Care Home: Avery Lodge

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What the care home does well The people live in very comfortable, modern, well maintained and clean accommodation. People are able to make their rooms more homely with their own personal belongings if they wish. Each person is encouraged and supported to be independent and take part in meaningful activities. They are also offered choices about what they wish to do and to make decisions about how they spend their lives. Staff communicate well with them and respect their choices and decisions. People living in the home are cared for and supported by a caring, educated and committed team of staff. There is a programme of education and training provided for staff, which ensures that staff know how to care and support the people who live at the home. Visitors are made welcome and kept well informed. This is a well managed service, which has systems in place to check on the overall quality of the care and accommodation provided to ensure good standards are maintained and improved. What has improved since the last inspection? Although this was the first key inspection visit since it was registered they have trained their staff to provide person focused care. Detailed care records are written and maintained. This has lead to care being individual and person focused. They have developed a varied activity programme to suit the needs of the people living in the home. They have introduced staff, resident`s and relatives meetings. The home was awarded 5 stars `excellent` by South Kesteven District Council in recognition of the catering service provided. What the care home could do better: Where improvements are required they are provided either by Avery Healthcare, the manager or staff. There is a well established quality assurance system in place and where improvements are required they are addressed by the service. Key inspection report Care homes for older people Name: Address: Avery Lodge 37 Beacon Lane Grantham Lincs NG31 9DN     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: Tobias Payne     Date: 0 3 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 27 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 27 Information about the care home Name of care home: Address: Avery Lodge 37 Beacon Lane Grantham Lincs NG31 9DN Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Caroline Greaves Type of registration: Number of places registered: care home 65 Avery Homes Grantham Ltd averycare@btinternet.com Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of people who can be accommodated is 65. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender:- either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE, Physical Disability Code PD Date of last inspection Brief description of the care home Avery Lodge Care Home is a 3 storey purpose built building providing a bright, modern, spacious environment. The ground floor is Balmoral but was not occupied on the day of our inspection visit. The first floor is Kensington and second floor Care Homes for Older People Page 4 of 27 Over 65 0 65 0 65 0 65 Brief description of the care home Sandringham. The home is approximately half a mile from the town centre on a prominent site in its own grounds laid to lawn with gardens. The home offers personal care for older people and people with dementia for long and short stays, respite and convalescent care. Car parking is provided at the front of the home. All bedrooms have en-suite showers. There are 6 lounges, 3 dining rooms, 5 assisted bathrooms and quiet areas as well as a hairdressing salon. There are 2 shaft lifts which serve accommodation on the first and second floors. The fees at the time of our inspection visit on the 3/12/2009 ranged from £438 to £550 each week. Additional charges were for hairdressing which ranged from £7 to £30 and chiropody £10, personal newspapers and magazines. Information about the home including the statement of purpose and service users guide can be made available at request from the manager. This information can be made available in large print and languages other than English on request. Care Homes for Older People Page 5 of 27 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 the first key inspection visit since it was registered on the 10/6/2009. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. At this inspection we used 2 inspectors and reviewed all the information we had about the home and made an unannounced inspection visit to the home which lasted for 5 hours. The manager was present throughout the inspection visit and was given feedback at the end of the inspection. The main method of inspection used was called case tracking which involved selecting 3 people and tracking the care they receive through the checking of their records, discussion with them, the staff and observation of how the staff and people living in the home related to one another and the care practises in the home. We looked at a sample of care records and policies and procedures as well as staff records and walked around the home to see the quality of Care Homes for Older People Page 6 of 27 accommodation and visited some of the bedrooms with the permission of the people living in the home. We spoke with 10 people living in the home, 3 visitors, a visiting community nurse visiting pharmacist as well as 4 members of staff. An (AQAA) Annual Quality Assurance Assessment was completed by the manager and sent to us before our inspection. This is a self assessment document completed by the manager of the care home. It sets out evidence from the provider to demonstrate that they are meeting the Care Home Regulations. It was very well completed with comprehensive information about the home. As part of this inspection we used a short observational focused inspection as part of our inspection process. This helps us to understand the experiences of people who are unable to tell us themselves and who are most likely to have the greatest care needs. It allows us to get an insight into the general state of well-being of individuals and staff interaction with people who use the service during the observation. We spent from between 10.15 am to 12.15 pm in the sitting room with the very vulnerable people who live in the home, to see what life is like in the home. We made notes every five minutes on their state of being (mood), their interaction with their surroundings and other people including staff interaction with the people who live there. We made notes every five minutes of what we observed. The details and outcome of this are included in the main body of this report. Before this inspection we sent out surveys to the people living in the home and staff but at the