Care Home: Autumn Lodge

What the care home does well The atmosphere in the home was comfortable, homely and relaxed and staff were seen to be kind and caring towards people living in the home. Care planning systems ensure that social, personal and health care needs are identified and met. Residents spoken with said that they liked the meals and were happy in the home. Wholesome, nutritious and well balanced meals are provided in addition to a wide range activities and outings. There is an open-house policy, which welcomes visitors at all reasonable times and complaints are handled well ensuring that residents and their relatives feel listened to and their views acted upon. People moving into the home are able to bring in their personal possessions to personalise their bedrooms and the home has a well maintained rear garden and there is limited parking at the front of the property. The home is well maintained and both safety checks and quality monitoring systems ensure any shortfalls are identified and addressed. Staff are well trained and the manager provides good overall leadership and clear direction to staff. What has improved since the last inspection? The Registered Manager has the required qualifications and a Care Manager with the same qualifications has been appointed to oversee day to day care practices. The Statement of Purpose has been reviewed and accurately reflects the services provided and all residents and their relatives are provided with a copy of the Service Users Guide. In addition the home continues to maintain a programme of renewal and refurbishment of the premises. What the care home could do better: Minor shortfalls in respect of daily notes and the provision of bedside lamps were identified but the Managers agreed to deal with these matters with immediate effect so no requirements were made. Following the site visit the Registered Manager provided evidence to demonstrate these shortfalls had been addressed as had other issues that were discussed during the site visit. Key inspection report Care homes for older people Name: Address: Autumn Lodge 35-39 Rutland Gardens Hove East Sussex BN3 5PD     The quality rating for this care home is:   three star excellent 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: Gwyneth Bryant     Date: 1 8 0 8 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: Autumn Lodge 35-39 Rutland Gardens Hove East Sussex BN3 5PD 01273271786 01273271786 braverycare@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Sheila Clare Bravery care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 35. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Autumn Lodge is a private care home registered to provide care and accommodation for up to 35 older people with a dementia type illness. There is also a respite flat available for couples where a person with dementia can be cared for by their relative. The home does not provide nursing care. The conditions of registration of care homes are currently being reviewed by the South East Registration Team as part of the Modernising Registration Agenda. The home is located in a residential area close to the centre of Hove, with all local amenities and the seafront close by. The area is well served with bus and rail services, and parking is available on the private forecourt and in the street outside. The property comprises three converted houses that have been linked together, and service user accommodation, including 23 single and five shared bedrooms, plus the respite flat, is arranged on three floors that are accessed by a Care Homes for Older People Page 4 of 26 35 Over 65 0 Brief description of the care home passenger lift. There is also a stair lift to an area on the first floor. Currently the fees vary from £480 to £650 per week depending on the room occupied and the package of care required. Extra services such as hairdressing and chiropody are charged separately and this information is available from the home. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should note that although the registration conditions state that the home only accommodates people under 65, this is inaccurate as the home is registered to provide care and accommodation to all adults whose needs can be met by the home. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Autumn Lodge will be referred to as residents. This was an unannounced inspection which began at 08:45 and ended at 15:30. The purpose of the inspection was to check compliance with key standards and other standards. There were Thirty-three people in residence on the day of which four were involved in the inspection. The Registered Manager, the Care Manager, the chef, four relatives and the Registered Provider were also involved in the inspection. The last key inspection was conducted on 28 September 2007 and an Annual Service Review carried out on 31 July 2008. Care Homes for Older People Page 6 of 26 A number of documents and records were viewed; including personnel files, medication charts and care plans. Fourteen bedroom were inspected, in addition to three communal bathrooms, three communal toilets and the dining room and lounge areas. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). 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 information about the service. This was completed well and provided when we asked for it and the information included in this report as necessary. Comments from relatives included: Its fantastic here. She feels safe here. Its always so happy here - it feels like a family. Its clean and there are always staff around to talk to. I am very pleased with everything they do. Care Homes for Older People Page 7 of 26 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 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. Satisfactory pre-admission assessments are carried out prior to people moving into the home, which ensures that their needs can be met, and they or their representatives are provided with detailed information on services provided by the home. Evidence: The home has developed a more detailed contract for all new residents which includes the number of the room they are to occupy and the services provided. In addition the home has updated both the Statement of Purpose and Services Users guides, both of which are provided to residents prior to admission. As part of the pre admission process each resident or their relative are sent an admissions pack which includes a request for a personal history to enable staff to have an understanding of the residents