Care Home: Barrowhill Hall

What the care home does well People have an active life with opportunity for leisure activities and to keep in touch with their families and friends. The service is good at involving other professionals to support them in monitoring how people develop and change, so they can continually meet all their health and emotional needs. Positive comments were received from two separate visiting health care professionals during our visit. The home now produces good plans of care offering information on daily routines, choices, likes, dislikes and preferences. This shows the service looks at every individual independently to ensure their lifestyle requirements are met. Medication and finances are well managed meaning people who use the service are suitably protected. The staff are suitably trained, this means they have the knowledge and skills to meet the needs of the people who live at Barrowhill Hall. What has improved since the last inspection? The home has met the 14 requirements made at the last inspection in February 2008. This shows they are committed to improve the outcomes for people who use the service. The home now manages the storage and administration of medications well. This means people who use the service can be confident their medications are kept and provided as required. The homes training programme offers all the required courses, this means the staff are suitably equipped to meet people`s needs. Plans of care have improved greatly and offer staff the information needed to meet individual`s needs. The malodour noted in communal rooms has gone, this means people who use the service live in a fresher environment. People who use the service are now offered all the necessary information in the Statement Of Purpose and Service User Guide. This means they are able to make informed choices. Daily entries are recorded on the morning, afternoon and night shifts offering accountability and a clear audit trail. Staff tell us they now feel they work well as a team and are clear on their roles and responsibilities. This means morale has improved at Barrowhill Hall. What the care home could do better: There should be better evidence to confirm the home is considering peoples best interests. This means when people lack capacity there is an assessment undertaken to show decisions have been made consulting professionals and families to act in the person`s best interests. Staff files should contain a photograph to meet with regulation. Information in plans of care can still improve, some `this is my life` details are incomplete. Information within the home could be more accessible to visitors with a notice board. This could offer clear information on how to comment on the service, advocacy, activities, so people who use the service and their families can be more involved in decision making if they so choose. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Barrowhill Hall Barrowhill Rocester Near Uttoxeter Staffordshire ST14 5BX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Davis     Date: 1 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Barrowhill Hall Barrowhill Rocester Near Uttoxeter Staffordshire ST14 5BX 01889591006 01889591431 home@bhch.eclipse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Staffordshire Property Investment Fund Ltd. Name of registered manager (if applicable) Nada Ana Evans Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia physical disability Additional conditions: 10 MD - minimum age 45 years on admission 41 DE - minimum age 45 years on admission 5 PD - minimum age 45 years on admission Date of last inspection Brief description of the care home Barrowhill Hall is registered to meet the needs of 45 adults with dementia or mental health related conditions, it may also support 5 people who have a physical disability. Barrowhill Hall can also offer day care to a small number of people. Care Homes for Older People Page 4 of 29 care home 45 Over 65 45 10 5 45 10 5 Brief description of the care home The home is a detached property situated in an elevated position on the outskirts of Rocester, near Uttoxeter. The accommodation is in two buildings, one known as the main house, which is two storeys and served by a lift and staircase, in this part of the home there is a spacious main lounge with a separate dining area. Further accommodation known as The Stables is an extention to the main building on ground floor level only. This area has 13 single occupancy bedrooms, all with en-suite facilities. There is a separate lounge and dining room area attached to this part of the home. Mrs Nada Evans is the registered manager for this service. The previous inspection for this service was undertaken on 11.02.08. The fees for this service range from £298.00 - £550.00, this information was accurate on 10.02.09 Care Homes for Older People Page 5 of 29 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 inspection took place over 1 day and was unannounced, this means the people who use the service and the staff did not know we were coming. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, national minimum standards of practice and focuses on aspects of service provision that may need further development. A quality rating is provided throughout the report based on each outcome area for the Care Homes for Older People Page 6 of 29 people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. Before visiting the home on this inspection, survey information was completed and returned to us by people who use the service and the staff. The service also has to complete an annual quality assurance assessment to tell us how they meet the needs of the people who use, or may use the service. This focuses on what they do well, how they evidence this and any areas in need of improvement. We looked around the home to make sure that it is warm, clean and comfortable. We looked to see whether people who use the service are being protected and the arrangements the service has for listening to what people think about Barrowhill Hall. When we are there we focus on a small number of people who use the service which involves discovering individual experiences of living at the home by meeting them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. This helps us to understand the experiences of people who use the service. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 29 There should be better evidence to confirm the home is considering peoples best interests. This means when people lack capacity there is an assessment undertaken to show decisions have been made consulting professionals and families to act in the persons best interests. Staff files should contain a photograph to meet with regulation. Information in plans of care can still improve, some this is my life details are incomplete. Information within the home could be more accessible to visitors with a notice board. This could offer clear information on how to comment on the service, advocacy, activities, so people who use the service and their families can be more involved in decision making if they so choose. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 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. Individuals are given clear information about the home to help them decide if they wish to live there. People are fully assessed prior to moving into the home, this helps to ensure their needs are met. Evidence: The Statement Of Purpose and a Service User Guide have been reviewed since the last inspection and contain all the necessary information. On the day of the inspection further amendments were made to include information on the smoking arrangements and also telling people who use the service the guides are available in different formats, for example audio, alternative language, easy read. People living in the home are assessed by the manager or a senior member of staff from the home prior to moving in. The manager said she visits each person in their Care Homes for Older People Page 11 of 29 Evidence: own home or in hospital to carry out these assessments. This helps to ensure peoples individual needs can be met. Paperwork available and discussion with the manager told us that a full assessment before admission to the home is taken seriously. Areas such as health care needs and social needs are considered along with the individuals ability to fit in with the current group of people living at the home. Copies of these assessments are available on the plans of care, some could have contained further information but overall they were satisfactory. Visiting professionals including the District Nurse and Community Psychiatric Nurse told us, the home meets the needs of the people well. In the AQAA, to demonstrate what the home does well, the manager states that: We provide an accurate, comprehensive, and up to date Service Users Guide, presented in an attractive and presentable format. We undertake a comprehensive pre-admission needs assessment, towards ensuring that the Home is right for the potential Service User, and they are right for the Home. We encourage any potential Service User to undertake a Trial Visit. These visits are encouraged to be without advance notice. We provide Day Care facilities, which provides for a Trial period for any potential Service User. It also says that they will; continue to develop and improve the pre-admission procedures by involving all care staff. Standard 6 is not applicable to this home as it does not provide intermediate care. Care Homes for Older People Page 12 of 29 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. Support is planned and provided in a respectful and sensitive manner. There is good regard for the diverse needs of the people using the service however information could be expanded upon to fully support people in living their lives in the way they so choose. The policies, procedures and practices in place ensure the safe administration of medication. Evidence: The home has a team of staff who can demonstrate knowledge of each individuals needs, abilities and preferences in how they wish their care to be delivered. On the day of this visit people who use the service were seen to be choosing what they did and where they went within the home. Staff were helpful and offered assistance where needed or requested. It was also observed that staff had a good rapport with Care Homes for Older People Page 13 of 29 Evidence: people that were not able to communicate their wishes verbally, where they indicated that they wanted assistance, this was quickly understood by the staff and the assistance provided. Staff said there had been great improvements since the last inspection and were confident they were providing good care. In discussions and in staff questionnaires the following comments were made, We ensure peoples quality of life is respected at all times ensuring their privacy, dignity and choices are always given and met. It is a joy to come to work there have been great improvements. We have a really good structure in place now. All people I have worked with on the night shift are professional, very understanding and helpful. Care plans are in place for each person living at the service and these follow a clear format. Essential information such as religion, ethnic origin, next of kin and doctor details are recorded. There