Care Home: Ashwood Care Centre

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well Prospective residents are fully assessed prior to admission to ensure the home is able to fully meet their needs. Care plans are in place and provide a good picture of each resident and their needs. There is evidence that residents receive input from healthcare professionals. Staff care for residents in a gentle, caring and professional manner, respecting their privacy and dignity. The wishes of residents and their families in respect of health deterioration are discussed and recorded, with evidence of input from the palliative care nurse specialist. The home has an open visiting policy and visiting is encouraged. Information regarding advocacy services is available, thus ensuring the right of each resident to independent representation is respected. The food provision is good, offering variety and choice to meet the preferences of the residents. The complaints procedure is available in the home and complaints are dealt with appropriately. Safeguarding Adults procedures are in place and are followed. The home is being well maintained, with an ongoing redecoration and refurbishment plan in place, which is followed. Procedures for infection control are in place and are followed, thus minimising risks. The home is appropriately staffed to meet the needs of the residents, and there is evidence that this is being kept under review. There is a programme of training, with over 50% of care staff qualified to NVQ level 2. There is an induction programme in place that is followed in order to ensure new staff learn the skills they need to care for residents effectively. Recruitment processes are in place and are followed, thus protecting residents. The manager has the skills and experience to manage the home effectively and is a good role model, providing effective leadership for the home. There are clear systems in place for quality assurance, with ongoing work taking place to maintain good standards within the home. Personal monies held on behalf of residents are being well managed and are securely stored. Health & safety is being well managed at the home. Comments received included: `They listen to me and try their best to meet my requests.` `Staff are always friendly and helpful` `Everybody is very caring. Nothing is too much for them.` `I have found all staff to be extremely polite and helpful. Their understanding and treatment of my relative has always been outstanding. The staff are very patient and ready to answer any queries or requests I may make.` `Over the course of my visits to Ashwood Care Centre I have found the premises to be well kept, clean and tidy. Staff appear friendly and welcoming to me and attentive to service users needs. I find the general atmosphere calm and friendly.` What has improved since the last inspection? There have been environmental improvements on the second floor dementia care unit to include new flooring in the corridors and improved lighting, and this has made a big difference to the environment overall on that floor. What the care home could do better: Some shortfalls were identified in recording in the medication records on the ground floor nursing unit. The auditing tool in place had not been used effectively and therefore these had not been picked up and addressed promptly. Medication fridge temperatures had not always been checked and recorded daily and this must be addressed. The 2 small bathrooms need reviewing to provide facilities that will better meet the hygiene needs of the residents. Some comments had been received in respect of staffing on the second floor, attention to detail to ensure activities information is always up to date, more interaction with activities between floors and the opportunity for more walks out. These were discussed with the manager, and action had already been taken to look at these points. Key inspection report Care homes for older people Name: Address: Ashwood Care Centre 1a Derwent Drive Hayes Middlesex UB4 8DR     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: Clare Henderson-Roe     Date: 1 3 1 0 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 26 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 26 Information about the care home Name of care home: Address: Ashwood Care Centre 1a Derwent Drive Hayes Middlesex UB4 8DR 02085731313 02085731124 ashwood@lifestylecare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd care home 70 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 15 Elderly Personal Care 23 Older people with dementia - personal care. 32 Elderly Frail, of which 24 beds are for nursing and 8 are personal care or nursing Minimum Staffing notice. Date of last inspection Brief description of the care home The home is situated between Uxbridge and Hayes. It is a purpose built home and there are 3 floors accommodating residents, with 2 units on the ground floor and 1 unit on each of the 1st and 2nd floors. The home can accommodate a total of 70 residents. There are 68 single rooms and one double room, all with en suite facilities. There are communal sitting and dining rooms on each unit, plus an activities room on the ground floor. There are local shops, bank and post office facilities nearby. The Beck Theatre is near the home, as are local pubs and restaurants. The home can be accessed by bus Care Homes for Older People Page 4 of 26 Over 65 0 70 70 0 0 3 1 1 2 0 0 8 Brief description of the care home and main line train services. A Devotional Meeting is held regularly and religious and clergy visits are arranged as required. The fees range from £480 to £1,008 per week. Care Homes for Older People Page 5 of 26 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 carried out as part of the regulatory process. A total of 28 hours was spent on the inspection process, and was carried out by 2 Inspectors. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Residents, staff and visitors were spoken with as part of the inspection process. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents, staff and health & social care professionals have also been used to inform this report. There were no equality and diversity issues identified at the time of inspection. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 7 of 26 Some shortfalls were identified in recording in the medication records on the ground floor nursing unit. The auditing tool in place had not been used effectively and therefore these had not been picked up and addressed promptly. Medication fridge temperatures had not always been checked and recorded daily and this must be addressed. The 2 small bathrooms need reviewing to provide facilities that will better meet the hygiene needs of the residents. Some comments had been received in respect of staffing on the second floor, attention to detail to ensure activities information is always up to date, more interaction with activities between floors and the opportunity for more walks out. These were discussed with the manager, and action had already been taken to look at these points. 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 26 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 26 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. Prospective residents are fully assessed prior to admission, to ensure the home is able to meet their needs. Evidence: Pre-admission assessments are carried out by one of the senior staff at the home for all prospective residents. Those viewed were well completed and provided a good picture of the persons needs. In addition copies of the assessments carried out by Social Services or the Primary Care Trust, plus hospital discharge summary information was available in the files viewed. Care Homes for Older People Page 10 of 26 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. Service user plans are being well completed, providing a clear picture of the resident and how their needs are to be met. There is evidence of input from healthcare professionals, ensuring that residents healthcare needs are being met. Although in most units medications are being well managed, shortfalls identified could place residents at risk. Staff care for residents in a gentle and professional manner, and clearly hold residents privacy, dignity and rights in the highest regard. The wishes of residents and their families in respect of health deterioration and end of life care are discussed and recorded, thus ensuring their wishes can be respected. Evidence: We sampled the service user plans on each unit. The service user plans had been well completed and the information in the care plans was personalised to the individual. Documentation had been completed promptly following admission and there was evidence of monthly reviews and updates. Where a new need had been identified a care plan had been formulated to address this. Risk assessments for falls were in place and there was evidence of updates following a fall. There was evidence of input from residents and representatives, and also where meetings had been arranged to Care Homes for Older People Page 11 of 26 Evidence: get input from representatives, this had been recorded. We viewed wound care documentation. Pressure sore risk assessments, body mapping records and photographs of wounds had been completed. Care plans for wounds, clear records of wound dressings being carried out and the progress of each wound had been recorded. Pain assessments for residents with wounds were available, with one being completed at the time of inspection. It was evident from the medication records that the resident had been receiving appropriate pain relief. Nutritional assessments had been carried out and care plans for nutritional needs were in place. Where a significant weight loss had been recorded, action had been taken to refer the resident to the GP and in turn to the dietician for assessment. Continence assessments were in place and care plans for continence care needs had been formulated. These identified the continence care management for each individual. Moving and handling assessments and risk assessments for equipment to be used for moving and handling were in place. We saw an example of professional input being obtained to help with residents who have complex moving and handling needs, in order to ensure good practice. Risk assessments for identified areas of risk had been completed. These included bedrail assessments and risk assessments, plus written consents for the use of bedrails had been obtained. We discussed the need to ensure that the use of any safety measures that could be interpreted as restraint are risk assessed and written consents for their use obtained, and the manager was very clear on this. There was evidence of input from healthcare professionals to include GP, optician, chiropodist, palliative care nurse, district nurses, speech and language therapist, community psychiatric nurse, psychiatrist and tissue viability nurse. Medications management and records was viewed on each unit. Lists of specimen signatures and initials for all staff administering medications were available. An information sheet is available for each resident and this includes a photograph, allergy and other relevant information. A printed medication administration record (MAR) was available for each resident, and where staff had been required to insert handwritten entries, these had been checked and signed by 2 staff. Approved lancing devices for blood glucose monitoring were in use on the nursing unit, and on the residential units there was evidence of input from the district nurses. Fridge and room temperatures had been recorded, however on the residential dementia care unit these had not always been recorded daily. Controlled drugs had been recorded, however on occasion staff were using their initials instead of the required full signature when signing the controlled drugs register. For medications with specific administration instructions these had been recorded. With the exception of the ground floor nursing unit, all medications had been signed for when administered, and receipt records were also available. On the ground floor nursing unit we noted one gap in recording the receipt Care Homes for Older People Page 12 of 26 Evidence: of a medication and two gaps in administration records. There was also an instance when a medication appeared to have been signed for twice for the same dose. The registered nurse was able to confirm only one dose had been given. The importance of ensuring all medications are clearly signed for when received into the home and when they are adminstered was discussed. There was also a discrepancy noted with a change in