past life and hobbies and interests. Prior to admission each resident or their relative are sent a letter confirming that the home is able to meet their assessed needs. Care Homes for Older People Page 10 of 26 Evidence: Pre-admission documentation was viewed for recent admissions and it is evident that these documents are used effectively to ensure the home is able to meet the needs of prospective service users. One of the relatives spoken with confirmed a contract was given along with detailed information on the services provided. This relative also said that the manager was available to answer any questions. Care Homes for Older People Page 11 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. All aspects of the health, social and care of those living in the home are identified and planned for enabling staff to deliver care in a structured and consistent manner. Evidence: Four care plans were viewed in conjunction with daily records and it is evident that residents care needs are identified and planned for. Care planning documents included information on meeting residents healthcare needs such as hearing and eyesight checks and also provided clear direction to staff as to how residents daily care needs are to be met. Although the plans did not include dates for eye sight tests the Registered Manager confirmed that the optician monitors this and informs the home when residents are due for an eye test. The Registered Manager added that the optician specialise in working with people with dementia and use equipment that reduces the need for responses to complex questions. Care plans included information on visits from district nurses and GPs and there was evidence that regular reviews of the plans takes place. The plans are written in a person centred way and although not all were signed to indicate residents or relatives were involved in compiling them, one relative spoken Care Homes for Older People Page 12 of 26 Evidence: with confirmed they were involved in the care planning process. The plans included information on preferred terms of address and some information on hobbies and leisure interests. Throughout the inspection staff were noted to treat residents with care and respect and it was evident that good working relationships had been developed. Comments from relatives included: they are fantastic, I am extremely happy with mum being here. Risk assessments had been carried out and they clearly identified the hazards and included sufficient detail for the management of risks. Not all risk assessments had been reviewed but the Care Manager explained that she is in the process of re writing all care plans in order to ensure they are more comprehensive. Currently some information such as that related to bowel function and activities are recorded separately and the Care Manager explained that she intends to ensure that in future all information is held in the care plans. Daily notes were variable, with some giving good insight to how an individual spent their day and others more limited with comments such as slept well or she enjoyed her meals today. This was discussed with both the Registered Manager and the Care Manager who said they were in the process of finding a happy medium in respect of daily notes especially as the staff hand overs included good details on each resident in the home. Night notes showed that individuals were enabled to get up at night and sit in the communal areas and were given drinks and snacks as requested. Through direct observation and discussion, it is clear that staff are aware of the care needs of those living in the home and of how to ensure their privacy and dignity is protected. Medication records and storage arrangements were viewed and systems are effective. Medication administration charts were up to date, accurate and clear. Medication is stored in a locked cabinet to ensure unauthorised persons cannot access it. Only staff who have been trained, administer medication and this was confirmed by staff training records. Care plans did not include the triggers for those who are prescribed medication as required but the Care Manager explained that currently all residents could easily communicate a need for pain relief. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place for residents to experience an excellent lifestyle that matches their expectations, choice and preferences in respect of both leisure and meals. Evidence: The home has a wide range of activities both during the morning and afternoons. These activities included outings, walks, arts and crafts, sing-a-longs and visiting entertainers. Discussion with the Registered Provider found that she has been advertising for activity providers and is inviting each to the home to determine which ones residents most enjoy. In addition to the day to day activities, the home provides regular get togethers for Barbecues and parties. These include celebrations for Easter, Saints days, Valentines Day, Halloween and Christmas. During December there are almost daily activities in the run up to Christmas to make decorations, cards etc. A mobile clothes shop regularly visits the home and there are outings to the theatre and local attractions. Discussion with the Registered Provider and Managers found that residents are encouraged to do some gardening and other jobs such as sweeping paths to ensure they have the opportunity to maintain self esteem. It was evident that routines are flexible as at the start of the inspection some Care Homes for Older People Page 14 of 26 Evidence: residents were dressed and finished their breakfasts while others were still eating their breakfast. One resident was noted to be given breakfast at 10.45 and one relative said their mother is always served breakfast in bed at her request. Visitors are welcome at all reasonable times and each relative spoken with on the day were clearly happy to chat to staff and the management team. One relative said they were always offered refreshments and made to feel welcome. Two relatives had come to take residents out and it was clear that residents were delighted with the visits and looked forward to the shopping trips. Menus were viewed and demonstrated that meals were nutritious and well balanced. It was good to note that for those who needed pureed foods were pureed separately and the meal was presented in a way to enable the resident to easily see each component. There is a dessert trolley with several desserts available for residents to choose from and the Registered Provider confirmed they are