Care Home: Barty House Nursing Home

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What the care home does well The service provides good documentation for enquirers and new residents, and the staff are very good at welcoming people and providing them with the required information. Care plans are implemented with input from the resident or their representative, and are very detailed. They demonstrate exellent ongoing standards of nursing and personal care. Survey comments included: "the home provides very good individual care and friendship; I am happy, contented and comfortable"; and "the staff are absolutely excellent; the home does everything well"; and "the staff are always very friendly and caring." The home has developed a good range of activities, enabling residents to take part in the things they are interested in. Entertainment is brought into the home on a regular basis, and there is the opportunity to take part in outings. The manager said that the company provide the home with a very generous budget for carrying out activities. The chef provides a varied and nutritious diet, and enables residents to take part in shaping the menus. The complaints log shows that any concerns raised are taken seriously, and are dealt with appropriately by the manager. The home is kept clean in all areas, which is a credit to the domestic staff during a time of ongoing building work and refurbishment. Several surveys include comments such as " the home is clean, friendly and has nice rooms and surroundings. Hygiene standards are excellent". The home has a good staff team, led by a caring and effective manager. Other surveys stated " there is a very friendly atmosphere, and a well managed and stable task force"; and "my relative was only in for respite care, but we were both treated exceptionally well and we would not hesitate to recommend it". What has improved since the last inspection? Since the last inspection, the building of a new extension has been completed, and it is now up and running. The decor and furnishings are of a high standard. A previously built wing has been refurbished, and the original building is in the process of refurbishment. This is nearly finished now. The home will provide the opportunity for residents to choose between rooms in an older Georgian building, and a new purpose built extension. The new extension includes communal lounges and bathrooms; and a new kitchen and laundry room. Residents and relatives have been kept informed of the progress of the building work and the refurbishment. The manager has been in post for a year, and has developed updated policies and procedures. She has also arranged for increased staff training, and an increase in activities for residents. What the care home could do better: The service users` guide could be produced in larger print, so as to enable residents with poor sight to view it more easily. The clinical room may be too small to store all of the medication effectively when the rooms are all occupied, and this will need to be kept under review. We noted that one of the medication storage cupboards did not include a lock; and that medication trolleys were not attached to the wall. The manager said that immediate action would be taken to address these matters, and we are confident that this will be done. Therefore a requirement has not been given. Key inspection report Care homes for older people Name: Address: Barty House Nursing Home Roundwell Bearsted Maidstone Kent ME14 4NH     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: Susan Hall     Date: 0 7 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: Barty House Nursing Home Roundwell Bearsted Maidstone Kent ME14 4NH 01622737025 01622737725 bartyhouse@bmlhealthcare.co.uk www.bartyhouse.co.uk Barty House Nursing Home Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jacqueline Butler Type of registration: Number of places registered: care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 59 The registered person may provide the following category/ies of service only: Care home with nursing - (N) 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 (OP). Date of last inspection Brief description of the care home Barty House consists of an original detached Georgian building, with two additional extensions. The second of these has just been completed, and the original building is being refurbished. All areas provides high quality accommodation on three floors. There are four passenger lifts providing easy access to all areas. The home provides nursing and personal care for up to 59 older people. The home is set in extensive Care Homes for Older People Page 4 of 27 Over 65 59 0 Brief description of the care home grounds, and is situated in the village of Bearsted, which is approximately four miles from Maidstone. It is easy to reach via the M20 motorway, and the A20; and there are good links with public transport. The current fees range from £580.07 to £995.00 per week, and are arranged according to the individual needs of each resident. Clear guidance is given to show the items which are not included in the fees, such as hairdressing and chiropody. 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: 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 home is assessed as having a rating of Excellent, 3 stars This was a key inspection, which includes assessing all of the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. The manager did not receive a request for an AQAA prior to this inspection, but will be asked to complete one within the next few months. The previous one was completed satisfactorily. We (i.e. CQC) sent out survey forms prior to the inspection visit, and received nine Care Homes for Older People Page 6 of 27 replies from residents; two had been assisted by relatives in completing these. All of the surveys contained positive comments, and demonstrated that residents feel confident that the home is a caring and friendly place, and that they can easily share any concerns and know that these will be addressed. The visit was carried out by one inspector, commencing at 09:30; and lasted for over six hours. The manager was present throughout the day, and was very helpful in providing documentation, and informing us about the development of the building work. We viewed all areas of the home, and talked with four residents and seven staff during the day. We inspected a variety of documentation, including a sample of care plans, maintenance files, some policies and procedures, staff recruitment and training files, and the complaints log. We also inspected medication storage and administration. 