time of producing this report we have received no response. However there was nothing arising from this inspection visit to show that the needs of the people were not being met. Where the use of we or us has been used throughout this report it refers to the Care Quality Commission. Care Homes for Older People Page 7 of 27 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 27 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 27 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. Good and clear information is provided to people to enable them make an informed choice of where to live. They are assessed before they come to the home which ensures that individual needs can be met within the home. Evidence: At the reception area to the home was information about the home, other important leaflets, a service users guide and a statement of purpose. All information in these documents was clear and detailed and up to date. The manager told us that where a referral was made she visited each person and made a thorough assessment of their needs involving the person and any other person involved in their care and support. This could include a visit to the home to meet the people living in the home and the staff. Once a person agreed to stay, written confirmation was sent to them to confirm that based on the assessment the home could meet their needs. Through case tracking we looked at records for 2 people who had recently been admitted to the home. We could see that a detailed pre admission assessment had taken place and Care Homes for Older People Page 10 of 27 Evidence: that the person had received a letter confirming the home could meet their needs. We also spoke to the 2 people who confirmed this and told us I was visited by the manager before I came here and she gave me information about the home and answered my questions, when I arrived I received a very warm welcome and have settled in the home and am very satisfied with everything. The service does not currently offer intermediate care. Care Homes for Older People Page 11 of 27 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 health and social care needs of the people are being met in a safe and dignified manner. Medication was safely given by staff who knew what they were doing. Evidence: Each person had detailed care records outlining their care and support. Each included a photograph of the person, details of their assessment at the time the person moved into the home, care plan, moving and handling and risk assessment. In addition, there was information about the person including their life history, communication needs, personal hygiene, nutritional assessment using a nationally recognised tool daily and evaluation reports. The manager told us that she was in the process of introducing a mental capacity assessment to ensure the peoples rights and choices were protected. We looked at 3 care plans and saw that the amount of information had clear instructions about how staff could meet the needs of the person. The care plan outlined each person my typical day for each aspect of care with likes, dislikes, what I can do myself, what I need help with together with goals and outcomes of the care plan. Each entry was dated with a signature of both the key worker and where ever possible the person receiving the care and support or their advocate. As part of the Care Homes for Older People Page 12 of 27 Evidence: very comprehensive quality assurance procedures monthly reviews took place of each persons nutrition, weight, moving and handling and risk as well as how the care records were written. In addition each person had a review of their care at least every 6 months involving them and other people connected with their care and support. Again evaluations and reviews were clear and entries were signed and dated. We spoke with a visiting community nurse who was positive about the home and comments included, at the beginning there were a few communication problems but whenever I visit now, I find staff receive me in a very welcoming manner and know about the needs of each person and introduce me to the person. They do this in a professional manner. People we spoke with were all very positive about the way staff attended to their needs. Comments included, I cannot fault the staff, I always find them kind and considerate and they are always very polite and respectful. Throughout our visit we saw staff being polite and courteous and helped people in a calm, kind, sensitive and unhurried manner. We heard and saw staff greeting visitors and laughing and talking with the people living in the home. During the two hour observation we saw that people were not agitated and their mood was positive, we did not observe any signs of ill-being and saw the people became very animated and jolly when the staff entered the room and interacted with them. We observed the staff continually prompting and encouraging people to drink. We observed staff interaction with the people which was very kind, sensitive and comforting. One person was given a rag doll to hold and spent the time chatting and smiling at the doll. The person became very animated when given the doll and was very pleased to show it to us. Although we saw books on a shelf and a photograph album with photos of recent social activities, the people mainly sat in their chairs and had nothing to occupy them. Music was playing softly in the background and at times people were seen napping for periods of time. We observed a care worker inappropriately lifting a person from their arm chair, however the senior carer entered the room and immediately pointed out that this was not appropriate and guided the carer through the manoeuvre. Where required, people living in the home were referred to local doctors, Community Nurse, Community Psychiatric Nurse, Tissue Viability Nurse, Continence Nurse, Speech and Language Therapists, Physiotherapist, Opticians, Dentist, Chiropodist and other Care Homes for Older People Page 13 of 27 Evidence: specialists. The manager told us that senior care staff gave out medication. There was a policy and procedure for this and each person was assessed before they were considered safe to administer medication. The manager told us that the people were encouraged by the staff team to self medicate and on the day of our inspection visit one person took responsibility for this. Each person had a locked drawer in their room. Other people needed a degree of assistance in order to ensure they took their medication safely. They received regular pharmacy inspections the last being on the 26/8/2009 which had some concerns about gaps in recording on the medication record sheets and they were not recording the minimum and maximum temperatures