Care Home: Ash Lodge

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What the care home does well The home has good systems in place to make sure that each person has their needs assessed in full before they move into the home. People are given the opportunity to discuss their needs throughout this process. The home does provide people with the opportunity to take part in activities of their choice. People told us "I like to sing, I like this best". The home has a responsive complaints system in place. This means that people can be confident the home will listen and take action to address their concerns. People told us "I would always speak to the nurse in charge" and "I know who to speak to I needed to make a complaint. I wouldn`t hesitate the manager and the staff always try to sort things out for us". The physical environment is well maintained and offers a pleasant place for people to live. There are sufficient staff on duty to meet the needs of the people living in the home. People told us "the staff are very good and I don`t have to wait too long for them to come and help me". What has improved since the last inspection? We have seen an improvement in all areas of service provision in this home since our last key inspection. The home has improved upon it`s assessment and care planning system. This means that staff have received training to show them how to use it and have been supported by the manager to make sure it is completed correctly. For people who use the service, this means all of their needs will be assessed and appropriate care planned. Medication practises in the home has also improved, we found only one area for improvement during this inspection that the home will need to address. There are more activities and more choices on offer for people to take part in. The appointment of the activity coordinator has meant that people are more engaged in their surroundings and lead more of an active life. There have been concerns about the home`s ability to protect people from harm and this led to a suspension of placements by the local authority. Throughout this suspension the home has worked hard to improve and to protect the people living in the home by making sure their needs can be met. This has meant alot of staff training, staff supervision and also the recruitment of new staff to build on the existing staff team. The home has improved sufficiently for the suspension to be lifted and for people to feel confident they will be protected from harm in this home. What the care home could do better: The home needs to continue with it`s own planned improvements. We have made one requirement as a result of this inspection. The home must take action to reduce the temperature of the medication storage rooms on the first floor. They need to be able to demonstrate they can store medication as per manufacturers instructions. Key inspection report Care homes for older people Name: Address: Ash Lodge Londonderry Lane Smethwick West Midlands B67 7EL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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: Mandy Beck     Date: 1 9 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 28 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 28 Information about the care home Name of care home: Address: Ash Lodge Londonderry Lane Smethwick West Midlands B67 7EL 01215589808 01215589808 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Care First (Smethwick) Ltd care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 54. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 54 Physical Disability (PD) 54 Dementia (DE) 14 Date of last inspection Brief description of the care home Ash Lodge is a care home offering both nursing and residential care for up to 54 older people with general care needs and 14 of these people may also have dementia care needs. There is a separate unit on the first floor for 8 people who have more complex dementia care needs, requiring residential care. The home is located in a residential area, close to shops and public transport links. There is ample off road parking at the front of the building and there is one garden used by all people living at the Care Homes for Older People Page 4 of 28 Over 65 0 54 0 14 0 54 Brief description of the care home home.Accommodation is provided over two floors and bedrooms offer single occupancy. There is a passenger lift so that people with restricted mobility can access these areas of the home. En suite facilities are provided in the vast majority of bedrooms however assisted toilet and bathing facilities are provided. Corridors are wide and equipment is available to assist people to move around the home. The home operates a no smoking policy within the building.There is information of interest to people living at the home and their visitors on display at the home. This is the first visit to Ash Lodge since registering with a new owner, therefore previous inspection reports were not available at the home.The range of fees charged to live at the home is between £364 and £498, these fees may be subject to top up fees and readers of this report should contact the home directly for this information. Care Homes for Older People Page 5 of 28 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 was an unannounced inspection of the home, they were given no prior notice that we were going. The inspection was completed in one day by one Inspector and one Local Area Manager. We looked at all the information that we have received, or asked for, since the home was last inspected in May 2009. This included the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical about the service. Information we have about how the service has managed any complaints and safeguarding