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: The service users guide could be produced in larger print, so as to enable residents Care Homes for Older People Page 8 of 27 with poor sight to view it more easily. The clinical room may be too small to store all of the medication effectively when the rooms are all occupied, and this will need to be kept under review. We noted that one of the medication storage cupboards did not include a lock; and that medication trolleys were not attached to the wall. The manager said that immediate action would be taken to address these matters, and we are confident that this will be done. Therefore a requirement has not been given. 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 9 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 10 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. The home provides suitable information to enable enquirers to make a decision about moving into the home. Evidence: A copy of the statement of purpose and the service users guide are kept in the reception area, so that they are always available for anyone to read. They include all of the required information, and are set out in a format which is easy to read. The statement of purpose includes details of the fees, and shows what is included in these, and what is not (e.g. hairdressing, chiropody, dry cleaning, newspapers). The service users guide includes helpful information for new residents, with explanations about items such as visiting hours, meal times, arrangements for religious beliefs, and the social activities available. All of the rooms in the new build extension have en-suite shower and toilet facilities; private telephone lines; and a flat screen television and DVD player. The old building is in the process of refurbishment, Care Homes for Older People Page 11 of 27 Evidence: and most other rooms will also have all of these facilities; with the exception of some which will not have en-suite toilet and shower. The home has a very friendly atmosphere, and people who wish to see round the home can make a prior appointment, or can just turn up. The receptionist is familiar with the admission processes and is able to assist people with all of the general information. All residents have a pre-admission assessment prior to making arrangements to stay in the home. These include all aspects of the persons physical health needs, lifestyle and preferences. We viewed two pre-admission assessments and saw that they were very well completed. All residents are provided with a contract which include the terms and conditions of residency. After admission, there is a trial period, and a review at the end of this time, to decide if it is appropriate to make the placement permanent. Care Homes for Older People Page 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning reflects good management of health and personal care; and residents feel that they are well cared for. Evidence: Residents, or their allocated representative, are invited to discuss care planning and to take part in ongoing reviews. We viewed three care plan files and found that they contain comprehensive assessments and associated care plans which are reviewed every month, and amended as needed. These cover all aspects of residents health and personal needs, such as mobility, nutrition, medication, continence, personal hygiene, communication and social preferences. Care plans contain specific directions such as whether a resident prefers a bath or a shower; the preferred times for getting up and going to bed; and if they like to join in with group activities or prefer not to. Risk assessments are well completed, and cover the use of bed rails and padded sides if indicated; and risks such as choking; use of hoisting facilities; and risk of falls. Consent for use of bed rails is obtained from the resident where possible, or from their authorised representative. Residents who need Care Homes for Older People Page 13 of 27 Evidence: hoisting have their own individual sling; and other equipment such as pressurerelieving mattresses is used as needed. We viewed the documentation for wound care for three residents. This was excellently completed, with a separate record for each dressing change, and clearly showing the progress of healing for each wound. There is good evidence of input from GPs and other health professionals, such as speech and language therapist, dietician, tissue viability nurse and dentist. The doctor may refer residents to the community physiotherapist; and some residents choose to pay for a local private physiotherapist. Medication is administered using a monitored dosage system, and is stored in a small clinical room. This room may not be sufficiently large enough to store all medication when the home is full, and the manager said that this would be kept under review. Medication was generally in good order, with no over stocking, and no out of date medication found. However, two items were found which did not have labels on them, and these were immediately discarded. The clinical room has recently been set up from a different room, and one of the storage cupboards did not have a lock on it, and we drew this to the attention of the manager. The medication trolleys were locked, but were not chained to the wall. The controlled drugs (CDs) are stored in accordance with legislation, and the CD register is well maintained. The numbers of CDs are checked between two nurses each day, and this is an example of good practice. Medication Administration Records (MAR charts) did not have any signature gaps. Some hand written entries on MAR charts had only one signature, and these must be checked and countersigned by a second nurse. Medication audits are carried out, and the manager said that an audit was due to be carried out. Medication policies are stored in the office, and were seen to be very detailed. We are confident that the issues raised will be speedily addressed, and so a requirement has not been given. Care plans demonstrate a good understanding of maintaining residents privacy and dignity, and this was confirmed by observing interaction between residents and staff, and the manner of staff towards residents. We received very positive comments from residents who completed survey forms, such as: the staff are absolutely excellent. There is