on the drugs fridge. As a result the manager took immediate action to address this. We spoke to the same pharmacist who was also making a visit to the home on the day of our inspection visit. She confirmed all had been acted upon and she was very satisfied with the medication arrangements in the home. As part of Averys quality assurance medication was to be audited during the year. Care Homes for Older People Page 14 of 27 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. Social activities are varied and provide stimulation and interest for people living in the home. People enjoy varied and nutritious meals. Evidence: On admission to the home details were obtained about each persons interests and life history and this information was contained in their care records. There was a written activities programme and newsletter available and displayed on notice boards throughout the home. There were 2 staff employed to provide activities. The manager told us that activities are reviewed taking into account the views of the people living in the home. We saw a copy of the December leisure and recreation programme. The home has a trolley shop several times a week. In addition there were exercises, library books, as well as talking books and puzzles, entertainment visits with a range of songs, dancing and singing. There had been a Christmas decoration making competition, Christmas Fayre and a future Christmas shopping trip. Church services were also provided in the home. The manager told us future plans were to include a knitting club, book club, shoe shining, watercolour classes, baking, pampering and floor games. As the weather improves they want to further develop the garden. The activities for the week of our inspection visit included bowling, movement to music, Bingo, cooking, manicures, games including dominoes as well as hairdressing and on Care Homes for Older People Page 15 of 27 Evidence: the day of our inspection visit a church service. Comments from the people included, there are enough activities going on which I like and I like to keep myself to myself which suits me and the staff understand my wishes. The people living in the home were offered 3 main meals a day plus snacks. South Kesteven District Council awarded the home 5 stars (excellent) on the 17/7/2009 following an inspection, in recognition of the catering service provided. Meals were served in the dining rooms or in their bedrooms on a tray. The menus which were displayed at the entrance to the home and at the entrance to the dining rooms showed us that there was a varied menu with fresh fruit and vegetables. The dining tables had clean table cloths, table mats and table decorations. Food was served from a hot trolley from the servery off from each dining room which contained catering equipment to provide drinks and snacks to suit their needs. We saw staff assisting those people who needed assistance in a dignified, unhurried, calm and sensitive manner sitting by the side of them. All the people we spoke with were complimentary about the food. Comments included, I like the food as it suits my needs, there is always a variety of fruit which I like and it is always served well and I look forward to my meals. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected from abuse by robust and safe recruitment procedures. Visitors are made to feel welcome and involved. Evidence: Each person received a copy of the complaints procedure in the service users guide and this was also in the statement of purpose. During our visit none of the people living in the home, visitors or the staff had any complaints about the home and felt they could discuss any concerns with staff or the manager. Staff also knew what to do if they received a complaint from a person living in the home. Information provided for us before this visit also confirmed that there were policies and procedures in place to follow in order to safeguard the people living in the home. Information supplied by the manager showed that they had received 4 complaints since the home was registered. Each one was investigated using their complaints procedure. We could see that very clear records had been kept which showed all had been thoroughly investigated. The service had an up to date copy of Lincolnshire County Councils Adult Protection Policy and all staff received regular training. We spoke with 4 staff who confirmed that had received this training, knew what abuse was and they showed knowledge about their role and what they would do if abuse was suspected. Care Homes for Older People Page 17 of 27 Evidence: We have received since we registered the home no complaints or safeguarding adults issues. We spoke with 3 visitors during our visit. Comments were very positive and included, I can visit whenever I wish to do so and everyone is very kind, I cant fault anything, the staff are very caring and friendly, Mum is very happy here and If I any worries I can discuss them with the staff. Care Homes for Older People Page 18 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean, very comfortable, safe and well maintained accommodation. The infection control policy is followed and a safe environment is maintained. Evidence: The home was newly built and decorated throughout to a very high standards. The environment was excellent, the dementia unit had been well designed with thought going into the use of plain, calm colour schemes and the use of signs on doors to identify the rooms (although the signs were quite small) and handrails painted in bolder colours for identity. The home also has a loop system for people who are hard of hearing and a call bell system is in place where pressure mats can be connected. We saw throughout our visit housekeeping staff cleaning all areas of the home thoroughly and showing pride in their work. People we spoke with told us they were very satisfied with the decoration and cleanliness of the home. They also spoke of how they liked their bedrooms. People told us, I like my room, my room is beautiful and very comfortable, they look after my clothes very well, the lounges are beautiful and its quite like a hotel, its very grand and we are well looked after. We saw people sitting in the lounges talking to one another, visitors or reading. Some of the people were in their bedrooms reading or watching television. There were grab rails, raised toilet seats and bathrooms and all toilets were Care Homes for Older People Page 19 of 27 Evidence: wheelchair accessible. Corridors were wide accessible for wheelchairs and had hand rails. There were equipment provided to basins and baths to prevent the people from scalding themselves. There were mobile hoists with a variety of slings and other moving and