Care Home: Ashurst Place

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What the care home does well The environment is clean and homely with plenty of space both within the home and the grounds. There are good staffing levels and clearly defined job roles. The residents say that they do not have to wait long when they need attention and staff were observed to interact with the residents in a respectful and friendly way. The home holds several events such as celebrations of religious festivals, garden parties and birthdays. Residents said they enjoy these very much. On the day of this visit the home was beautifully decorated for Christmas and the residents were looking forward to Christmas shopping trips and a Christmas party. The home is well managed and both the registered provider and the registered manager are in the home on a daily basis. What has improved since the last inspection? Staff training has increased and is better organised. At the time of the last inspection less than fifty percent of staff held the National Vocational Qualification (NVQ) in care at level two or above. Now sixty-six percent of staff hold this qualification. The home now has a website, ashurstplace.com. This gives good general information about the home. There have been a number of environmental improvements including new carpeting to some areas, redecoration of the kitchen and a new bathroom suite. What the care home could do better: There should be more activities that are suitable for those people who have failing mental capacity. The home should work to establish more formal means of communication. In particular one-to-one staff supervision and staff meetings should be in place. There should be a method of recording concerns that are not in the category of formal complaints so that trends can be identified. The home is to ensure that there is sufficient heating in all areas of the home. In particular, the bathroom and the rear corridor identified during this visit. Key inspection report Care homes for older people Name: Address: Ashurst Place Ashurst Place Lampington Row Langton Green Tunbridge Wells Kent TN3 0JG     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: Wendy Mills     Date: 0 8 1 2 2 0 0 9 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: Ashurst Place Ashurst Place Lampington Row Langton Green Tunbridge Wells Kent TN3 0JG 01892863661 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miss Julia Lynn Watts,Mrs Louie Watts care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 37 The registered person may provide the following category 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 category: Old age, not falling within any other category(OP) Date of last inspection Brief description of the care home Ashurst Place is a residential home that is registered to provide care and accommodation for up to thirty-seven older people. The home is a detached property, set in twenty-three acres of parkland and fields. The home is located in a rural area near to Langton Green where there are some shops, a church and a bus service. The town of Tunbridge Wells is situated Care Homes for Older People Page 4 of 28 Over 65 37 0 Brief description of the care home approximately three miles away and has all the facilities of a large town including a main line station. The home has plenty of communal space including a large lounge, conservatory and dining room. Accommodation for residents is provided on the ground and first floor with a shaft lift between the floors. Currently all residents are accommodated in single rooms. Eight rooms have en-suite facilities and there are call points and TV points in each bedroom. Some rooms have private telephone points. The weekly fees range from £400 to £750. Further information about this service can be obtained from the homes website:- ashurstplace.com or by contacting Paul Illes, the registered manager of the home. Telephone: - 01892 863661; e-mail:ashurstplace@tiscali.co.uk. 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 visit formed part of the inspection process of the Care Quality Commission (CQC). This report is compiled using evidence gathered during this visit and evidence obtained over the past year. The information obtained before the visit includes things that the home is required to tell us such as notifications about significant events and their Annual Quality Assurance Assessment (AQAA); information that other people, such as relatives and visiting health and social care professionals, have told us in conversations, telephone calls and surveys; and the outcome of any complaints or safeguarding incidents. During this visit we spoke to three of the people who use this service, three staff members and one relative in private; we spoke to seven other residents and relatives in the communal areas; we examined samples of important documentation, such as care plans; staff training records; staff files and health and safety records; in depth discussion was held with the registered provider and the registered manager; a tour of Care Homes for Older People Page 6 of 28 the home was made; and we made direct and indirect observations throughout the time we were in the home. Following the visit we spoke to three other relatives on the telephone, with the permission of the residents concerned. The evidence we gathered is used to make a judgement about the quality rating for this service. The people who use this service said that they like to be referred to as residents and therefore this is the term that is used throughout this report. The residents we spoke to all said that they are being very well looked after, that the food is good and that the staff are always helpful and kind. Their views were echoed by their relatives and our findings. The residents, their relatives, the staff and the registered manager and provider are all thanked for their help during this visit. The quality rating for this service is 2 Stars. This means that the residents experience good outcomes in all aspects of their care. 