medication treatment for one resident, and action was taken promptly to clarify this. For all residents there is an audit that is done at each handover to check that medication records are up to date, and the importance of carrying this out effectively in order to prevent such shortfalls occurring was discussed. The majority of medications are supplied in 28 day monitored dosage system packs (MDS), with some being supplied in the manufacturers boxes. A running stock balance is recorded for each medication at the end of each day. We audited a sample of both MDS and boxed medications and stock balances checked were correct. Overall medications are being well managed at the home, and the manager and registered nurses were very aware of the need to address the shortfalls identified without delay. Staff were seen caring for residents in a gentle and professional manner, respecting their privacy and dignity. We observed staff interacting with residents who were, at times, quite unsettled, and staff showed patience and understanding, reassuring the residents and effectively managing the situation. There are 4 Dignity Champions for the home, and within their roles they promote good practice in ensuring all residents are treated with respect and understanding, and are encouraged to express themselves as individuals. Southern Cross has introduced a new system called CHOICE, which is an easy, pictorial way for residents to identify their likes and dislikes for aspects of their care, which are then recorded. Each unit has a communication area with various items of information regarding the promotion of dignity throughout the home. Bedrooms are personalised and residents are encouraged to bring in their own possessions, in line with fire safety. There was a very good atmosphere throughout the home and residents spoken with said that they are well cared for and staff are very kind and helpful. One relative commented that nothing is too much trouble. We received several positive comments on the surveys we received from residents, staff and health and social care professionals. Care plans were in place for end of life care. In some instances the information was very general and work was needed to ensure that the wishes of residents and their families in respect of health deterioration and end of life care is known and recorded. We did see examples of where these wishes had been discussed and recorded, and the staff spoken with did acknowledge the importance of ascertaining the wishes of all residents in this area. The home has input from the palliative care nurse specialist and they were very complimentary about the care being provided at the home. Care Homes for Older People Page 13 of 26 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 activity provision at the home is good, covering a wide range of topics and striving to meet the needs of the individuals, with evidence of ongoing work in this area. Visitors are made welcome at the home and visiting is encouraged, thus ensuring residents keep in contact with family and friends. Information on advocacy services is in display, respecting residents rights to independent representation. The food provision at the home is good, offering variety and choice and meeting the nutritional needs of the residents. Evidence: The home has a full time activities co-ordinator who arranges a range of activities and outings. Activities programmes are displayed throughout the home. Information regarding the interests and hobbies of residents is recorded in the care plans. The home has drivers who are qualified to drive the Hillingdon mini bus so these are regularly used for outings from the home. The home has representatives from several different religious groups who visit the home on a regular basis, and if any residents are admitted whose religious needs are not presently catered for, then action is taken to arrange input from the particular religious organisation. The home has good links with the local community to include schools, theatre and musical groups and Beaver, Cub and Scout groups. They provide entertainment for the residents during the year Care Homes for Older People Page 14 of 26 Evidence: and at festive times such as Christmas, both within the home and also by inviting residents to attend parties and concerts. Pets in Therapy is being re-introduced to the home, and links have been formed with the local library, who visit the home and also residents go out to the library and can learn about other events going on in the borough. Residents have been invited to attend a weekly Tea Dance in a local community hall, and this all adds to maintaining contacts with the local community. There were activities going on in the home during the inspection, to include a musical entertainment. The old activities room was out of action for some time, however it has now been divided so there is an activities room and a separate smoking room. The area was being decorated at the time of inspection. Several people commented that activities provision is one of the areas the home does well in, and it was clear that the activities co-ordinator is motivated and is working hard to promote and increase activities throughout the home. The manager said that the introduction of additional staff hours for activities is being looked at in line with the holistic care needs of residents, and work is ongoing on this. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome and offered refreshments. Representatives are kept up to date with any issues. There is information on display in the reception area regarding a variety of advocacy services, to include Age Concern, Hillingdon Council, Rethink and Care Aware, and this provides information to ensure residents rights to independent representation is upheld. Since the last inspection they have introduced a protected mealtime for the lunchtime meal, which is from 12-1pm. This means that only emergency calls are put through to the floors at this time, and there are also notices on display to inform visitors of this initiative. This is so staff can concentrate on ensuring that the residents have a good dining experience and distractions are minimised, thus residents can concentrate better on finishing their meal. The kitchen was clean and tidy and refurbishment work has been carried out to address a previous problem of a damp wall and to replace the flooring. The last visit from the Environmental Health Department resulted in a top score of 5 stars for the kitchen. The home has a 4 week menu and copies were on display. The mealtime menu is also displayed on the tables for residents to view, and choices are offered. In addition to the choices on offer each day, other options are available to meet residents preferences and any specific dietary needs. Residents spoken with expressed their satisfaction with the food provision at the home. Staff were available to assist residents who needed it and were doing so in a gentle and encouraging manner. Care Homes for Older People Page 15 of 26 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 clear policies and procedures for the management of complaints and safeguarding issues, which are followed, thus protecting residents. Evidence: The home has a clear complaints procedure and this was on display throughout the home. Contact details for CQC were updated at the time of inspection. We viewed the complaints file and there had been 3 complaints, all of which had been investigated and responded to. Any concerns raised are recorded and responded to. The CQC surveys received indicated that residents know how to raise a complaint, and people spoken with felt able to approach the manager and senior staff with any issues, in the knowledge that they will be listened to and have their concerns addressed. The home has a comments and suggestions book, which we viewed, and there were several very positive comments. The home has a safeguarding adults procedure and also follows the Hillingdon safeguarding adults protocols. Southern Cross Healthcare have introduced a free, confidential helpline to Action for Elder Abuse, which offers informaiton and support to anyone who has any concerns regarding abuse, and posters with the contact information were on display throughout the home. Staff spoken with were very clear to report any concerns and had received safeguarding training, both from Southern Cross and also from the Metropolitan police safeguarding officer for Hillingdon. Care Homes for Older People Page 16 of 26 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 continued improvements to the environment, which is now at a good standard throughout, thus providing a pleasant, homely environment for residents to live in. Infection control policies and procedures are in place and are followed, thus minimising risks to residents, visitors and staff. Evidence: We carried out a tour of the home and it was clear that there has been ongoing work to continue to improve the environment throughout the home. The second floor dementia care house has had a lot of work carried out to include improved lighting, replacement flooring in the corridors and redecoration throughout several areas, providing a lighter, pleasant and homely environment for the residents who live there. There is a comprehensive redecoration and refurbishment plan which the maintenance man keeps up to date and there was evidence of work having taken place throughout the home to improve the environment, which is now at a good level throughout the home. The garden is being maintained and developed, and provides a nice environment for residents and their visitors to sit out in during the good weather. There are 2 bathrooms that are out of use and on discussion it was clear that the usage of these 2 rooms was in need of review, to provide shower wet room facilities, which would better meet the needs of the residents. Serious consideration needs to be given to this in order to provide improved facilities. Care Homes for Older People Page 17 of 26 Evidence: We viewed the laundry and the area was clean and tidy. There were clear records to evidence daily wardrobe checks to ensure clothing is being kept in good order. In addition personal items are listed for new residents so their clothing on admission is identified to laundry staff. Personal clothing items viewed were appropriately identified to the individual. The home was clean and fresh throughout and the change of flooring on the second floor has made a significant improvement to the control of odours in that area. Infection control procedures are in place and are followed, and protective clothing to include gloves and aprons was available and in use. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately staffed to meet the needs of the residents, and staffing is subject to ongoing review, to ensure the needs of the residents can be met at all times. Staff receive induction and ongoing training to provide them with the skills and knowledge to care for residents effectively. There are robust employment procedures in place and these are being followed, thus protecting residents. Evidence: At the time of inspection the home was being staffed appropriately to meet the needs of the residents. We had received comments on some of the CQC surveys in respect of the staffing on the second floor dementia care house, plus some comments regarding staffing on the first floor nursing unit were received at the time of inspection. On discussion with the manager is was clear that she had already identified this and had increased the staffing on the second floor, and was keeping the staffing on the first floor nursing unit under review in line with resident dependencies. We also discussed the possibility of more hours dedicated to activities provision. This had already been reviewed by the manager, who was also looking at this area in conjunction with having additional hours to meet the holistic needs of residents, to include some additional activity provision, and this is an ongoing piece of work for when the home is back to full capacity. It is acknowledged that the residential unit had several empty beds at the time of inspection. There were appropriate numbers of staff on duty to include nursing, care and ancillary staff to meet the needs of the residents and the Care Homes for Older People Page 19 of 26 Evidence: home in general. According to the AQAA over 50 of care staff are qualified to NVQ 2 or above and there is an ongoing training programme. We viewed 3 sets of staff employment records and these contained all the information required under Schedule 2 of the Care Homes Regulations 2001. The manager said that there had recently