nothing they could do better; and the staff are always kind and friendly to everyone. Care plans show that residents and relatives are asked about any specific preferences in regards to death and dying; and the staff strive to meet residents wishes, such as Care Homes for Older People Page 14 of 27 Evidence: staying in the home if they do not wish to have hospital treatment. The nursing staff obtain additional advice from hospice nurses where needed. There could be more evidence in care plans in regards to assessments for people who no longer have all of their mental capacity, and the manager stated that she was already aware of this, and addressing this issue. Care Homes for Older People Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a varied activities programme. There is a good choice of menus, and food is well cooked and presented. Evidence: The home has a very motivated activities co-ordinator who has worked at the home for some time; and a second co-ordinator has just been recruited. This is to ensure that the ongoing programme of activities can be maintained for all residents, now that the number of residents is increasing. There is a monthly programme in place, and this is displayed outside the lounge; in the activities room on the lower ground floor; and in other places around the home. Activities include things such as music and movement, crafts, musical bingo, games and quizzes, and watching films together. The new co-ordinator is initiating coffee mornings, with discussions regarding topical items in the newspapers. The coordinators vary their hours so as to be available for different activities in the evenings and at weekends. Some residents are confined to their own rooms, or prefer to stay in their own rooms, and the co-ordinators will spend time reading with them, carrying out hand massage, or listening to music etc. The manager said that she is given a very generous monthly budget for activities by the providers, and this enables them to Care Homes for Older People Page 16 of 27 Evidence: carry out an increasing range of activities and outings. There is regular entertainment from singers, dancers etc., and there are very good links with the local community. On the day of the visit, residents were looking forward to a visit from the local cubs and brownies in the evening, who were coming to sing carols. Residents are enabled to go out for shopping trips, to local clubs such as the stroke club, and to church. There are monthly church services held in the home, and one resident commented in a survey that they really appreciate this, as they have been unable to go out to church for some time. Residents are encouraged to bring in items to personalise their rooms, and this was evident in some of the rooms that we viewed. Residents state that the food is of good quality, and there is plenty of choice. There are three choices of main course at lunch times, and a variety of dishes at other meals. Residents can have a cooked breakfast if they want it, and snacks are available at any time. Mid-morning coffee is served with biscuits; and there are home made cakes with afternoon tea. Local suppliers are used for the provision of meat and vegetables. The chef and manager discuss menu changes together, and the residents are involved in providing ideas for different dishes. Menu programmes are discussed with a nutritionist prior to implementing them. The kitchen was seen to be clean and in good order. The kitchen premises have been changed and are incorporated into the new building now. The Environmental Health Officer awarded the kitchen four stars at the last visit, and this was for the old kitchen; so the chef is working towards five stars for the next visit. Care Homes for Older People Page 17 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. Residents are confident that any concerns or complaints are taken seriously and will be dealt with effectively. Evidence: The complaints procedure is included in the service users guide and is available in the front entrance hall, so that it is easily available for anyone. It provides the details of the manager and director, and includes timescales for a response, so that complainants will be aware of the processes involved. We viewed the complaints log, which is well maintained, and shows how action is taken to address all issues of concern and complaints. There have been several recent complaints in regards to the newly fitted call bell system. The records show that the the company who fitted this were called back in to alter the system, and improve the way that it works. Residents reported that this is much better now. The manager carries out a monthly complaints audit which is sent to the Head Office. The manager is familiar with safeguarding policies and the procedures for contacting the Social Services Safeguarding team. All staff have training in the protection of vulnerable adults (POVA) at induction, and have yearly updates. There were some gaps on the training matrix, and in response to this the manager said that the training had been delivered, but the matrix was due for updating. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are well maintained, and provide an attractive and homely environment for the residents. Evidence: The home comprises an original Georgian house, with an additional wing added some years ago. A further large new extension has been completed during the past year, and is now in use while the original building is being totally refurbished to the same high standard of decor and furnishings. The new extension has a large lounge on the ground floor, and an attractive conservatory area adjacent to the entrance hall where residents enjoy sitting. There is a large dining room on the lower ground floor, which overlooks the gardens. There is also a large lounge and a separate dining room in the original building, which is currently being refurbished along with all other rooms in this area. The new building has an open courtyard area with raised flower beds, where residents can enjoy sitting out in good weather. Some of the bedrooms have patio doors opening out on to this. There is a decking area leading out from the conservatory. The home is surrounded by gardens. Some areas have been levelled as a result of building work, and are due for landscaping when the internal refurbishment has been completed. This work is nearly completed, and carpets were being laid on the day of Care Homes for Older People Page 19 of 27 