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: 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 8 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 9 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. The home gives prospective residents and their supporters the information they need to make an informed decision about moving into the home. Appropriate pre-admission assessments are made prior to a place being offered at the home. This ensures that only those people whose needs can be met and who are suited to the home are offered a place. Evidence: The home has a statement of purpose and service user guide. These documents provide good information about the home and the complaints procedure. The home also has a website that has recently been updated. In addition, there are notice boards around the home that tell the residents about the daily menu choices, forthcoming events,such as the Christmas party, and shopping trips. Care Homes for Older People Page 10 of 28 Evidence: We inspected four care plans to see if there were pre-admission assessments in place. Care plans are important documents because they are one of the means by which the residents and their supporters can tell if their needs and wishes have been identified and the way these needs are to be met recorded. They are also an important source of information for staff who need to ensure that care is delivered in a consistent way that is in line with current best practice. In addition they can provide useful information that can contribute to the decision making process for people who no longer have full mental capacity. All four care plans had written assessments in place. The registered manager said that he always carries out the pre-admission assessments and visits prospective residents in their own homes, or in hospital, to carry out these assessments. Where indicated, for example, when a resident is coming to the home from hospital, the comprehensive assessments made by the hospital team of doctors, nurses, therapists and other health care professionals, have been obtained and used to inform the care plan. Arrangements are made for pre-admission visits when possible and relatives are welcome to visit on behalf of prospective residents. Trial periods are offered to give people an opportunity to decide if the home suits their needs. The home does not offer intermediate care although it does offer respite care in some cases. Care Homes for Older People Page 11 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. The home promotes the health and welfare of the residents in a way that protects their privacy and dignity. Evidence: Four care plans were examined in detail. A further four care plans were looked at specifically to check bathing records because we were worried that one bathroom was very cold. We asked three members of staff about personal care and how it was delivered and talked to some of the residents to seek their views on their care. We also talked to relatives during the inspection and contacted others later by telephone, to find out what they thought of the care their relatives receive. The care plans state the amount of help each resident needs in respect of support with personal care but would benefit from more detail. For example, the care plans should tell staff how frequently an individual may like a bath, whether a shower or bath is preferred and how personal care should be offered. This is particularly important for those people who no longer have the mental capacity to make some decisions for themselves. In these cases, simply asking, Would you like a bath today? is likely to Care Homes for Older People Page 12 of 28 Evidence: receive a negative answer. However, if it is previously ascertained that a person would have been used to having a daily bath, then records should show this and staff should find ways of ensuring bathing is offered in a positive way, on a more regular basis. Residents told us that they are very happy with their care. They said that the staff are, Marvelous, and always kind and respectful. One said, They are really good, they given me the help I need and keep all my clothes clean and well looked after. Relatives were, in general, very satisfied with the care their relatives were receiving. All the residents were well dressed and well groomed on the day of their visit. Staff were observed to treat the residents with kindness and respect. Relatives told us that they have never observed the staff to lack patience when dealing with residents and have always found staff welcoming and cheerful. We found good evidence that the home seeks health care advice on behalf of the residents. All residents are registered with local General Practitioners (GPs). The GPs and other health and social care professionals such as district nurses, chiropodists and care managers visit the home. The care plans show that these visits are recorded and the advice given by health and social care professionals is followed. There are sound policies and procedures for the management and administration of medicines in the home. All staff administering medicines have received the necessary training and medicines are stored safely and securely. Samples of the Medicines Administration Records (MARs), were examined in detail. No errors were found in the sample inspected. Care Homes for Older People Page 13 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 provides a good range of activities so that the residents can lead full and interesting lives. The home should now work to introduce more person centred activities, based on previous interests, to help those with failing mental capacity to lead more meaningful lives. Evidence: There are notice boards in the hall and main lounge that tell the residents activities are going on. The notice board at the time of this visit told of a forthcoming Christmas party, a shopping trip and what the main meal of the day was to be. Relatives said that the home holds lots of parties and events. One said, Theres something going on every month, last month there was a Halloween party and the staff all dressed up. Entertainers, ministers of religion and children from local schools also visit the home. The home is set in extensive and well maintained grounds and there are horses in an adjacent field. Residents said that they had really enjoyed the garden during the summer. They said there had been garden parties and lots of time when they had been able to walk outside and enjoy the views. Care Homes for Older People Page 14 of 28 Evidence: Some staff have learned sign language so that they can communicate better with residents who have profound hearing loss. On the day of this visit we observed some staff spending time with individual residents, encouraging one to one activities. Several residents said they prefer to read their newspapers or do crossword puzzles rather than join in organised activities. On the day of this visit most residents were spending time in the main lounge and conservatory but some residents say they prefer to spend the time in their rooms, reading, doing puzzles, listening to music or watching television. They said that they never feel pressurised to join in organised activities when they do not want to. The needs of some residents are changing. There are now more people with short term memory loss and other signs of failing mental capacity. The care plans we examined did not contain enough information about previous interests and hobbies so that activities can be centred around these interests. For example, some residents previously enjoyed looking after their homes and gardens. The home should now work to develop activities that reflect their past interests such as dusting, baking and gardening. More information and training is also needed to help staff understand the ways in which choice should be offered to people with failing mental capacity. The