Care Home: Ascot House Care Home

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What the care home does well People are given easy to read information and support to help them decide if the home is the right one for them. They are welcome to look around the home and meet staff who will be their point of contact when they move in. Assessments are carried out so that it is clear that a person`s needs can be met at the home. People are cared for and supported by staff who are well known to them. Staff support people, where possible, to keep in touch with family and friends and links with the community. Medicines are managed safely to make sure that people health and wellbeing are protected. People are confident that their concerns or complaints would be taken seriously and they have told us that they feel safe and protected. Ascot House provides homely accommodation for the people who live there. There are enough staff working at the home and people benefit from a stable, well established staff team. What has improved since the last inspection? Most of the repairs needed to the home environment identified at the last inspection have been repaired. A risk assessment relating to the steep stairs in the home has now been done. Information about incidents at the home are now being sent to the Care Quality Commission, as required by the law. What the care home could do better: Care plans are becoming more individual and centred around each person. They need to reflect that people have had a Mental Capacity Act assessment which takes account of their needs and how these are to be met. More improvements need to be made to activities within the home and in the community, to make sure people get involved in activities that they enjoy, so that they do not become isolated. The refurbishments currently being carried out at the home need to continue to take place, to create a more pleasant environment for people living at the home. All staff must be provided with the training that is relevant to their work. This includes support in working towards an NVQ (National Vocational Qualification) Level 2 qualification. Staff appraisals and supervision needs to be put place to help staff understand how well they are working.The results of the surveys carried out at the home should be analysed, published in a report, and shared with people who have an interest in the home. Key inspection report Care homes for older people Name: Address: Ascot House Care Home 34 Percival Road Sherwood Nottingham NG5 2EY     The quality rating for this care home is:   one star adequate 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: Frances Shillito     Date: 1 2 0 2 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 29 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 29 Information about the care home Name of care home: Address: Ascot House Care Home 34 Percival Road Sherwood Nottingham NG5 2EY 01159606506 PF01159606506 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr William Scott Name of registered manager (if applicable) Mr William Scott Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home may only accommodate male residents. The maximum number of persons the registered provider may accommodate in Ascot House is 20. To be able to admit the named person of category DE(E) named in application no V35244 dated 20/9/06 To be able to admit the named person of category DE(E) named in application No. V35244 dated 20/9/06. To be able to admit the named person of category DE(E) named in application V35244 dated 20/9/06 Date of last inspection 1 8 0 2 2 0 0 9 0 Over 65 20 Care Homes for Older People Page 4 of 29 Brief description of the care home Owned and managed by Mr. W Scott, Ascot House, consists of 3 terraced houses joined together and situated in Sherwood, close to shops, pubs, post office and other local amenities. The home provides personal care and accommodation for 20 male older people. Accommodation includes 7 single bedrooms, with the remainder being double rooms, none of which have en-suite facilities. All bedrooms are located on 2 floors, staircases are steep, but there is a stairlift enabling people with mobility difficulties to gain access to the upstairs rooms. There is an enclosed garden area to the rear of the home and on street parking to the front. The fees are currently agreed with the council rate and apply equally to funded and self-funded residents, dependent on the care needs of service users, and includes general toiletries, but not the cost of hairdressing or chiropody. Care Homes for Older People Page 5 of 29 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: one star adequate 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 focus of inspections carried out by CQC (Care Quality Commission) is on the experiences and outcomes for people using a service, and their views on the service provided. This process assesses how well the service provider is able to meet regulations and minimum standards of practice. Our inspections also look at aspects of service provision which need further development or improvement. This was our first visit to Ascot House since February 2009. This inspection visit involved one inspector, it was unannounced and took place in the daytime. Before the visit an analysis of the home was carried out from information gathered over the last year, including that from the Annual Quality Assurance Assessment completed by the manager. We also sent out survey forms called Have Your Say About... to people living at the home and ten were completed and returned to us. The main method of gathering information followed is known as case tracking. This Care Homes for Older People Page 6 of 29 involves looking at the quality of the care received by a number of people living at the home. We also use evidence from our observations during the visit, we speak with people living at the home and their relatives, about their experience of the service. We look at records and talk with staff about their understanding of the needs of the people they care for. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care plans are becoming more individual and centred around each person. They need to reflect that people have had a Mental Capacity Act assessment which takes account of their needs and how these are to be met. More improvements need to be made to activities within the home and in the community, to make sure people get involved in activities that they enjoy, so that they do not become isolated. The refurbishments currently being carried out at the home need to continue to take place, to create a more pleasant environment for people living at the home. All staff must be provided with the training that is relevant to their work. This includes support in working towards an NVQ (National Vocational Qualification) Level 2 qualification. Staff appraisals and supervision needs to be put place to help staff understand how well they are working. Care Homes for Older People Page 8 of 29 The results of the surveys carried out at the home should be analysed, published in a report, and shared with people who have an interest in the home. 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 29 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 29 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. People can visit the home to have a look round, and they have the information they need to help them decide if Ascot House is the right home for them. Evidence: Before this key inspection took place the registered manager told us in the AQAA (Annual Quality Assurance Assessment) that making time for new people to explore the home and meet people living there and staff, is something that the service does well. We found that the home has an information booklet which is kept in the reception of the home. The deputy manager told us that this booklet is given out to people who are interested in the service, in order to give them as much information as possible about Ascot House. This booklet is produced in large print, making it easy to read. We found that it contains lots of information about the service provided and the running of the home. We saw that the contact details of the Care Quality Commission Care Homes for Older People Page 11 of 29 Evidence: (CQC) had been updated. The home does not provide intermediate care. During the inspection visit we looked at the care records of three people. This is known as case tracking and is a method of gathering evidence on the experiences of people using the service. We saw that for each person there was an assessment which was carried out before they moved into the home. Staff said that this helps the home to be confident that a persons needs can be met there. People living at the home also said that staff had ensured that they could have a look around the home before they moved in, to ensure that they were making the right decision. They confirmed that they were shown around by a staff member who helped them to settle in when they moved in. As part of our inspection we received ten Have Your Say... survey forms, which were filled in by people living at Ascot House. The majority of people told us that they had received enough information about the home before they moved in. Care Homes for Older People Page 12 of 29 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 are cared for by staff who work hard to meet their assessed needs. Evidence: At the last inspection we asked the registered manager to make sure that peoples privacy was ensured by the toilet door next to bedroom 6 being repaired, so that it can close, and that the lock on the toilet next to bedroom 1 must be operational and capable of being locked. During this inspection visit we found that these repairs have been carried out. We also saw that three care plans selected contained some useful information on the action that staff need to take to meet peoples needs. We saw that staff had recorded a regular update to show if a persons needs had changed. We found that some improvement had been made in this area, but care plans also need to show that people have had their needs assessed in line with the Mental Capacity Act and Deprivation of Liberty safeguards, and that a plan is in place to meet any identified needs. The registered manager and deputy manager had told us that they are aware of the improvements that need to be made, and are working hard to make sure that Care Homes for Older People Page 13 of 29 Evidence: care plans and related risk assessments are individual to the person. Staff told us that they have time to read care plans to guide them about how to support and care for people. During discussion they said that what works well at the home is the Key working system and that Staff have developed good working relationships with service users. We saw that care plans and other confidential information was being stored in an open plan office space leading to the communal dining room. The registered manager told us that all confidential information is stored in locked filing cabinets and that additional space is available in a locked office within the home. One person living at the home said, They look after you. Another person told us, They look after you. The majority of people who filled in our survey forms also told us that they have the care and support they need and want from staff. During this inspection visit we found that medicines are managed safely. We saw that the home is carrying out medication audits as part of its quality assurance activities. These regular audits help tp ensure that if errors occur, they are promptly put right, which protects the health and well being of people living at the home. We found that the medication records were in good order and that the medication stocks are well organised. There were opportunities to speak to a number of health professionals. This included two family doctors (General Practitioners), two paramedics and a community nurse. One doctor said, Staff seem caring and another who told us they have had a number of years of dealings with the home said, The staff are sensible and we are called in appropriately. In addition a community nurse who was visiting the home told us, They encourage people to be themselves. They are all different.. People living at the home said that staff ensure that they get health care support when they need it. They told us that staff make appointments for them to see the GP, the optometrist, the dentist and the chiropodist. This was confirmed by what staff told us and the records they had made on an ongoing basis. The registered manager and staff also said that the home has positive working relationships with a range of professionals, such as social workers, occupational therapists, community nurses, and GPs. Staff told us that they work hard to ensure that people get the best care possible. Care Homes for Older People Page 14 of 29 Evidence: People spoken with said that staff are friendly and respectful to them and that their privacy and dignity is safeguarded within the home. During the inspection visit we saw staff knocking on peoples doors to demonstrate that they respect peoples privacy and dignity. