication is stored in one treatment room and administered by means of trolleys, one for each floor. There are two nurses on duty at all times during day time hours although sometimes one at night, when extra care staff are made available (not usual). The home use a monitored dosage system, supplied by Boots the chemist. The home recently had a visit from the Primary Care Trust, with regard to their medication systems. Two pharmacists and one consultant visited in February 2010 which was followed by another visit from a pharmacist a week later. No requirements or concerns were shared with the home. It was discussed, on the day of the Key Inspection visit, that some creams prescribed to be administered twice a day were recorded as only being given once. Some guidelines with regard to the administration of medication prescribed to be taken , as required, were in place but it was discussed that it may be good practice for all as necessary medication to have have detailed guidelines for when it is to be administered, particularly if it is prescribed to relieve anxiety or to alleviate convulsions (rectally). The manager agreed to put more detailed guidelines in place, as soon as possible. Staff were observed, during the visit, generally treating people with respect and ensuring that their dignity was upheld. Some staff attitudes at the lunch time period were not as sensitive, but they were able to identify and discuss this later and said it was as a result of the chaotic lunch service and the stress this caused them. Nine people,who live in the home, were spoken to, five at some length. There were no negative comments about staff, positive ones included, staff are very good, they look after us well, there are a few people that I dont really like but it is more personality clashes, they listen to you and do something about any concerns you have, they are very caring, they always come when you ring for them and often when you dont!. Several people said that they liked living in the home , it is a nice place. Surveys Care Homes for Older People Page 14 of 30 Evidence: from people who use the service were very positive comments included, not sure if staff appreciate what my sight is like, they do care and attention well,they make sure that Im well cared for,Im quite satisfied, they are very attentive,its comfortable Staff commented, we care for residents very well, the home supports residents and relatives needs, it meets the individual need of every resident,it is good at looking after frail and elderly residents. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home make sure that people have an interesting and rewarding lifestyle, remain part of the community and keep in contact with families and friends. The people who use the service are offered varied and nutritional food, with good choices. Mealtimes are not always as well organised and pleasant as they could be. Evidence: The home has three activity co-ordinators, who cover the hours from 10am until 4 or 5pm, six days a week. Activities include gardening, singing, puzzles, quizzes, horse racing events, art, PAT dogs and bingo. The home held a St. Georges day party which was attended by family, friends, people from other care homes and community contacts. Several people (those spoken to at lunch) said that they really enjoyed the party. The home is very near to the town centre and has some local shops within minutes (walking) of it, the manager said that staff occasionally mange to take people to local shops or into town. The home also organise outings and there were records of visits to local museums and garden centres. People said that they like the activities and have things to do if they want to. Everybody spoken to knew the activity cocoordinators who also do room visits to those people who may be unable or unwilling to participate in the group activities. People had their own choice of entertainment in Care Homes for Older People Page 16 of 30 Evidence: their bedrooms although one person said that people have their televisions much too loud. Three surveys from people who use the service said, the home do activities well. The AQAA noted that activities were an area of improvement, they now occur six days a week, people have clubs and there is a new format for activity advertisement. The manager also said that they have several volunteers, including students who come to help support peoples participation in activities or social contacts. One family member spoken to said that the home always made them feel very welcome and they were satisfied with the care given to their relative. The visitors booked showed that the home has numerous family and friends visiting aswell as visits from other professionals and people from the community. The home has regular resident meetings organised and conducted by the activity coordinators, notes from the last one could not be located but the manager said it had concentrated on the new activity programme which is developing as a result of what people wanted, their ideas and comments. Changes have been made to the way the main meal (lunchtime) is served as people said that it felt too much like a canteen. The home does not have control of anyones money, families usually act as appointees or agents for their family members. The home keep a limited amount of personal allowances so that people are able to pay for hairdressing and other personal needs, one person looks after their own money. Menus seen were very varied and well balanced. The Chef said she uses mostly fresh ingredients and she makes all the dishes herself. People have a choice of breakfast and are able to have a cooked breakfast everyday, if they choose. Lunch is served in the large dining room, most people eat in dining room but some eat in bedrooms, if they choose or are unable to go to the dining room. Food looked fresh and well cooked but two surveys noted that, food is not always properly hot, one staff survey said , sometimes food is the wrong consistency, its too runny. one survey said,the catering is very good. Of the nine people spoken to seven said that the food was usually or always good, one person said it was wonderful one person said that her portions are too large and it puts her off her meal, she would prefer to choose the size of her meal. One person said it was alright but is sometimes not hot as they take a long time to serve us. On the day of the visit the meal time was observed, it was not very efficient some people waited for well over half an hour for a meal, people sitting on the same table were served at different times, some people waited for others on their table which could be up to 20 minutes and some people started their meals but felt uncomfortable starting before the others. Some people felt aggrieved that they were waiting longer Care Homes for Older People Page 17 of 30 Evidence: than others on their table . Staff were stressed and therefore not responding to people as I had observed them to do in usual circumstances. Staff spoken to said that they feel lunchtime is not always properly organised and were going to make it an agenda item for the next staff meeting. People who live in the home, said that some lunchtimes were much better then others. 