able to have more than one dessert. Staff were seen to offer second helpings for both the main meal and the desserts. Where staff assisted residents to eat they followed good practice by engaging with the resident and talking to them. Two residents said they enjoyed the meals and relatives spoken with said meals always looked good. Discussion with the chef found he was aware of the importance of the presentation of meals. He was equally knowledgeable about both fortifying meals and the needs of diabetics and said he is working on additional ways of ensuring diabetics can enjoy all the meals served in the home, including desserts. All cakes are home made and it was clear that residents very much enjoyed the cakes with their afternoon tea. There was clear evidence that residents are treated as individuals with one area of the garden reserved for those residents who like to smoke. Throughout the site visit it was clear that residents are encouraged and enabled to spend their day in a manner of their choosing. Where bedrooms were shared it was not clear whether or not it was from the residents choice. Following the site visit the Registered Manager provided a newly created document for future use which clearly outlines whether or not a room is shared by choice and that when a single room becomes vacant residents have the choice of moving into those rooms. 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 a satisfactory complaints procedure with evidence people are listened to and acted upon and residents are further protected by satisfactory adult protection systems. Evidence: The complaints log was viewed and the home has had three complaints in the last twelve months but only one was in respect of care. This complaint was investigated and found to be unsubstantiated and one the day it was evident that this complaint was not valid. The two other complaints were, in essence, neighbour disputes as they were in respect of an overhanging tree and residents feeding seagulls. It was good to note that these issues were still dealt with in lines with the homes complaints procedures. There is a staff training programme to ensure all staff are trained in Safeguarding Adults and information in the AQAA demonstrated that any incidents which may come under the Safeguarding Adults procedures are handle in line with good practice. The Registered Manager and one of the deputies has received training in the Mental Capacity Act and the issues surrounding Deprivation of Liberty Safeguards. The Registered Manager confirmed that all residents have been assessed in recent months to ensure none are subject to Deprivation of Liberty. 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. The standard of decor within the home is good, and all areas are homely, safe and comfortable for residents. Evidence: Fourteen bedroom were inspected, in addition to three communal bathrooms, three communal toilets and the dining room and lounge areas. The conservatory was viewed and the rear gardens. The home maintains a rolling programme of maintenance and renewal ensuring all areas remain pleasant and safe for residents. Residents bedrooms were well maintained and pleasingly decorated and it was evident that residents are able to bring in their own possessions in order to personalise their bedrooms. Only one room was malodorous and later the housekeeper explained that it was due to a resident disposing of an incontinence product inappropriately. While communal bathrooms were adequate the Registered Manager outlined plans for the refurbishment of three bathrooms which will include changing one to a wet room and ensuring integral hoists are fitted where possible. Currently all parts of the downstairs communal areas are to be painted as part of the refurbishment programme. There is a garden to the rear of the property which is well stocked with a variety of plants, flowers and shrubs. Various garden ornaments have been installed and there is a goldfish pond, all of which provide areas of interest for residents and topics of conversation. Care Homes for Older People Page 17 of 26 Evidence: Not all bedrooms included a bedside or over bed light and this was discussed with both the Care Manager and Registered Manager who said that in the past bedside lamps have been broken, putting residents at risk. They agreed to review the provision of lamps, perhaps using touch type ones so that should residents wake at night they can easily switch it on and reduce the risk of falls during the night hours. Following the site visit the Registered Manager provided evidence that lamps had been purchased and would be placed in rooms within a risk assessed framework. Similarly one shared rooms was found to have heavy and difficult to move screens and again following the site visit the Registered Manager provided evidence that lightweight screens had been ordered for all shared rooms. The laundry was found to be in good order with impermeable flooring and machines that wash at temperatures that reduce the risk of cross infection. All staff are trained in infection control and no one was seen to be wearing glove and aprons in communal areas which suggests good practice is followed. It was good to note that the home provides hand gel and requests that all visitors use it on arrival and before leaving the home. 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. There are sufficient staff with the skills and knowledge to provide consistent care to those living in the home and recruitment practices are robust and offer further protection to those living in the home. Evidence: Information in the AQAA indicated that there are sufficient care staff on duty with the skills to meet the needs of those living in the home. Currently there are sixteen care staff of which twelve either have or are working towards achieving at least National Vocational Qualification in care at level 2 therefore the home exceeds the required level of 50 of staff with this qualification. An additional four care are due to be employed subject to satisfactory Criminal Bureau Record checks. There are five care staff on duty during the morning shift, in addition to the Care Manager, Registered Manager and a deputy manager. In addition to care staff there is a maintenance person, domestics, cooks and laundry staff. The home organises staff into teams consisting of maintenance, housingkeeping, management and staff teams, each with a clearly defined role but a duty to report anything that may affect the welfare of residents. During the afternoon