Care Home: Arlington House

What the care home does well Arlington House provides a comfortable and homely environment for residents. Comments received both from surveys sent out prior to inspection and conversations with residents during the inspection included: " They do everything well, I have always found staff to be very helpful." "Whatever I need, they(staff) see I get it". "Everything here is spot on, you would have to be extremely difficult to please if you were not happy here". Comments received from health and social care professionals included "The residents are very happy at Arlington House, they have regular care staff who offer appropriate care and support to each resident". "The care staff contact (health professionals) appropriately and follow advice. They are friendly to us and the residents I have met seem happy and relaxed in their home". Care plans were comprehensive addressing the needs of the individual and including clear instructions for staff. The management of medication was generally good. Staff turnover is low, with staff covering for each other in cases of absence, therefore negating the use of agency staff. 50% of the staff have attained the National Vocational Qualification in care at either level 2 or 3. All residents praised the standard of catering and the menus seen were varied and nutritious. Residents are provided with choices of menu at all meals. Activities take place in house and have been enhanced by outings taking place in the company minibus when weather permits. What has improved since the last inspection? The home now has new owners and the manager spoke of the good level of support she was getting across all areas of running the home. The home has recently installed a new stair lift and also a wide screen television which will assist residents in participating in the computerised exercise and games programmes provided. New carpets and curtains are in the process of being fitted and the home has an ongoing programme of refurbishment. Policies and procedures used by staff are being reviewed. What the care home could do better: Some aspects of medication documentation requires amending to ensure that residents receive `as required` medication in a timely manner. A requirement has been made There were some health and safety issues found, these included lack of restricted opening on windows, unguarded electric heaters and one area where an area of corridor could prove a trip hazard. Immediate requirements were made for the windows and heaters and the manager asked to address the trip hazard.The manager has given assurances that other issues noted in the main body of the report will be addressed, therefore no requirements have been made. These will be checked at the next key inspection. Key inspection report Care homes for older people Name: Address: Arlington House 10 Tennis Road Hove E Sussex BN3 4LR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Dudley     Date: 0 8 0 1 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Arlington House 10 Tennis Road Hove E Sussex BN3 4LR 01273413222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Niki Clarke and Mr Driss Zemouli t/a Arlington House Name of registered manager (if applicable) Ms Deborah Anne Coghill Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: (1) The maximum number of service users to be accommodated is 33. (2) The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Date of last inspection Brief description of the care home Arlington House provides personal care for up to 33 older people. It is situated in Hove close to the sea front and the building was originally 4 terraced houses. The home has a small rear garden accessible to all residents There is no on site parking but currently there is on street parking which is not subject to parking meters. The nearest shops are at Portslade approximately one mile away. Care Homes for Older People Page 4 of 32 Over 65 33 0 Brief description of the care home The residents accommodation is over three floors, there is no shaft lift but stair cases are provided with a chair lift. There is a range of communal space for residents which includes three lounges, conservatory and dining room. The current fees charged at the home range between £268 and £400 per week, these do not include other services such as chiropody and hairdressing and these are available from the home. Care Homes for Older People Page 5 of 32 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: This key unannounced inspection took place on the 8th January 2010 from 10:00 to 16:00 and was facilitated by the registered manager and registered provider. Methods used to collect information about the home included examination of documentation in the home, observation of staff working with residents, the serving of lunches and conversations with residents, staff and visitors to the home. All residents were spoken with during the inspection, and six residents were spoken with in depth and gave their views on life in the home. Documentation examined included care plans, personnel files, staff training and supervision records, catering records and health and safety files. Prior to the inspection questionnaires were sent out to ten residents, ten members of staff and three health care professionals. Of these nine were returned from Care Homes for Older People Page 6 of 32 residents,all ten from from staff members and three from health and social care professionals. These gave information about the daily life in the home and helped to inform the judgements made in this report. Thanks are extended to those people who responded. The Annual Quality Assurance Assessment, required by the Care Quality Commission, which gives an overview of what has been achieved in the home and issues to be addressed, was received by the CQC prior to the inspection. This accurately reflected the current status of the home. This was used as part of the inspection process. This is the first inspection following the new registration of the home. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Some aspects of medication documentation requires amending to ensure that residents receive as required medication in a timely manner. A requirement has been made There were some health and safety issues found, these included lack of restricted opening on windows, unguarded electric heaters and one area where an area of corridor could prove a trip hazard. Immediate requirements were made for the windows and heaters and the manager asked to address the trip hazard. Care Homes for Older People Page 8 of 32 The manager has given assurances that other issues noted in the main body of the report will be addressed, therefore no requirements have been made. These will be checked at the next key inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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. All prospective residents receive a full assessment of need prior to being admitted to the home. Prospective residents receive sufficient information about the home and are invited to visit the home and meet other residents prior to deciding whether they wish to live there. Evidence: Although the care home has recently changed owners there has been no change of registered manager. A new Statement of Purpose and Service User Guide has been produced and this complies with regulation, the manager is in the process of ensuring that all residents in the home receive a copy of the new Service User Guide. All residents receive a copy of the homes Terms and Conditions of Residence and a Care Homes for Older People Page 11 of 32 Evidence: contract, irrespective of their funding arrangements, on their admission to the home. The home is currently in the process of producing new contracts following the change in ownership. Present contracts show only the residents contribution to the fees and should show a full breakdown of fees. The manager and provider gave assurances that this would be identified in the new contracts. Prospective residents are assessed by the manager prior to being considered for admission to the home to ensure that the home can meet their needs. Whilst the present documentation used for assessment allows for sufficient information to commence a care plan, improvements to allow more detailed information to be gained would be beneficial. This was discussed with the manager. The home is not currently sending written information to residents to confirm whether or not the home can meet their needs and admit them. The manager gave assurances that this would commence. Prospective residents and their representatives are encouraged to visit the home and have lunch with the existing residents prior to making the decision over whether they wish to live at the home. Recently admitted residents confirmed their satisfaction with the admission process and said how welcome they had been made at the home. The home admits residents for permanent and respite care but not for transitional or intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents spoken with were satisfied with the standard of care that they received and the manner in which it was given. Observations during the day and discussion with residents showed that the privacy and dignity of the residents were upheld and the emphasis was on individualised or person centred care. The home is proactive in accessing advice and treatment for residents from health care professionals. Some aspects of medication administration may not fully safeguard the residents. Evidence: During the course of the day three care plans were examined. These were generally comprehensive, were person centred, detailed the current personal, health and social needs of the residents, and provided clear instructions for staff. There was evidence that they had been reviewed on a regular basis although there was no evidence that they were formed in consultation with the residents. Minor amendments are required in some parts of the care plans and this was discussed with the manager. Care Homes for Older People Page 13 of 32 Evidence: Residents are weighed on a regular basis and it was suggested that the manager implement the Malnutrition Universal Screening Tool (MUST) into the care planning to enable accurate assessment regarding residents nutritional status. Whilst the standard of the daily records detailing the care the resident had received during the day were informative, this was not extended to the night records. The manager must ensure that night staff are aware of their responsibilities in documentation and also ensure that residents preferred times of rising and retiring are noted. Staff are proactive in accessing a range of health care professionals which include GPs, district nurses, dentists and opticians, and a comment received by the CQC from a health care professional stated Care staff contact (health care professionals) appropriately and follow advice given. The residents I have met appear relaxed and happy in the home. Residents spoken with expressed their satisfaction with care given and comments received in surveys included I am very satisfied with the care I receive here. We are treated as individuals and I am very happy with the care we are given. Residents spoken with and observation of staff working confirmed that staff uphold the residents dignity and treat them with respect. Residents said that call bells were answered promptly. It was noted that call bells were generally sited by the residents bed and residents had no means of getting attention in any other part of the room. Residents should have accessible call bell leads both in their personal rooms and in communal rooms to ensure their safety. All care staff have received a recognised training in the administration