issues over the past twelve months. Care Homes for Older People Page 6 of 28 What the service has told us about things that have happened in the home, these are called notifications and are legal requirement. We have also used the information given to us by the home in their improvement plan following the inspection in May 2009. We have also used the information from any other visits we have made to the home since the last inspection and also the results of any enforcement action we have taken with the home. The home has been subject to a suspension of placements (nursing beds only) as a result of concerns raised about peoples care in the home. This suspension has now been lifted following a significant improvement in the homes management, staff training and peoples care. We also looked at the care of five people who use this service in depth. This is part of our case tracking process and helps us make judgements about the homes ability to meet peoples needs. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to continue with its own planned improvements. We have made one requirement as a result of this inspection. The home must take action to reduce the temperature of the medication storage rooms on the first floor. They need to be able to Care Homes for Older People Page 8 of 28 demonstrate they can store medication as per manufacturers instructions. 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 28 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 28 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 have the information they need to be able to make a choice about living in the home. Each person can be confident their needs will be assessed prior to them moving in. Evidence: The home has both a Statement of Purpose and Service User Guide that gives people all of the information they will need to know about the service the home provides. It did not, however, include the range of fees people are expected to pay and the additional extras that will not be included in the weekly fee. We pointed this out to the person in charge at the time of the inspection and it was addressed immediately. People who answered our surveys told us they had been given enough information about the home to enable them to make a choice about living there. The statement of purpose and service user guide can be found in the reception area of the home. Each person is also given their own guide when they move in. Care Homes for Older People Page 11 of 28 Evidence: Before people agree to move into the home the manager will spend time with them completing an assessment of their needs. This is done to make sure the home is able to meet peoples needs and that it will be the right place for them. We looked at the needs assessments of four people during this inspection and found that each one had been completed and provided a sound basis for staff to be able to plan care for people. This is an improvement based upon our findings of our visit to the home in May 2009. People choosing to live here are given ample opportunity to sample the service before they agree to move in. We were told that people are encouraged to spend time in the home on trial visits. One person told us I had been to several places but chose this one, another person said I go to a lot of homes to see different people. Some I could not live in myself. This one I could cope with. The home does not provide intermediate care facilities at this time. Care Homes for Older People Page 12 of 28 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. Improvements made by the home mean that people will have their healthcare needs met. Medication is being safely managed and people are not being placed at risk. Evidence: We looked at the care records of four people during this inspection. This is part of our case tracking process. We found that each person had their own individual plan of care. The home has taken time to sit with people to discuss their needs and preferences and as a result care plans have been tailored to individual need. This is an improvement since our last visit to the home in May 2009. We found at that time peoples care plans were not being kept up to date, their health and care needs were not being clearly recorded and staff did not know what they were in some cases. The home now makes sure that each person is assessed for their risk of developing pressure sores, being malnourished and falls. Where risks are highlighted the home completes a risk management plan and records what action they will take to reduce the risks to people. All care plans are kept under regular review and are updated to reflect any change in a persons condition. Care Homes for Older People Page 13 of 28 Evidence: People who answered our surveys told us we always get the care and support we need, the staff here are wonderful and nothing is ever too much trouble for them, I am never rushed by them, they always take their time and give me the support I want. We spent time talking to staff during this inspection and they were able to give us a detailed account of peoples needs and the support they wanted. They told us we are told by the nurses who needs what care but most of the time its nice to sit with the resident and ask them. The home is also supported by community services such as doctors, psychiatrists and community mental health nurses. People also have access to dentists, chiropodists and opticians, as they need it. People told us didnt feel very well today, they are helping me feel better and they have called the doctor. We looked at the systems in place for the ordering, safe storage and administration of medication. We found the home has good systems in place and medication is administered as the doctor has prescribed it. The