is some information about peoples preferred daily routine, activities, likes and dislikes which is a great improvement from the last inspection. The staff have all received training in care planning and told us they had found it very useful. Plans of care have This is my life booklets within them, these give information about their family , previous employement , hobbies and interests and offer a flavour of the individual. These are person centred, this means thay look at people individually and offer specific information. We saw one that has been completed which included photographs and gave a real insight into the individual. Two plans of care seen contained empty booklets and a staff questionnaire revealed I was suprised to find very few of the care plans had this is my life sections filled in so getting to know previous lives is difficult. We recommend these are completed for all people who use the service. Plans of care also need to provide evidence with regard to the Mental Capacity Act 2005. Decision record sheets should be in place and people should be assessed by the General Practitioner when they lack capacity. We recommend the home offers a checklist and a decision record. Assessments need to confirm advocates are involved and Independent Mental Capacity Act ( IMCA) advocates have also been included Care Homes for Older People Page 14 of 29 Evidence: where necessary. People were seen to make decisions in the home, such as what they wanted for breakfast and where they sat and from discussions they said they made choices about what to do in their spare time. All documents are up-to-date to reflect current care needs (except where more detail is required as mentioned earlier) and have been signed by staff and the person using the service. Risk assessments are in place to accompany care plans and have also been signed and kept up-to-date. Again, these are much improved and offer staff clear information on how to manage the risk. People living at the home are making use of community health care facilities, such as doctors, dentists, opticians and the community psychiatrist nurse. Routine health checks are being undertaken and the district nurse visits regularly. They said, staff do communicate well , they contact us appropriately and overall I think there have been improvements. Medication is being managed using a monitored dose system whereby the pharmacist pre-packs tablets into blister packs. The medication cabinet is secure and kept locked when not in use. A medication fridge is in place and the temperature is maintained. The medication policy and procedures are available to provide guidance to staff, these have all been updated since the last inspection and again are much improved. We have asked the home to offer better information about people who self medicate. Presently it is not always clear , for example, one persons medication administration record read self administers but staff do support this person. We have asked for records to offer information on how to manage individual situations, for example, as and when required medication. This should evidence the person is aware of the medication and how, when and why they would ask for it, or administer it, and if they have the capacity. We checked the controlled drugs register and this tallied with the medication presently in stock. The service has not mentioned anything about medication or the management of such within their Annual Quality Assurance Assessment ( AQAA), we feel this needs to be included to help support and evidence that the service manages this area Care Homes for Older People Page 15 of 29 Evidence: appropriately. Care Homes for Older People Page 16 of 29 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 people who live at Barrowhill Hall can be confident their social needs are met and they are supported to maintain relationships with friends and family. Evidence: The staff in the home encourage and support people to join in the range of activities provided. People who use the service are also supported to maintain links in the local community. The activities coordinator works 30 hours a week and said she was, actively encouraged to use community transport and support people to visit local friendship groups and activities arranged at the village hall. She also told us she really enjoyed her role and likes working with each person to find out what they enjoyed, she also told us that she recognised some of the people were happy to observe and not participate. One person who uses the service told us that they take pleasure in the activities and another person told us that they enjoy playing pool. Care Homes for Older People Page 17 of 29 Evidence: Activities in the home include arts and crafts, sing a longs, armchair exercises, dominoes, quizzes, pool, air hockey, bingo and parties. The staff on duty confirmed that they are able to spend one to one time with people who are not always able to join in group activities. Weekend and evening entertainment is also offered on occasion, for example Burns night included a haggis tea and bagpipes. The people living in the home are encouraged to plan these events and decorate the lounge and dining room according to the occasion. Buffet teas and parties are provided for birthdays and live entertainment is offered on a regular basis, these include singers and local groups. The meals are served in the dining room, which is part of the open plan lounge. The tables are laid with table-clothes and place mats. It is bright, cheerful and homely. The mid-day meal was pork casserole or liver and all the people seen in the dining room enjoyed their meal. Two people told us that the