of medication. The provision of medication are generally in prepacked blister packs apart from those medications used on an as required basis. The manager must ensure that these medications are kept in their original packaging prior to be administered to the resident. Care plans are required for the administration of as required medication to demonstrate the individuals needs for that specific medication. Risk assessments in place for those residents who keep and administer their own medication do not show evidence of regular review, which is required to ensure the safety of residents. There are no controlled drugs prescribed in the home for any of the current residents. Storage and recording of medication was good, with regular audits taking place. Care Homes for Older People Page 14 of 32 Evidence: There are few end of life care plans in place at present. Discussion was held with the manager on the provision of these and the obtaining of residents wishes for resuscitation. The one end of life care plan seen showed that planning was in place and a GP consulted. The manager gave assurances that planning would take place with residents to ensure that the home is aware of the residents wishes and where they would like the care to take place. Care Homes for Older People Page 15 of 32 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. There is scope for the range of leisure activities to be increased following consultation with individual residents. Residents are enjoying the outings provided by the home. Routines in the home are sufficiently flexible to enable residents to have choices in their activities of daily living. The standard of catering meets the residents expectations and the chef is aware of residents preferences and dietary needs. Evidence: The programme of leisure activities offered has increased in the past few months with outings to places of interests being included. The home now shares a minibus with sister homes and residents have commented on how much they have enjoyed the outings. Current leisure activities include board games, quizzes and the use of a computerised games programme. A new large screen television has been purchased to enable Care Homes for Older People Page 16 of 32 Evidence: residents to participate in these games. There is no structured or preplanned activities programme in place and there was no written evidence that residents are consulted about their preferred activities and present and current interests although records of participation in activities are kept. Whilst it is appreciated the care staff provide the leisure activities and are aware of the residents interests, there is no documentation relating to having consulted the individual; and discussing past interests with residents may encourage the resident, or a group of residents, to renew interest in these. Satisfaction surveys received by CQC included comments from a social care professional and stated The home could have more social activities, however I believe that since the new owner has taken over this issue is being addressed. Residents spoken with said that they enjoyed the activities offered, particularly the bingo and quizzes although one resident said A bit more variety would be welcomed. Care plans do not show evidence of discussion with the residents regarding their current and previous interests. A minister of religion visits the home and the manager will access ministers of various faiths should the residents wish for this. Visitors are welcome at any time and can join residents at meals if they wish. The routines of the home are sufficiently flexible to accommodate residents individual preferences and life styles. Residents confirmed that they could maintain their preferred times of rising, retiring and breakfasting and that staff did their best to meet their wishes. Residents are able to bring in their own furniture or possessions and rooms are redecorated in accordance with residents preferred colours. A varied and nutritious menu is provided which offers choices at all meals. The chef has been working in the home for some time and knows the individual residents, their likes and dislikes and special diets or allergies. He stated that sometimes he cooks up to five different meals to accommodate residents wishes and he recognised the importance of fortifying meals for those residents who do not have large appetites. Residents can have snacks or beverages on demand throughout the twenty four hours. All residents spoken with said that they enjoyed the food provided: Unfailingly good. The cook makes sure we have what we fancy, if we dont like whats on the Care Homes for Older People Page 17 of 32 Evidence: menu he will cook something else. Very nice meals and we get plenty of food. Whilst fruit and vegetables are used in the catering, discussions were held with the manager over the possibility of providing a fruit bowl in the lounge or dining room or some other means of ensuring that residents are eating sufficient fresh fruit. Care Homes for Older People Page 18 of 32 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. Residents are confident that any complaints or minor concerns they may have would be addressed in an open and transparent manner and felt comfortable with making complaints known to the manager. Staff showed awareness of how to ensure that residents in their care were safeguarded and the procedures to be followed in the event of any abuse occurring. Evidence: The home has a complaints procedure which is included in the Service User Guide. The registered provider stated that this will be displayed in a prominent position in the home. Records are kept of all complaints received and how they have been addressed, this practice should be extended to minor concerns raised. The home has had one complaint since the last inspection. Residents spoken with were