registered provider told us that staff have received some training in dementia care. She said that most staff and two cooks have attended the Alzheimers Society Care to make a difference, training. More training in dementia care is planned for the near future. During this visit we spent some time discussing the changing needs of some of the residents and how the home could improve on specific activities for this group. The home should ensure that more information is added to the care plans to help people make choices. This will also provide a basis on which choices may be made on behalf of those who can no longer make these choices for themselves. Relatives told us that they can visit at any time and are always made welcome to the home. They said that the staff are very helpful and attend to any concerns they have as soon as possible. Pets are also welcomed and the owners dog is a regular and popular visitor to the home. During this visit we spoke to the cook. She demonstrated a very good knowledge of the specific needs of individual residents, including likes and dislikes, special dietary needs, food texture needs and portion sizes. She told us that there is always plenty of fresh produce available and that she discusses menus with the registered manager. Menus were noted to be well balanced and nutritious. The residents we spoke to all Care Homes for Older People Page 15 of 28 Evidence: said that the food in the home is very good. One said, The food is really nice - we can always have something different if we dont fancy what theyve got on the menu, but I like it all and havent had to ask for anything different. The home has a large and airy dining room that provides a pleasant and congenial place for the residents to take their meals. On the day of this visit it had been beautifully decorated for Christmas. The tables were attractively set with festive tablecloths, napkins and table decorations. 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. The home has sound policies and procedures for dealing with complaints and safeguarding. Learning from complaints and concerns could be improved by more diligent recording and monitoring of more minor concerns. Evidence: The home has sound policies and procedures for dealing with complaints and safeguarding. Neither the home nor the Commission has received any formal complaints since the last inspection. The registered provider told us that any day-today concerns are dealt with as they arise. Day-to-day concerns are not recorded and time was spent during the inspection discussing the value of recording these issues. It is recommended that the home begins to record the more minor expressions of concern so that they can be audited and any trends identified and addressed. All staff receive safeguarding training as part of the induction programme for new staff. Further updates are arranged for staff to ensure they are reminded of the procedures. Safeguarding training is important because all staff need to now how to keep the residents safe from all forms of harm. The staff we spoke to during the inspection had a good understanding of safeguarding procedures and said they would have no hesitation in reporting any concerns to the manager if necessary. Care Homes for Older People Page 17 of 28 Evidence: There have been two safeguarding incidents since the last inspection. Neither involved allegations against staff and both incidents were dealt with using the correct reporting procedures. 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. The home is safe, clean and well maintained and provides the residents with a pleasant and homely place in which to live. Evidence: Ashurst Place is a large Victorian country house that has been used to provide long term care for varying groups of people since the second word war. It has been altered at various times since then. The present owner took over the home in 1975 and further alterations have been done since that time so that the home can meet the needs of older people. Currently all accommodation is provided in single rooms but some rooms are large enough to accommodate couples should this be required. The residents we spoke to all said they were very happy with their rooms, many of which have lovely views of the grounds. All rooms were comfortably furnished and relatives told us that it had been possible to bring items from home to give a more homely feel to individual rooms. The communal accommodation consists of a large entrance hall, lounge, conservatory and dining room. The home is set in extensive and well maintained grounds that provide attractive outside space for the residents when the weather permits. Housekeeping and maintenance staff are employed and the home is clean and well Care Homes for Older People Page 19 of 28 Evidence: maintained. Two groundsmen are employed to look after the gardens. The home has a laundry with a sluice and is staffed by a laundry assistant on every day of the week. There are sound infection control measures in place. A tour of the home was made. All areas were found to be clean and odour free. The home was beautifully decorated for Christmas and a Christmas tree had been placed in each of the residents rooms. The homes Annual Quality Assurance Assessment (AQAA) told us that there are robust health and safety checks in place for the environment and that all necessary safety certificates such as electrical and fire safety are in place. The AQAA is a self assessment document that the registered provider is required, by law, to submit to the Commission. It is an offense to give any false information in this document and therefore mush of the information it contains is accepted by the Commission without additional checks. However, parts of the AQAA are chosen for verification during the key inspection and during random visits to the home. Whilst most areas of the home were comfortably warm, one bathroom and a rear corridor were cold. The registered provider agreed to look into the reasons for this. There is an improvement plan for the environment and a number of improvements have been made since the last inspection. New carpets have been fitted to some areas, a new bathroom suite fitted, a new hoist purchased, some rooms and the kitchen have been painted and new garden furniture purchased. There are plans to fit more new carpets and to refurbish rooms as they become vacant. 