food was lovely and that they always had enough to eat. We did not inspect the kitchen on this visit, the service has a four star rating from Environmental Health and needs to replace one extractor. Staff spoke highly of the cook who is an agency worker, they said meals were presented beautifully and this was seen on the day. Meals are served individually to the people who use the service and choice is offered. The activities coordinator has begun to produce a book offering visual support for people. It covers five a day ( fruit and vegetables), soft diets , what is available at tea time , vegetarian options and choices. We recommend visual support is offered on the menu board covering the meals of the day to further support people with complex needs. It would be useful if the home had a notice board where information could be readily available covering activities, meals, pictorial support, advocacy, questionnaires on how to improve the service etc. Care Homes for Older People Page 18 of 29 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 suitable complaints procedure and ensures the people who use the service are protected from abuse in accordance with written policies. Evidence: The Annual Quality Assurance Assessment tells us: We have looked at and clarified the wording in the Whistle blowing Policy stressing the need for immediate action. All staff have been provided with a copy of the Act and updated policy of the home. We have introduced a new complaints form and encourage staff to fill them in when appropriate. These forms are easily available to all staff at all times. We have broadened the Preparation for Appraisal (Supervision) forms to cover Customer Care and abuse and adapt the questions to reflect new subjects. We can verify these improvements have been incorporated into the homes procedures. This means there are better procedures in place meaning better outcomes for the people who use the service. We have not received and formal complaints about the home since the last inspection. The manager advised us in the AQAA there have been ten since the last inspection. The manager was able to evidence complaints made to the home have been logged Care Homes for Older People Page 19 of 29 Evidence: and dealt with. All offer information on how the outcome was reached. The complaints procedure is available in the Service User Guide and it is also sited in the hall. Questionnaires returned to us evidenced knowledge of the homes complaints procedure. Comments, compliments, a grumble or concerns are now recorded; it is recommended the home should provide a comments book or suggestion box in the hall. The manager is happy to promote the recording of complaints in a transparent manner. On the day of the inspection the home produced a leaflet saying, Concerned about anything, something you would like to change, anything youre not happy with? Let us know. We hope these will be promoted and available to the people who use the service and visitors. From the records available on the day of inspection it was clear that the staff are trained to recognise the signs and symptoms of adult abuse, this training is mandatory. One vulnerable adult referral has been made since the last inspection, it was dealt with appropriately and is now concluded. As a result of this a recommendation from the safeguarding meeting was made to ensure a timescale was offered in the homes Whisleblowing policy, and this has been included. This means staff are clear on how important it is to pass over information quickly. We consider peoples legal rights are protected by the systems in place in the home to safeguard them. These include their contract; the continual assessment and review in care planning, the policies in place, for example, the complaints procedure and Whistleblowing policy. Care Homes for Older People Page 20 of 29 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. People live in a safe, secure and homely environment. Evidence: Barrowhill Hall is a large is a two-storey property that is in a satisfactory state of repair. The home has a refurbishment plan and the manager told us people who use the service are actively involved in how areas of the home are utilized and managed. Since the last inspection the flat roof has been repaired and new carpets are in the hall and lounge, we are told there is an ongoing refurbishment programme. Last year we made a requirement because there was a strong malodour in the home, this has reduced significantly. We asked visitors to the home if they felt this was a concern. They too had noted an improvement. One questionnaire returned did say: The chairs they sit on for dinner need to be cleaned more. And someone said they thought the home was fresh and clean sometimes. People need support to leave the home but community involvement is actively Care Homes for Older People Page 21 of 29 Evidence: encouraged. Where possible people have a key to their own room. It was pleasing to note the craft work in the home and a selection of collages and pictured have been displayed. The home meets with infection control standards, staff were seen wearing gloves and aprons, paper towels and liquid soap is in all bathrooms and toilets, the kitchen is managed effectively and there is suitable safe storage for cleaning products. We have asked the manager to ensure they have adequate information with regard to smoking areas and any decisions made, this should be clearly reflected within the homes statement of purpose and service user guide. This information was completed on the day we visited but needs to be reflected in the copies provided to people who use the service and or their significant others. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are suitably recruited to make sure people who use the service are protected. The staff are trained to meet peoples needs, this means they have the knowledge and skills to support people who live at Barrowhill Hall. Evidence: Staff are suitably recruited to make sure people who use the service are protected. The staff are trained to meet peoples needs, this means they have the knowledge and skills to meet the needs of the people who live at Barrowhill Hall. We looked at two staff files and can confirm the recruitment of staff is safe and protects the people using the service. This includes two written references, criminal records bureau checks, application forms that cover gaps in employment history and the required identification certificates, health declaration. We reminded the manager that photographs of staff are required on files also. Male staff are recruited to the home, which promotes equality and choice. During the time we spent at Barrowhill Hall we spoke to a number of staff and observed them supporting people. We found there were positive and engaging interactions between those people living at Barrowhill Hall and the staff members. Care Homes for Older People Page 23 of 29 Evidence: Staff reported, We have structure now. We work well as a team We have better communication Training has improved. All staff receive relevant training that is focused on delivering improved outcomes for the people who use the service. One questionnaire did reveal that training was usually on Wednesdays and this was inconvenient for them. They said there is no flexibility with this. Staff report they are supported to meet the individual needs of people who use the service. To further this, the home will offer staff training in equality and diversity and the Mental Capacity Act 2005. We checked to see if staff were being appropriately supervised and supported, records and discussions with staff confirmed this to be so. Care Homes for Older People Page 24 of 29 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 service is now run in the best interests of the people who use it. Evidence: The Annual Quality Assurance Assessment, this is a mandatory document completed by all services prior to their inspection contained clear, relevant information, but it could be supported by a wider range of evidence. We discussed its content and ways to improve the AQAA with the manager during our visit. People who use the service and staff felt the manager Nada is: Very helpful Firm but fair Approachable Care Homes for Older People Page 25 of 29 Evidence: Nada will put her hands to the deck when needed. Communication between staff, people who use the service and outside professionals works well. Records such as daily diaries, key worker entries and reviews are up to date and in good order, which shows that the well being of people using the service is being monitored and improvements are being made as needed. The service has improved considerably in the last year. They have met all requirements made which covered medication management, care practices, care planning and record keeping. This means people who use the service now receive good care. This was further demonstrated and confirmed by the staff team, visiting professionals and the manager. The AQAA says, we have improved by: We have developed the pre admission assessment process by involving Senior carers and carers. We have reviewed our training, towards implementing improvements in caring for the dying, and bereavement, and dealing with challenging behaviour. We have arranged more outings, and have encouraged more families to engage with our social and fund raising events. We have increased our levels of supervision and training. The public areas have been re-decorated, and the carpet changed. The Activities Room has been re-vamped to provide a more relaxing and flexible environment. The newly recruited staff have been more experienced and are better suited to their roles. We have developed the audit and quality assurance procedures, thereby developing and improving our services to the service users. Finances were checked on this inspection to make sure peoples money was kept safely and suitably recorded. Each person has a wallet kept in the office for safekeeping. Records are being maintained of expenditure, with receipts kept to verify spending. Money is kept secure and a check of one wallet showed the balance tallied with their records. From the evidence gathered we are now satisfied this service offers good outcomes for the people who use this service. Care Homes for Older People Page 26 of 29 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 27 of 29 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 1 7 Information within the plans of care should offer more detail on past history and decision making. This means staff have all the information necessary to fully support people in living their lives in the way they so choose. Records of daily activities for each person should be more detailed and describe the activity and their participation. The home should consider a notice board where all useful information can be available. This will mean people know where to find important literature. Staff files should have a photograph to meet with Regulation. The manager could add further evidence into the annual quality assurance assessment to show how they promote the health, safety and well-being of the people who use the service. This will help to support their information. 2 3 12 19 4 5 27 31 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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