aware of how to make a formal complaint but all said that primarily they would discuss any concerns with the manager. All residents were confident that any concerns that they may have would be addressed in a confidential and fair manner. The home has had one adult safeguarding in the past twelve months. This was unable to be proven. Care Homes for Older People Page 19 of 32 Evidence: Management and staff have received updated adult safeguarding training and staff spoken with were aware of the procedure to be followed if they were aware of any abuse to residents taking place. Safeguarding training also takes place with new staff during their induction period. There are written policies now covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a homely and comfortable environment for residents which will be improved once the refurbishment is completed. Lack of attention to detail and to ensuring that the home is regularly risk assessed could impact on residents comfort and safety. Evidence: The home has recently been purchased by the current owners, and whilst some redecoration and replacement of carpets and curtains has taken place, the owners are aware that there is much still to be done. The provider intends to refurbish the home including purchasing new furniture for the home. Redecoration of rooms is taking place and residents are able to choose the colours for their rooms. Residents rooms are over three floors, the upper floors of the home are reached by chair lifts, one of which has been recently replaced. However staff said that one of the other chair lifts is unreliable. Residents currently in the home are mobile. Care Homes for Older People Page 21 of 32 Evidence: Surveys received from staff and residents identified that the home is in need of refurbishment: The rooms could be furnished a bit better and communal carpets need replacing. We need refurbishment and another stair lift. Management needs to do the home up a bit. The kitchen is also urgently in need of refurbishment and the provider has made this a priority. Whilst the management is aware of the need for refurbishment, the home has maintained a comfortable and homely atmosphere and this is enhanced by residents being allowed a free rein with their rooms and enabled to bring in small items of their own furniture and other possessions if they wish to do so. All residents rooms have a lockable door and a lockable drawer and residents are given a key to their rooms following risk assessment. The communal areas are comfortable and residents are able to take their meals in a pleasant dining room. There is a conservatory which gives access to a small garden which is equipped with seating for residents to enjoy in the summer months. The home offers assisted bathing facilities and the majority of residents rooms provide en suite facilities consisting of a WC and washbasin. Three of the en suite facilities also include a shower. The temperature of the hot water outlets in residents facilities has been monitored and recorded on a regular basis and are within recommended parameters. Residents did not have any cords or extensions for call bells and therefore unable to summon help if in their chairs or unable to get to their beds and there were no call bell extensions in communal rooms, the provider gave assurances that these would be provided, therefore no requirement has been made. The top floor corridor has an area which requires to be identified as a trip hazard, no warning signs were in place which could lead to injury of residents, visitors or staff. Other issues found that may affect the safety of residents are detailed in a further section in this report. The home was free from odours Staff have received training in infection control but the home does not currently have an infection control champion. This was discussed with the manager. Care Homes for Older People Page 22 of 32 Evidence: Staff should be made aware of the importance of ensuring that all parts of the home are free from unwanted or discarded items and therefore kept in a manner which will encourage all residents to use rooms. A pressure mattress was awaiting collection in the upstairs lounge and there were cardboard boxes from a delivery in the conservatory. A ground floor corridor also had items left in it which the manager said had been placed there during the refurbishment of one of the rooms. Care Homes for Older People Page 23 of 32 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. There are sufficient staff on duty to meet the needs of the residents currently in the home. Staff are encouraged to gain a qualification in the work that they do and over 50 of the staff now have the National Vocational Qualification in Care at level 2 or above, which ensures that residents have the benefit of receiving care from knowledgeable staff. Recruitment procedures were not always sufficiently robust to ensure residents safety Evidence: The duty rota, comments from surveys sent out, discussions with staff and residents and observations of staff working showed that there are sufficient staff on duty over a twenty four hour period to meet the needs of the residents in the home. All staff have an induction course at the commencement of employment. This is currently the in house induction course and not the recognised Skills for Care, but is quite comprehensive. The provider said that they intend to commence the recognised induction course and it is anticipated that this will commence in the next few months. Other training is provided to staff, currently this is mainly health and safety mandatory training such as moving and handling and some staff have attended dementia care training. The provider is currently reviewing the training programmes and is aware that more training in the meeting the needs of older people would be Care Homes for Older People Page 24 of 32 Evidence: beneficial. Staff are encouraged to gain their National Vocational Training in Care, and 50 of the staff have attained this qualification at either level 2 or 3, with a further two members of staff studying for this. The chef has sufficient knowledge and experience regarding the dietary needs of the older person but was unsure whether his Food Hygiene Certificate was still valid, the manager should ensure that this is checked and a further course provided if needed. Personnel files of recently employed staff were examined, one member of staff did not have two written references prior to employment and the manager was reminded of her duties to ensure resident safety. Assurances were given by both manager and provider that this would not reoccur. Care Homes for Older People Page 25 of 32 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. Management systems in place provide a comfortable and friendly home for residents. Residents and staff are able to approach the manager at any time. Staff supervision does not always take place in a timely manner, formal supervision ensures that staff are maintaining the ethos of the home and maintaining standards of care central to the well-being of the residents. Some health and safety issues may put residents at risk Evidence: Whilst the home is under new ownership the registered manager has been in post for three years. She has suitable care qualifications and sufficient experience to run the home and is to registering to undertake the required Leadership and Management course this month. She has not yet undertaken any training in the Deprivation of Liberty Safeguarding Care Homes for Older People Page 26 of 32 Evidence: training but has given assurances that she will attend this. The registration certificate was displayed and gave correct information about the home. There is a friendly and homely atmosphere in the home and this was verified by residents and surveys from health and social care professionals who described it as having a nice friendly atmosphere. Residents continue to speak highly of the manager and staff in the home. She is a very good manager, always listens and puts us first, sorts out any of our problems. The manager is very caring. Staff are very good, lovely people. Staff stated that the atmosphere in the home was good and they receive support from the manager The manager is very supportive and helpful and manager very approachable and supports staff and residents. All residents spoken with and surveys received were positive in their support of the home and the staff. The Annual Quality Assurance Assessment (AQAA) was received when we asked for it, was comprehensive and accurately reflected what was occurring in the home. The home assesses the quality of the services it provides by sending out annual questionnaires to residents and their relatives. Currently this does not extend to health and social care professionals or other interested parties. Meetings for residents and their representatives do not currently take place but staff meetings are held bi-monthly and minutes of these were seen. Policies and procedures are in the process of being reviewed. The home keeps small amounts of money for safekeeping for some residents. Monies and receipts were inspected and were accurate. The home does not have any further involvement in residents money. Regulation 26 visits (monthly visits and reports by the provider as required by regulation) are taking place and samples of these were seen. Action plans to address any actions required by the provider were not in place but the manager said that these will be commenced. Whilst formal supervision of staff has been commenced the manager has not been ensuring that these take place at intervals directed by the National Minimum Care Homes for Older People Page 27 of 32 Evidence: Standards, the manager gave assurances that she would be more proactive in ensuring that these take place. All staff have undertaken mandatory training and records relating to the servicing of equipment and utilities were up to date. Some health and safety issues were identified. It was noted on walking around the home that some window restrictors were not in place and some other windows were opening too wide to ensure resident safety. Free standing electric heaters were found in a room and in the conservatory with no risk assessments in place. This could pose a risk to residents. An immediate requirement has been made to address these issues. The manager should ensure that regular checks for health and safety issues take place and address any which are identified in this report. Care Homes for Older People Page 28 of 32 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 29 of 32 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 1 38 13 That window restrictors are 18/01/2010 in place in all windows above ground floor and that the width of open windows meets health and safety guidelines or that robust risk assessments are put in place. That any free standing heat appliances are suitably guarded and risk assessed. To ensure the safety of service users 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 That medicines are not removed from original packaging until being administered to the service user. That care planning is in place to identify in what circumstances as required medication is required by the individual. That risk assessments for self medication are reviewed at regular intervals. To ensure that service users receive the correct 20/02/2010 Care Homes for Older People Page 30 of 32 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 medication for their individual circumstances and conditions. To ensure the safety of service users. 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 31 of 32 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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