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in some activities at the home, and where possible they are supported to maintain contact with family and friends. Evidence: At the last inspection we found that improvements needed to be made to achieve a varied programme of activities within the home which was led by peoples preferences, so that people have opportunities for social contact. The manager told us in the AQAA (Annual Quality Assurance Assessment) that plans for improvement include to, Ensure that the daily routine reflects the needs and aspirations of the people living at the home. During the inspection visit staff said that some people are interested in activities, others prefer to spend time in their rooms. The registered manager and a person living at the home said that people can spend their days as they wish, and that they were going out to do some shopping and have a pub lunch. The person told us, Im alright, top of the world. Another person living at the home said, I like my own room, I dont like to mix. Ive got my son who comes every Thursday. We saw that staff keep a Personal Activities Plan, in which activities a person has Care Homes for Older People Page 16 of 29 Evidence: participated in are evaluated. Staff told us that the plan is to empower and enable people to complete this record themselves if they wish. We saw from the minutes of meetings held with people living at the home, that people have been asked about their interests and preferences. We found that staff had recorded that celebrations had been arranged for Halloween, Bonfire Night and Christmas, and that some people had started playing cards and dominoes, which was felt to be a good start. In addition preferences relating to meals served at the home had led to improvement. We saw that staff had asked for ideas to be brought to the next meeting, however the last meeting took place in September 2009, which means that people are not able to express their preferences in a group regularly enough for changes and improvements to be made promptly. People said that staff encourage them to maintain contact with their family and friends. They said that they are supported to live the lifestyle of their choice as far as this is possible. People living at the home filled in some Have Your Say About..... survey forms. There were a number of comments made about the service. One person said, The food was very bad at one time. We have now got a new cook and its a vast improvement. Hes topps, I like ordinary cooking. During discussion the cook told us that people are consulted on choice of meals, and that they are asked about their needs and their likes and dislikes, to identify their individual food preferences. Menus were seen during the inspection visit. The deputy manager and the cook told us that new menus are going to be planned, so that meals served will be more in line with health living initiatives. During the inspection visit people were observed having lunch. The meals served looked tasty and where needed, staff were offering support to people whilst they were eating. Most of the people who filled in our Have Your Say About... survey forms, said that they like the food. People spoken with during the inspection visit said that they enjoy the food and that there is always a choice. They said that if they prefer something different they can tell staff, who will sort it out for them. One person told us, The meals are good. Care Homes for Older People Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident in the homes approach in dealing with complaints and they feel safe and protected from abuse. Evidence: The manager confirmed to us in the AQAA that the complaints procedure is available to people living at the home, their representatives and staff, and that it clearly states the appropriate procedure to be followed in the event of a complaint. We saw that the complaints procedure is in large print, making it easy to read. During the inspection visit the registered manager showed us that complaints are recorded on complaints record sheets. The complaints records forms were seen. We found that the home had not received a complaint since the last inspection. Information has been received by the Care Quality Commission on two occasions since the last inspection, which we asked the local authority Adult Social Care department and the registered manager to look into. We have found that the registered manager and staff at the home have worked hard to make improvements since that time to care plans and records kept at the home, with further improvement needing to be made. The registered manager has made arrangements for staff receive the training they need. We also received information that important incidents at the home had not been reported to the Care Quality Commission, as this is what is expected by law, which could have placed people at risk. Care Homes for Older People Page 18 of 29 Evidence: All the people who filled in the Have Your Say About... surveys forms, told us that they know how to make a complaint. They all said that they know who to speak to if they are unhappy about something. People spoken with during the inspection visit said that they know how to complain, and are confident that if they are not happy about something, this will be resolved by staff. They told us that the meetings they have are one way of making any concerns known to staff, though these meetings have not been taking place regularly. The registered manager told us that a safeguarding procedure is in place, and that staff at the home will be receiving safeguarding training in March 2010. Policies and procedures were seen in place, including the Nottinghamshire County Council Safeguarding Adults, Policy, Procedure and Guidance for Alerters - October 2007. Staff spoken with during the inspection confirmed that they will be receiving this training and they demonstrated that they understand their responsibilities in