there is four care staff in addition to the other staff who are on duty in the mornings. At night there are two care staff and one duty manager all of whom are waking staff. The home has a policy of ensuring all staff have a turn at each shift which ensures they are aware of residents needs over a 24 Care Homes for Older People Page 19 of 26 Evidence: hour period. The cook is knowledgeable about the individual dietary needs of those living in the home and ensures that meals remain of good quality and a kitchen assistant is also employed. The home has developed a detailed staff employment contract which clearly states start date is subject to receipt of Criminal Bureau Records checks and that the employee must inform their employer if they acquire a criminal conviction during employment. Recruitment records for two members of staff were viewed and it was found that all staff had provided the required information prior to appointment including two written references, employment history and Criminal Records Bureau and Protection of Vulnerable Adults first check. A staff training matrix is in the process of being developed to provide a clear check on the need for both mandatory training and updates as required. The matrix supplied on the day indicated that there were shortfalls but individual personnel records showed that staff do have regular training and the Care Manager confirmed the matrix needs more work to accurately reflect staff training. There are three staff handovers each day and when residents are discussed photos are used to ensure all staff know which resident is being discussed. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living in the home benefit from excellent leadership and direction and all aspects of their health, safety and welfare are protected and promoted. Evidence: The Registered Manager has just completed the Registered Managers Award and National Vocational Qualification in care at level 4, which ensures he has the required qualification in addition to his long term experience of the care industry. The Care Manager who is responsible for the day to day care of residents also has these qualifications and is experienced in managing care services. The management team consists of theRegistered Provider, Registered Manager, Care Manager, an Assistant Manager and four deputy managers. The home holds monies for all residents and the money is held in a separate residents account which is administered by the secretary. Information in the AQAA stated that detailed accounting records and receipts for all residents transactions are held in the finance department in the home. Individual payments are verified and authorised by the external accountant. The Care Manager said that any interest accrued is left in the account and good practice suggests that Care Homes for Older People Page 21 of 26 Evidence: the home discuss this with residents and their representatives to ensure they are happy with this policy. There is a suggestion box in the hallway to enable visitors, relatives and residents to make suggestions anonymously if they wish, although relatives spoken with said they are happy to raise any concerns with the Registered Manager. One relative said that his mother did not like the mattress on her bed and within 12 hours of mentioning it to the Manager it had been changed. There is an extensive quality monitoring process with particular emphasis on consulting with staff, relatives and residents. In addition to the daily staff handover period, staff meetings are held four times a year as are resident meetings and relatives surveys. There is a weekly management meeting and records are maintained for staff handovers and for deputy handover sessions. The minutes of the staff, management and residents meetings were viewed and it was evident that the meetings are used to ensure all stakeholders are consulted and their views taken into account and acted upon. The Care Manager collates the results of the surveys. Of the twenty-two returned surveys all responses were positive and only three raised issues related to a particular resident. Where issues have been raised the Care Manager writes to the individual with a solution when this is possible. The home provided copies of comments from relatives that included comments such as: - Grateful thanks to Autumn Lodge for all their kindness and care. - We would like to express our utmost thanks and gratitude for the kindness and care shown to my mother. - the family are very grateful for all the care and attention given to (name) whilst in Autumn Lodge. The home has accountants who ensure financial arrangements are satisfactory and in consultation with the Registered Provider and Registered Manager ensures adequate funding is available for the refurbishment programme. The Registered Manager maintains the monthly cash flow accounts which ensures financial commitments can be met in the short term. The staff training programme ensures they are trained manual handling, infection control, fire safety, dementia care, food hygiene and first aid. Information in the AQAA indicated that safety checks are carried out on all electrical and gas systems and appliances and that they are serviced annually. In addition documents relating to safe working practices and Health and Safety are available and regularly reviewed. Accident records were viewed and it was found that they are appropriately maintained in accordance with health and safety guidance. The Care Manager said she regularly reviews these records in order identify potential hazards and as part of the quality monitoring system. The AQAA also indicated that appropriate fire safety assessments have been carried out. The home also provides regular staff training to ensure that they have a working knowledge of what to do in the event of fire. Fire alarm checks are carried out weekly by the maintenance staff. Care Homes for Older People Page 22 of 26 Evidence: Fire drills are carried out regularly and feedback from the drills used to improve procedures where necessary. All aspects of the service were discussed with the Registered Manager and the Care Manager, both of whom responded positively to any comments and it was evident that they are actively working towards improving all aspects of the service. Care Homes for Older People Page 23 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 24 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 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 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!