handling equipment. There were various special bath hoists to assist people when bathing. The manager told us that staff had been trained to use the equipment safely. The gardens which could be accessed from the ground and first floors were colourful, stimulating and well maintained. All footpaths were clear from hazards and garden seating was available for the people to use so they could sit outside in warmer weather. Communal areas were spacious with sufficient space for those people who use wheelchairs to move around freely. Care Homes for Older People Page 20 of 27 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 is a safely recruited, well-trained, supported staff team available who have the skills to meet the varying needs of the people living in the home. Evidence: People we spoke with did not express any worries about the level or availability of staff. During our inspection visit we saw staff attended to the needs of the people promptly and in a calm and friendly manner. Throughout our visit people we spoke with felt the home was adequately staffed with staff who were experienced and competent to care for the people living in the home. All the comments were very positive. The people we spoke with told us I love living here, everyone is so kind, friendly and helpful, if I need anything they go out of their way to help. We examined the files for 2 new members of staff. Records were clear and included a check by the Criminal Records Bureau (CRB). When new staff started work at the home they received a supported nationally recognised induction programme during which time they learnt about the policies and procedures of the home and how to provide the necessary care and support to the people living in the home. Staff are encouraged and supported to obtain training in care to National Vocational Qualification standards. The manager told us that 80 of staff had either achieved or were studying for an NVQ level 2. Training over the last year had included fire Care Homes for Older People Page 21 of 27 Evidence: prevention, first aid, food hygiene, infection control, safeguarding adults, dementia awareness, moving and handling, health and safety, customer service and communication, safe handling of medicines and nutrition. We spoke with 4 members of staff who told us, there is a lot of training provided, I enjoy what I do, I have learnt so much which has given me confidence to develop my skills and we work very well as team. Care Homes for Older People Page 22 of 27 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 people and staff benefit from the positive leadership of the management team. Evidence: We registered a new manager in June 2009. This person is a registered nurse with considerable nursing and managerial experience. She also had a management qualification and was studying for a dementia qualification. People living in the home, visitors and staff we spoke with told us they had a good relationship with the management team and felt they were open and supportive. People and visitors we spoke with echoed these views. Comments from people living in the home included, I cant fault them, I am very satisfied, the home is perfect in every way, it is a smashing place to live and I am pleased I came to live here. Staff comments included, I like working here, we all work well together and It is a very friendly place to work and we have good support from the management. Avery Healthcare had comprehensive quality assurance procedures known as Care Homes for Older People Page 23 of 27 Evidence: Optimise. This places the person living in the home at the centre of all quality initiatives. Optimise looks at quality of life, quality of care, quality of management and quality of the environment. There is a 6 monthly internal audit and a self audit by the manager. The last audit was on the 5/11/2009 and the home scored 81.8 . Where there were any issues there was an action plan. Each month an audit takes place which focuses on one item. We saw this will cover, medicines, health and safety, person centred care, food, infection control, care practises and the environment. The service also carried out a survey to obtain the views of the people living in the home in September 2009. The survey covered admission, surroundings, hotel service, courtesy, daily routine, care, catering, activities, recommendations and any complements or suggestions. Eighteen replies were received. Most of the comments were very positive. We saw that where a person had any specific views then each person had a personal response by the manager. There were also regular resident meetings as well as staff meetings. We could see that Avery Health care were committed to involving people in the running of the home and the manager was in the process of establishing Avery Resident Involvement and Experience Strategy (ARIES) which will involve a resident, a relative, staff member and manager meeting regularly. The aim being to give a voice to the people living in the home and encouraging active resident participation. The manager told us she was in the process of establishing a support group and the first meeting was to take place on the 10/12/2009. Avery also made unannounced monthly monitoring visits to the home and produced reports for each visit which we looked at during our visit and found no concerns. We found very clear records were being kept throughout our visit which were available and up to date. The manager also told us staff received supervision every 2 months. There were a range of policies and procedures which were regularly reviewed and updated. Information was in place, which was easily available for staff to refer to covering aspects such as residents personal care, health and safety matters. Records were in place demonstrating that risks have been assessed relating both to individuals and the environment in order that action can be taken to minimise them. There were comprehensive health and safety policies, which also included detailed and up to date risk assessments and a fire risk assessment. There were regular tests of the fire system as well as regular fire drills and monthly monitoring of hot water temperatures. There were also infection control policies and alcohol hand washes throughout the home and at the entrance to further prevent any infection. Records we looked at showed that equipment was regularly checked and serviced and there were systems to monitor any maintenance issues. Care Homes for Older People Page 24 of 27 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 25 of 27 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 26 of 27 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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