relation to reporting safeguarding concerns if they suspected abuse. People living at the home said they feel safe and protected. One person spoken with said, I feel safe here. Another person said, They look after you. During this inspection visits we spoke to the registered manager,who takes responsibility for the management of peoples personal monies. He told us that people are being encouraged to open bank accounts to make sure that they have suitable arrangements in place for the management of their personal monies. We found that each persons monies are kept in the homes safe. We also saw that the records are well kept reflecting transactions which have taken place. We found that a small float is kept separately and securely, to ensure that people have round the clock access to their money should they want this. Care Homes for Older People Page 19 of 29 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 generally provides clean and comfortable accommodation for the people living there. The environment of the home is in the process of being improved. Evidence: At the last inspection we asked the management of the service to make sure that self closing devices were installed and in working order on all doors, to protect people in case of fire. The smoking room door needed to have a self closing device and fire and smoke containing equipment needed to be installed to protect residents in case of fire. During this inspection visit we found that self closing devices had been installed within the home, but work still needed to be done to the smoke room door to install a self closing device. The registered manager told us he would attend to this. We also asked the registered manager to make sure that a risk assessment was drawn up for the steep stairs at the home, to indicate the need for a detailed initial assessment of all people who may live at the home in the future, as this would better protect both people resident and anyone moving in, in the future. This risk assessment has now been completed. At the previous inspection we also asked the registered manager to make sure that all radiators are guarded, or that an appropriate risk assessment is in place, to show how the risk to people is reduced. During this inspection contractors were seen repairing Care Homes for Older People Page 20 of 29 Evidence: the radiator cover in the main lounge which had become detached and we found that action had been taken to address this. At the last key inspection we also found that toilets at the home needed to have soap for hand washing, to ensure infection control and protection of people living at the home. During this inspection we saw that there was soap for us in all of the toilets within the home. Before this inspection the registered manager had told us in the AQAA that the plan for the service is to, Continue refurbishment and redecoration internally and externally. During this inspection visit we found that the home is currently in the process of being refurbished and saw contractors moving ahead with works. We saw that carpets are being laid and rooms are being redecorated and refurbished to improve the environment. We also found that certain areas within the home are still in need of decoration such as the first floor of building. The registered manager and the deputy manager explained they are developing rooms with en suite facilities. They said that one person used to have a shared room but now he has his own room. The plan is for everyone to have their own room to ensure their privacy is respected. A tour was provided by the registered manager and we saw that the environment was generally clean and tidy. Three people living at the home told us in the Have Your Say About... surveys, that the home is always kept fresh and clean and the other seven people said that this is generally the case. One person told us that the home is Warm and clean. Another person said they are, Well accommodated. The deputy manager and the staff we spoke with told us that people are encouraged to personalise their bedrooms. During the tour of the building a number of peoples bedrooms were seen. They were very individual with personal belongings and an array of photographs of family and friends on the walls. During the inspection visit we found that the garden at the back of the house provides space for people to sit out in during good weather. The registered manager said that he is planning improvements to this area to ensure that people can enjoy sitting out in the spring and summer. Care Homes for Older People Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate staffing levels are maintained at the home. Staff have started to receive the training that is relevant to their work. Evidence: During this inspection visit we looked at three staff files and found that the recruitment process followed by the home is robust. One staff member recently started work at the home. They told us that they were not allowed to start work until all the necessary checks had been carried out. In the AQAA the registered manager told us that the home prides itself in having a committed staff team and keeping staff employed at the home, Retention rates are good. Staff spoken with said they benefit from Good team work. Another staff member told us that, Staff are really nice, they really care. This helps to maintain a stable environment for people living at Ascot House. The deputy manager told us that staffing levels are well maintained to make sure that peoples needs are met. The staff rotas were seen during the inspection visit. Staff said that there are enough staff on duty to allow them to give support and care, as well as complete the daily records when there are quiet times during the day. Care Homes for Older People Page 22 of 29 Evidence: During discussion the deputy manager expressed her commitment to the improvement of staff training and personal development. We found that the home has not yet met its target for the amount of staff who have achieved an NVQ (National Vocational Qualification) Level 2 qualification. However some staff have achieved this qualification a well as Level 3, and others are now working towards Level 3. The training records at the home were seen. We found that some staff had received some of the mandatory and specialist training which is relevant to their work. However we saw from records and from