been a full audit of the staff employment records and action was being taken to address any shortfalls identified in that audit. Southern Cross Healthcare have a general induction programme, that familiarises new staff with the home, environment and specific policies and procedures. There is also a comprehensive induction programme that covers the Skills for Care common induction standards. This is completed over a 6 month period, and practical sessions are undertaken alongside the theory, so that each standard is covered in depth. It was clear from speaking with staff that the training provision at the home is very good and the AQAA for the home evidences several areas where staff have undertaken trainers courses to enable them to cascade training within the home, to include moving and handling, dementia care and dignity champions, the latter covering many aspects of care and the maintaining of residents dignity at all times. The AQAA also lists several areas of specialist training provided to staff to include tissue viability, continence, dysphagia and swallowing difficulties, dignity in care and trainings in dementia related subjects. Staff spoken with said that they are provided with a good amount of training. Care Homes for Older People Page 20 of 26 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 manager has the skills and experience to manage the home, and does so effectively, ensuring good outcomes for the residents who live there. There is a good system for quality assurance in place, which provides a process of audit and review for the ongoing improvement of the home. There are systems in place for the management of residents personal monies and these are clearly followed. The processes in place for health and safety management are robust and are followed, proving a safe environment, thus protecting residents, staff and visitors. Evidence: The manager has many years experience in management and her qualifications include the Registered Managers Award, NVQ level 4 in care and level 5 in management, IOSH Care Home Managers Health and Safety Award and has completed the certificate in training practice. she has also undertaken training in dementia, challenging behaviour, management skills, palliative care, safeguarding adults and attended moving and handling updates and development days. We received very positive comments received about the manager and the improvements in the home Care Homes for Older People Page 21 of 26 Evidence: since she came into post. It is clear that she has good leadership skills and provides a good role model for staff. Staff, residents and visitors spoken with said that the manager was approachable, supportive and they were aware of the improvements that she has implemented for the home overall. The manager has applied to CQC to become the registered manager for the home. The post of deputy manager is currently being recruited to and the persons qualifications will include being a first level registered nurse, in order to be the clinical lead for the home. The Head of Care for the residential units is a second level registered nurse and works well alongside the manager, plus the two nursing units have a first level registered nurse on duty at all times, to ensure the nursing care needs of the residents are being met. The home has a system for quality assurance in place, with audits that are comprehensive and cover all aspects of resident care and the home overall. It is clear that, with the exception of the shortfall in medications on the ground floor nursing unit, the auditing processes in place are effective and have ensured that standards in the home have continued to improve, and the importance of maintaining this improvement is clearly understood. There are 3 monthly meetings with relatives, 2 monthly meetings with staff and also frequent meetings with various staff groups within the home. Regulation 26 unannounced visits are carried out on behalf of the Provider and reports from these visits were available in the home. The home has computerised records for any personal monies held on behalf of residents. We viewed the records for 3 residents and these were clear and up to date, recording all income and expenditure. There was evidence of interest being allocated to accounts up until February 2009, and with the current financial climate, no further allocations had been made as yet. Invoices for all expenditure were available and receipts are given for all monies recieved on behalf of residents. We sampled the maintenance and servicing records and these were up to date. Kitchen records were also up to date. Southern Cross provide books for the recording of various in house checks on systems and equipment and these were also up to date. The fire risk assessment was last reviewed in July 2009 and risk assessments for equipment and safe working practices are in place. Fire drills are carried out to meet good practice and legislation requirements, and are clearly recorded. The damp proofing in the kitchen has been carried out and given a 5 year guarantee on the work. Staff have undertaken training in health and safety topics and ongoing training reviews are in place to ensure that all staff attend training and updates within the required timescales. There were no health and safety issues identified at the time of inspection and health and safety is being well managed at the home. Care Homes for Older People Page 22 of 26 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 23 of 26 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 Medication records must be 05/11/2009 complete and up to date, and accurately reflect the receipt and administration of medications. The auditing process for medication management must be adhered to. To ensure medications are well managed and residents are protected. 2 9 13 Daily minimum, maximum 05/11/2009 and actual temperatures of the medications fridges must be carried out daily. To ensure medications are being stored at the correct temperature. Care Homes for Older People Page 24 of 26 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 21 That serious consideration be given to reviewing the use of the 2 bathrooms not in use, and they adapted to provide facilities that are accessible to and meet the needs of the residents. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!