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 know how to complain and are confident that the home will listen and do something about any concerns, they have. People who live in the home feel safe, staff have the knowledge and ability to keep them safe from all forms of abuse. Evidence: The home has a robust complaints policy and procedure. All surveys said that people know how to complain and the people spoken to confirmed this. The manager said that the home had received ten complaints since the last inspection but has been unable to locate the records for those made before her appointment. Only one has been made since she has been in post. Provider records (on computer) were recording the number of complaints but not the detail or content of them. The procedure has now changed and the is computer recording the complaint and the content. The home keeps detailed paper records about complaints and the action taken as a result of them. One complaint, the investigation, action plan and outcome were well recorded. The organisations Quality department monitor complaints and raise questions if they think issues are arising. The home has robust safeguarding policies and procedures, staff spoken to confirmed that they have received safeguarding training that is up-dated as necessary. They were able to describe legal and moral obligations with regard to the safety of the people in their care, one staff member was clear about who to approach, externally, if Care Homes for Older People Page 19 of 30 Evidence: necessary, the other was not so clear. Both were able to describe how they would protect people in their care and were confident that the manager would take any necessary action. One survey, received from someone who uses the service, said I feel safe and two people spoken to said they felt very safe in the home. One family member said that they were confident that their relative was safe in the home. The Commission has received no information, with regard to complaints or safeguarding issues about this home. The home does not have anyone living there who has behavioural issues and do not use restraint or behaviour guidelines, however medication is prescribed to be used , as necessary by the G.P to reduce someones anxiety/agitation levels, this needs guidelines, as discussed with the manager. The manager has completed Mental Capacity Act training including Deprivation of liberties and is aware of its relationship with the work of the home, she has completed the training for trainers course on Deprivation of Liberties. 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. The home is very comfortable, kept to high standard of cleanliness and provides people with a pleasant home that meets the individual and diverse needs of the group. Evidence: A brief tour of home showed that it is very well kept, there were no odours in any areas although one person said that the sluice opposite their bedroom gets smelly on occasion. The home has recently undergone some refurbishment, with new flooring in some areas and most of the building being newly decorated. The several bedrooms seen were individualised to peoples taste and choice, with good quality furniture and fittings. Three people spoken to said that they like their bedrooms and enjoy spending time in them. The home is on two floors and has two lifts available, incase of breakdown. Eleven rooms have an en-suites facility. There are five toilets downstairs and five upstairs, three bathrooms and two shower rooms. The manager said that people can bathe /shower when they choose, bathing rotas are not necessary as there are plenty of bathrooms. Staff are trained in infection control and laundry is done on site by laundry assistants. The home have had no complaints (since the manager has been in post) with regard to poor clothing care. A survey completed by someone who uses the service said, it is very comfortable but Care Homes for Older People Page 21 of 30 Evidence: they could give my husband a more comfy chair when he visits. The home does not use any assistive technology at this time. 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. The home has enough staff to meet the assessed needs of the people who live there. The recruitment process ensures, as far as possible, that staff are safe to work with people but must take the additional measures necessary to ensure they have the correct paperwork for overseas staff. Staff are properly trained and a large percentage have an NVQ qualification, so that they know how to offer the best possible care. There are some staff team issues but the manager is aware of these and IS dealing with them. Evidence: Minimum staffing levels are two nurses (one on each floor) and eight care staff from 8am until 2pm and two nurses and six carers 2pm until 8pm. There is a twilight shift 4.30 pm until 10.30pm and an 8pm until 8am night shift. Staff regularly work twelve hour shifts, the manager said that they can opt out of them if they cannot sustain performance for that amount of time. Staff surveys commented that , there has been a staff shortage although this has improved, we need more team work,hours should allow staff to finish their jobs at lunch time before they leave the home,we need more staff, we need more time to spend with residents, the team could work better and keep hold of good carers. The home has no handover time for carers and nurses work an extra 15 minutes on their shift to effect a handover, this is an area that the manager is reviewing. The manager and deputy felt that the home has enough staff Care Homes for Older People Page 23 of 30 Evidence: but there are some organisational issues that need addressing. The manager is aware that some work is needed with the team, who are skilled and enthusiastic. Staff spoken to were aware that there are some staff issues, but felt that things