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. Staff training, staffing levels and recruitment procedures are all good. This means that the residents are cared for by a well qualified and carefully vetted staff team. Evidence: The home has good staffing levels and a stable staff team. Only one staff member has left in the last year and this was to go on to further education. There are six care staff on duty on the morning shift and three in the afternoons. There are two awake night staff and both the manger and the owner, as well as some other staff, live on the premises. This means that there is always back up if needed. In addition, the home employs a strong team of ancillary staff. Seven day a week cover is provided for cleaning, laundry and catering and groundsmen and maintenance staff are employed to look after the grounds and general upkeep of the building. The Annual Quality Assurance Assessment(AQAA) told us that the home rarely has to use agency staff. This is good because it means that the residents receive care from staff who know them well. However, the staff rosters show that some staff are working very long hours. Whilst this is with staff agreement, it means that residents may be cared for by staff who are tired and will not, therefore be at their best. The home should review the way it draws up the staff rosters. Staff training has improved since the last inspection. Nearly all the staff have Care Homes for Older People Page 21 of 28 Evidence: undertaken basic training in dementia care and more training is planned. At the time of the last inspection less than fifty percent of staff had achieved the National Vocational Qualification (NVQ) at level two or above. Now approximately sixty-six percent of staff hold this qualification. There is a stable staff team and a family atmosphere in the home. Some staff members are related and the home should take care that staff who are related do not work on the same shift together on a regular basis. There is good evidence in the staff files to confirm that all necessary checks are made on staff before they start work in the home. All files inspected had evidence of a current and satisfactory Criminal Records Bureau (CRB)check had been carried out, that two written references had been obtained and that other checks such as a health survey and an in depth interview had been carried out. One-to-one supervision of staff has yet to be established. This type of staff supervision is important as it gives staff a chance to speak frankly with their supervisor and an opportunity to identify training needs and to check that the method of training meets the learning needs of the individual staff member. The registered provider has already obtained information about establishing one-to-one supervision and said that this is now a priority for her. It is strongly recommended that the home set up a structure for supervision and train senior staff in this process, particularly as this deficiency was highlighted at the previous inspection. The home does not hold formal staff meetings. We were told that this was because everyone knows each other well and there is no need. However, it should not be assumed that everyone will get an opportunity to hear about developments and to put their ideas forward if there is no formal process for this. It is recommended that the home develop a means of communicating with staff in a more formal way. Minutes of meetings should be recorded to ensure there are no misunderstandings. The registered provider takes responsibility for overseeing and organising staff training. Training records and three staff files were examined in detail. These records showed that a good level of training is being undertaken and there is a clear vision for the specialist training that staff need. Sixty-six percent of staff now hold the National Vocational Qualification (NVQ) in care at level two or above. Some staff are currently undertaking training for the NVQ III. Residents and relatives all said that the staff are very good. They confirmed that their call bells are answered promptly and that staff are always respectful and polite. Care Homes for Older People Page 22 of 28 Evidence: The staff we spoke to said they enjoy working in the home and that there is a stable and friendly staff who work well together as a team. They told us they feel they can easily talk to the manager of the home. Care Homes for Older People Page 23 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 well managed and run in the best interests of the residents but communication and continuous learning and development would be improved if there were more formal processes in place for monitoring concerns and listening to staff views. Evidence: The registered provider and the registered manager both live on the premises. The AQAA tells us that they both now have the National Vocational Qualification at level four (NVQ IV) in care and the Registered Managers Award (RMA). In addition they are both NVQ assessors to level three. The registered provider has owned the home since 1975 and the registered manager has been in post since 1987. Staff and residents told us that they find it easy to talk to the manager. Discussion with both the manager and the provider showed that they have a good understanding of care needs and that they value continuing professional development. Care Homes for Older People Page 24 of 28 Evidence: Communication in the home is generally good on an informal basis, however, the home could improve on the way it communicates more formally. For example:general day-to-day concerns are not recorded as they are dealt with as they arise; there are no formal staff meetings and no one-to-one staff supervision. This means opportunities to identify trends, to learn from concerns and to receive staff feedback about learning needs and ideas for service development are being lost. Some of these points have been covered earlier in this report under the relevant outcome areas. The registered provider said that she is currently in the process of preparing to introduce more formal staff supervision which will include one-to-one supervision. It is strongly recommended that she does this as a matter of some urgency. The homes Annual Quality Assurance Assessment (AQAA) told us that there are good quality assurance systems in place. It confirmed both the registered manager and provider are in the home most days and spend a lot of time talking to the residents and finding out what they think about the home. There has recently been an activities questionnaire and, as a result of this, a personal trainer has been booked on a regular basis to encourage the residents to be more physically active. The home holds some small amounts of money on behalf of some residents. Each residents money is kept separately and securely and accurate records and receipts are kept. The registered provider confirmed, during conversation and in the AQAA, that the home has sound Health and Safety procedures in place. Regular checks are made and all certificates required by law are in place. The kitchen has received a gold star award from the local Environmental Health Department for cleanliness and safety. All staff attend the necessary statutory training with respect to Health and Safety such as fire training, manual handling and first aid. 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 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 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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