home was also visited by the pharmacist from the PCT who completed a report and made recommendations. We found during this visit those recommendations have been addressed. We have made requirements that will also make further improvements. For example we noted the temperature of the medication storage room on the first floor was too warm and this means the home cannot be certain they are storing medication as recommended by the manufacturer. We saw one person had been prescribed cream by the doctor, the storage instructions on the tube of cream said to store at 25oC or below, we checked the temperature in the room and found it to be 28oC. We looked at peoples medication administration records (MAR) we saw that handwritten entries were not always signed by two staff. We have recommended this happens because it will help reduce the risk of errors occurring during transcribing. We spoke to some of the people living in the home during this inspection. They told us staff here are very good We asked if staff paid particular attention to their dignity and need for privacy. They said, oh most definitely they are very caring We saw staff talking to people in a polite manner and when they were giving assistance to people they did so sensitively and did not rush people. Care Homes for Older People Page 14 of 28 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 has a detailed activity programme for people to take part in. People are supported wherever possible to remain active and keep in touch with family and friends. All people living in the home are provided with a well balanced meal. Evidence: People we spoke to during this inspection said we would like to do more Others said they try very hard with games and such like. We spoke to staff who told us we have tried very hard to make it more interesting for people. We spent time with the homes activity coordinator, who told us that about the different types of activity that are available for people to take part in. We were told I like to do something for everyone, its a very good job. I have time to spend with people in groups or on a one to one. During our inspection we saw people taking part in hand massages and nail care. Activities on offer are displayed in the reception area, and throughout the home. This gives people plenty of opportunity to see what is available for them to take part in. The home also runs raffles and other fund raising activities. There are also themed evenings in the home, recently the home has arranged for people to talk in the home about financial management, making wills and advocacy services. People are encouraged to have visitors when they like. We saw plenty of people Care Homes for Older People Page 15 of 28 Evidence: visiting throughout this inspection. One visitor said I am very satisfied with the care I visit a lot of homes but this is the best one. We saw some peoples bedrooms as part of our case tracking process. We saw people had taken the opportunity to decorate their rooms with their own personal belongings. People who responded to our surveys told us they would most liked most of the meals in the home. They told us the choice is very good. We spent time observing dinner time and saw that people were offered choices, on the menu for this day was liver and onions or pork chops both served with fresh vegetables and potato. Dessert was also available. We tasted some of the food and found it to be hot, tasty and cooked well. People said I like the food very much, they always ask what I want although at times I do forget but it doesnt bother them. The home also makes provision for those people who require a special diet, such as a soft or pureed diet and diets for people who have diabetes. Most of the dining rooms were clean and offered a relaxing place for people to eat their meals. The manager told us that new flooring has been ordered for the dining room on the ground floor and it will be redecorated in the near future. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can feel confident their views will be listened to and acted upon. Staff have been trained to recognise abuse and protect vulnerable people living at the home. Evidence: The home has a complaints policy that is available in the service user guide and in the reception area of the home. In addition to this there is a suggestions box at reception where people are also encouraged to make their views or suggestions known. Throughout the home there are many compliment and thank you cards on display from people and their families. We have recommended the correct address of the Care Quality Commission be added to the complaints procedure. Since our last key inspection of the home in March 2009 we have been made aware of one complaint about the service the home was providing. As a result of this complaint we conducted a random inspection of the home and found some areas for improvement, notably in the care planning, risk assessment and record keeping systems. The local authority was also concerned about some of the issues raised and at a strategy meeting it was decided that placements to the home were suspended until improvements could be made. This agreement was kept under regular review by the local authority and the Primary Care Trust (PCT). During this time the home was supported by the PCT and the home manager has bought about significant changes of practice and record keeping within the home. This has improved to such a level that Care Homes for Older People Page 17 of 28 Evidence: the suspension of placements has now been lifted and the home is able to take admissions once again. We spoke to staff and the manager during this inspection about the safeguarding of vulnerable adults. Staff were able to tell us about the different