what managers and staff told us, that a number of training courses have been booked and there are plans for further training once this has been completed. This training includes safeguarding, food hygiene, health & safety and moving & handling. We saw that plans are also being made to ensure staff receive training in first aid and the Mental Capacity Act and Deprivation of Liberties Safeguards. We also found that staff have already had recent training in medication and fire training. One staff member told us, Theres lots more training. The registered manager told us in the AQAA that an area for improvement is to develop a more regular staff supervision and appraisal system. Staff spoken with during the inspection visit said that they sometimes have supervision with their manager and that they feel supported by management. The deputy manager told us that appraisals are planned for the coming weeks so that training needs can be identified and how they are getting on in their roles can be explored at a one to one meeting. Staff said that they are a good team. They told us that they enjoy working at the home and that improvements are being achieved there. People living at the home said that what the home does well is, Care and cooking. Care Homes for Older People Page 23 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is experienced and although improvements to the service need to continue to be made, the home is run in the best interests of the people who live there. Evidence: The deputy manager who has been working at the home since November 2009 told us that she intends to make an application for registration in the near future. We found that meetings occasionally take place with people living at the home to obtain their views on how the home is run. The views and comments made by people living there now influence the way in which the service is provided. We saw that people had asked for more activities to be provided and for changes to be made to the meals served at the home, and staff had acted on this. We found that some improvement has taken place. Staff said that surveys have been carried out at the home in the past, but results of the surveys have not been analysed, published in a report, and shared with people who have an interest in the home. Care Homes for Older People Page 24 of 29 Evidence: Staff and people living at the home said that the management team are approachable and they encourage their views on the direction and running of the home. During discussion the deputy manager told us that there are plans for staff appraisals and supervision to be put in place to support staff, and to help them understand how well they are performing in their roles. During the inspection visit the registered manager demonstrated how records are made every time money is spent by people living at the home, to confirm each transaction. He also showed us that the personal monies of each person are kept in the homes secure safe. In addition we found that a system is in place which makes sure that money is available to people whenever they want to spend it. The paperwork known as the AQAA was completed and returned to us by the registered manager when we asked for it. The information shared with us in the AQAA though limited, showed us that the management of the home are aware of changes that need to be made and are committed to making improvements within the service. Notifications of significant incidents or occurrences at the home are now made to us without delay, although we have received information that there have been occasions when we have not been notified of events when this is required by law. The monthly visits required are taking place and a report is written afterwords which have been sent to us. During the inspection we found from the records seen and through discussion with the registered manager, that matters of health and safety within the home have been dealt with appropriately. We saw that all installations have been serviced regularly and records are kept. The registered manager told us that he is aware of which improvements need to be made to the environment and work is underway to ensure this is addressed. Care Homes for Older People Page 25 of 29 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 26 of 29 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 30 17 All staff must be provided with the mandatory and specialist training that is relevant to their work. This will help them give the best possible care to people living at the home. 31/05/2010 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 plans need to reflect that people have had a Mental Capacity Act assessment, which takes account of their needs and how these are to be met. More improvements need to be made to activities within the home and in the community, to make sure people get involved in activities that they enjoy, so that they do not become isolated. The registered manager should continue to ensure that any safeguarding concerns are reported to the Local Authority Adult Social Care Department and the Care Quality Commission, so that safeguarding enquiries may be started promptly by the local authority. 2 12 3 18 Care Homes for Older People Page 27 of 29 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 4 19 The refurbishments currently being carried out at the home need to continue to take place to create, a more pleasant environment for people living at the home. The smoking room door needs to have a self closing device and fire and smoke containing equipment installed to protect everyone at the home in case of fire. the management of the home should work with the Fire Officer to make sure this is achieved. All staff need to be supported in working towards and achieving an NVQ (National Vocational Qualification) Level 2 qualification. Meetings with people living at the home should continue to make sure that their views on the running of the home are taken into consideration. The results of the surveys carried out at the home should be analysed, published in a report, and shared with people who have an interest in the home. Staff appraisals and supervision needs to be put in place to support staff and to help them undertsand how well they are performing in their roles. 5 19 6 28 7 33 8 36 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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