were improving and getting more organised, they were happy to see the appointment of a deputy who they felt would have a positive effect on the home. Other staff comments (on surveys) were , its a friendly and a really nice place to work,I enjoy working at the Argyles,it makes people feel welcome and the residents are happy. There were overall positive answers to surveys staff and people who use the service, completed. People who use the service surveys did comment , staff work very hard, could be more staff, I want to be put to bed early, not always enough staff,possibly need one or two more carers, they could come quicker when I call People who use the service, spoken to, on the day of the visit, were all positive about the staff and said that they are always around when needed, they answer the bells quite quickly, they are very caring,they always listen to you and a lovely staff team. 14 staff have left in the past 12 months but the team is now stabilising, no nurses have left during that time. Four staff files were seen, all had the necessary paperwork in place, except for an individuals home office status. The manager said that she was not aware that this was a necessity but will obtain the correct paperwork as soon as possible and check with human resources whether she needs further training in staff recruitment. The home keep interview notes and people undergo a robust induction, which includes completing a skills for care booklet and shadowing (supernumerary ) an experienced member of staff for two weeks. 13 of the 23 care staff have an NVQ 2 qualification, or above and all staff participate in the providers Personal Best programme, which is a customer based programme that includes treating people with respect and dignity, at all times. The AQAA noted and the manager and staff members confirmed that all core training is up- dated, as necessary. Staff spoken to said that they get good training and development opportunities. 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 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 managed, in the best interests of the people who live there but the manager is not yet registered to manage the home. The management team is relatively new and are aware of issues that they have to address. The home have a quality assurance system which drives development and which involves people who use the service. The home adheres to Health and Safety policy and procedure to keep people as safe as possible. Evidence: The manager was appointed in December 2009, she had been acting manager since 14th September. She is a registered nurse and has trained in leadership and management of care services but has no formal management qualification, as yet. She is starting her N.V.Q in management award, which she plans to complete as soon as possible. The manager has had some experience in a deputy role and seven months as the manager of the home. She has not yet applied for registration, the registration application has been delayed because of CRB clearance problems, she is expecting Care Homes for Older People Page 25 of 30 Evidence: that the application will be with the Commission imminently. The home has appointed a deputy who has been in post for a few weeks, to support the manager and staff team. Staff spoken to said that the home has a good management team and are pleased with the appointment of the deputy. They felt that the manager is approachable and will listen to their views and ideas. The people who live in the home did not appear to know the manager very well and said that they always talk to the carers. The deputy said that she knew little about the people who lived in the home as she has been learning policies and processes throughout her induction, there was discussion about the home being process led and the management being more involved in that than in the management of direct care. The manager said that this will be addressed with the appointment of the new deputy manager whos responsibilities are as head of nursing and care. The home had a customer service review in October 2009 (they have one annually), the organisation send the results back to the home early in the year and from this an action plan and way forward is planned, with the participation of the people who live in the home. The home has new garden furniture and a new lunch serving system as a result of the views of the people who live in the home. The regional manager or other nominated managers, complete monthly regulation 26 visits which are recorded and the notes kept in the home. Financial records for two people were seen, the home keeps a joint account but individual balances of personal allowance. Money is generally dealt with by peoples families or powers of attorney, one person deals with her own money. The administrator has a good knowledge of peoples needs (financially) and ensures that they always have enough money available for their wants. She keeps some cash available for people to buy small items and or pay for trips out . All withdrawals of money have to have two signatures and receipts are kept for all expenditure. Internal and external auditors check the financial systems, on occasion. The home has robust Health and Safety policies and procedures, adhered to by the staff of the home. Maintenance checks are completed at the right intervals by the maintenance man or outside contractors, accurate samples were seen at this inspection visit. The home has no radiators and the manager confirmed that windows had restrictors, where necessary. Water temperatures are checked regularly, restricted in full immersion outlets and bedroom hand basins. An environmental health visit in 2009 resulted in the recommendation of new flooring for the kitchen, this has been done. The home keeps accident and incident records. A large and increasing number of falls Care Homes for Older People Page 26 of 30 Evidence: (not resulting in injury) have been recorded and the manager said that she is currently monitoring these and will develop an action plan, as necessary. Accident forms note what action the home is going to take to minimise further risk, such as, new risk assessments to be completed for individuals involved in accidents or incidents. Care Homes for Older People Page 27 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 28 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 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). 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. 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