types of abuse, who they would report to if they suspected abuse had occurred and what they would do to keep people safe. Staff also confirmed they had received training in safeguarding vulnerable adults. The manager is aware of her role in keeping safe and free from harm. She has worked pro actively with the local authority during the recent suspension and takes active steps to make sure that people in the home are protected from harm. We looked at the use of restraint in the home. We found that all people who required bed rails to keep them safe whilst in bed had the appropriate equipment. For example, bed rails supplied in pairs and protective bumpers in place. Each person had their own risk assessment and management plan that showed how the home is managing the risk of using this type of equipment for the person. We looked at the recruitment files of three new staff members during this inspection. We saw the home is recruiting people responsibly and is making sure that all required security checks such as a Criminal Records Bureau (CRB) and a check with the Independent Safeguarding Authority (ISA) have been completed. These measures will help reduce the possibility of unsuitable people working with vulnerable adults. Care Homes for Older People Page 18 of 28 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. There have been improvements made to the homes environment. The home is welcoming and offers people a pleasant place to live. People can be assured that the equipment they need to meet their needs will be provided. Evidence: The home clean and free from any offensive odours. We did take time to look around during our inspection. We saw that people are encouraged to make their rooms their own by bringing in their own possessions from home. One person said my bedroom is lovely I tidy it sometimes myself. During our last inspection we raised concerns about the general cleanliness of the home and the equipment in use. It was pleasing to see this time that this has been addressed. We saw dining rooms were clean and offered a pleasant place for people to eat their meals. We were also told by the manager that new flooring is due to be supplied in the very near future in the dining room on the ground floor. This will make the room more visually appealing for people to use. People spoken with were mostly happy with the cleanliness of the home, especially with reference to their own bedrooms. One person told us I am very at home here, I enjoy living at Ash Lodge. Rooms were comfortable, cosy and well decorated. Most bedrooms have en suite facilities. People had taken the opportunity to bring in Care Homes for Older People Page 19 of 28 Evidence: personal items, for example small pieces of furniture, pictures and ornaments. There is on ongoing redecoration programme for the home and at the time of our visit Rainbow unit is currently being painted and made into a more stimulating environment for the people living there. The home has also purchased more profiling beds for peoples added comfort and safety. People we case tracked had all of the equipment they needed to keep them safe and to meet their needs. For example, the correct size sling and hoist to meet their moving and handling needs, pressure relieving equipment in full working order and inflated to the correct setting for the persons weight. The home has a good sized garden. It has been designed to offer some sensory stimulation for people and a relaxing place to sit and enjoy the surroundings. Staff have had training in infection control and throughout the premises each toilet and bathroom had hand washing facilities with liquid soap and paper towels. Staff also said they had access to plastic aprons and gloves when they needed to assist people with personal care. All of these measures will help reduce the risk of cross infection to the people living here. There have been no outbreaks of infectious conditions in the home since our last inspection. Care Homes for Older People Page 20 of 28 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 numbers of staff on duty to meet peoples needs. The home is making sure that staff have the required training and support they need in order to complete their duties and keep people safe. Evidence: The home has a skill mix of both trained nurses and care workers on duty to meet peoples needs. In addition to the care staff there are housekeeping, kitchen, laundry and maintenance workers all working hard to keep the home running smoothly. One person said The staff are wonderful there is never anything that is too much trouble. Since our last inspection there has been alot of staff turnover. This has meant the home has had to use some agency nurses and carers until they can recruit their own staff. The home has tried to maintain some continuity of staffing during this time by asking the agency to supply to same nurses and carers. The home supports all care staff through training in National Vocational Qualifications. Staff we spoke to confirmed that they had completed both their level 2 and 3 NVQ training in Health and Social Care. This means that staff have the knowledge and understanding to be able to meet the peoples needs who live in the home. We looked at the recruitment processes in the home. We saw the staff files of four people. All of them contained the required information and security checks such as Care Homes for Older People Page 21 of 28 Evidence: previously mentioned ISA and CRBs. This means the home has systems in place to prevent unsuitable people from working with vulnerable adults. We looked at the training records for some staff, the home has supplied us with information of training that has been arranged. It is clear that staff will be trained as required. We spoke to several staff on duty during the inspection who confirmed they regularly take part in training and keep their knowledge and skills up to date. New workers are supported through an induction that meets the Skills for Care common induction standards. This induction will provide staff with the basic skills needed for completed their NVQ training. Staff told us in the last year we have been trained and trained, there is so much training going on sometimes its hard to keep up, its nice to take part in training before the new manager came the training had dried up a bit. Care Homes for Older People Page 22 of 28 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 well. The manager is aware of the homes shortfalls and is addressing them. People will be consulted about the service they receive and the home will respond to their views. Evidence: There has been a change in the management of the home since our last key inspection. Jane Shelley is now registered with us. People who responded to our surveys told us the matron is very good, she can sort things out, I find the management very approachable and helpful. It is very apparent the new manager has understood the shortfalls in service provision in this home prior to her appointment. We have seen that much improvement has taken place. The manager has worked with staff through supervision, support and training so that team skills have been developed and staff knowledge has been improved. We have found the home has worked in a positive manner with all of the agencies involved during the suspension of placements, this has included the Primary Care Care Homes for Older People Page 23 of 28 Evidence: Trust (PCT), the local authority and ourselves. There are still improvements to make and the home is aware of this but they continue to develop in the right way. The homes Quality Assurance file contained evidence that audits are carried out on the services provided in the home and identifies areas for improvement. We looked at some of the comments people had provided as a result of the homes most recent surveys. Generally they were very positive. Most people were happy with the way in which they received their care and the way staff carry on their work. Most of peoples concerns were around the homes activity schedule and some minor issues with the menu. The home is currently in the process of providing an action plan to address the issues raised as a result of these surveys. The homes Annual Quality Assurance Assessment (AQAA) was received on time and gave us a realistic picture of the service the home provides. It also shows us the home is continuing to plan for improvement of the home over the next twelve months. In addition to surveying the people living in the home the manager also completes monthly audits of accidents and incidents, care plans and the environment. This allows the home to identify problems earlier and to take action to prevent further problems occurring. We also spent time talking to the manager about her role and responsibility in understanding the principles and practice of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Both the manager and deputy manager have received training in this area and understand their role in making applications to the appropriate authority should they feel that peoples liberty is being deprived. The manager also told us there are further plans to arrange training for all staff. The home takes charge of some personal monies on behalf of people who live there. The monies are kept securely and written records are kept of all transactions. An audit takes place each day. A random sample of the monies and accompanying records were seen during our inspection and there were no discrepancies. Staff training in ongoing, recent training has included moving and handling and fire safety. Training for staff has been a priority for this home. It was pleasing to see the progress the home has made. Staff told us we have had that much training sometimes I feel trained out, the training is very good and so much better with the new manager here. There is a Fire Risk Assessment in place and a fire drill takes place every week. The Fire Alarms must be tested each week. The Emergency Lights are tested on a monthly Care Homes for Older People Page 24 of 28 Evidence: basis and records were seen to verify this. Records were seen to verify the regular servicing and maintenance of various systems, including: the emergency lighting system, the gas system and boiler, the hoists, the lift, the electricity system and all electrical equipment. The water system is regularly tested for legionella and the tanks disinfected. The water temperatures at outlets accessible to service users is tested regularly and recorded. There are policies and risk assessments in place with regard to safe working practises. Staff receive training in safe working practice topics during their induction. Care Homes for Older People Page 25 of 28 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 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The home must take action to reduce the temperature of the medication storage room on the first floor. They must do this to demonstrate they are keeping medication as per manufacturers instructions. 26/02/2010 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 9 Two staff should sign any handwritten entry on the MAR sheet, this will reduce the risk of errors in transcribing occurring. The home needs to update the service user guide with the correct address and contact telephone details of the Care Quality Commission. 2 16 Care Homes for Older People Page 27 of 28 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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