Evidence: the inspection visit. All bedrooms in the new build have en-suite toilets and showers; and most bedrooms in the original building will have en-suite facilities as well. Most bedrooms are for single use, but there are shared rooms available for people who may wish to share. All bedrooms have been fitted with telephone lines, and have flat screen televisions with integral DVD players. Residents are encouraged to bring in their own items to personalise their rooms. The home has four shared bathrooms with assisted baths, and four shower rooms; so that residents can choose their preference. We observed plenty of equipment available, such as mobile hoists, pressure-relieving mattresses and cushions, grab rails, and commodes. Most of the beds are electric profiling beds. All residents who need hoisting have their own designated sling for this purpose. There are now four passenger lifts in different parts of the building, and these provide access for wheelchair users to all areas. The new building has under floor heating, and each bedroom has its own thermostat for controlling the temperature according to choice. Radiators in the old building have covers for safety. Maintenance checks are in place for items such as weekly hot water temperature checks, wheelchair checks, and checks for the window restrictors. The laundry room is in the new building on the lower ground floor, and is very well set up with separate entrances for dirty and clean linen; and two commercial sized washing machines and tumble dryers. The staff use a red alginate bag system for dealing with soiled items. There is a designated laundry person on duty each day. The home was seen to be very clean in all areas; and with no offensive smells. 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. The manager ensures that there are suitable numbers of staff on duty in the home. There are good systems in place for recruitment and staff training. Evidence: The manager is ensuring that staffing numbers are being increased for all categories of staff in line with the increased numbers of residents. There are currently two nurses on duty in the day time, and one at night; and there are seven care staff in the day time, and three at night. These numbers will change according to the dependency levels and numbers of residents. Care staff are designated to specific areas, and there are care staff assigned to regularly check the lounge areas. The home has three domestic staff cleaning throughout the week, and currently one at weekends. The manager said that these numbers are also being increased. There is a designated laundry assistant on duty each day. Other staff include a full time chef and additional kitchen staff; a full time maintenance man; a part-time gardener, and a receptionist. The manager is also recruiting a part-time receptionist for weekends. Care staff are encouraged to study for NVQ levels 2 and 3, and there are over fifty per cent trained to this level. Another ten care staff are enrolled to commence NVQ level Care Homes for Older People Page 21 of 27 Evidence: 2, and this will provide a significant increase in staff trained to this level. We viewed three recruitment files, which confirmed that there are good recruitment procedures in place. These include POVA and CRB (Criminal Record Bureau) checks, a full employment history, proof of identity, two written references, a medical questionnaire and an interview record. Applicants provide confirmation of any relevant training; and nurses PIN numbers are checked. All staff have a detailed induction programme, which includes all mandatory training such as health and safety, moving and handling, and infection control. The induction also includes training in policies such as whistle-blowing and maintaining confidentiality. New staff are provided with a job description, a staff hand book, and a contract, which includes the terms and conditions of employment. Additional training is provided to enable staff to develop their skills and knowledge. Training in the next year will include an understanding of the Mental Capacity Act 2005, and Deprivation of Liberty. 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 home is run by a competent and efficient manager. Evidence: The manager has been in post for one year, and is a trained nurse and is suitably experienced. The company directors meet together with the home managers (i.e. from all the company homes) every three months. The manager said that the directors are very approachable. There are auditing systems in place to ensure that the Head Office is kept up to date with changes in the home and any events which take place. Regulation 26 monthly monitoring visits are reliably carried out each month by a senior manager. The manager said that the directors provide a good budget for the home, and are very generous in enabling her to purchase items which will enhance the home. Staff and residents said that the manager is friendly and approachable, and this was evident on the day of the inspection visit. She provides a good lead to staff in directing the progress of the home. There are monthly staff meetings when all staff are able to Care Homes for Older People Page 23 of 27 Evidence: express their views and ideas. Residents and relatives meetings are held three times per year; and questionnaires are distributed at least yearly. The results from these are collated and made available for people to view. Residents are encouraged to express their ideas and concerns on a daily basis; and all residents have a named nurse and two keyworkers, so that they can get to know these staff more easily. There are no residents monies stored in the home. Each resident has a lockable facility available in their room; and residents who are unable to manage their finances any longer have an authorised representative. The home provides monthly invoices for additional costs such as hairdressing and newspapers. All staff have one to one formal supervision sessions on a regular basis, providing the opportunity to raise any concerns and discuss training needs. We viewed some of the policies and procedures, and found them to be very comprehensive. They are reviewed yearly. Maintenance files contain confirmation of servicing and routine maintenance checks. We viewed a sample of these and found that all checks viewed were up to date. The night staff have a cleaning rota in place for wheelchairs to ensure that they are all cleaned each week. Accidents are appropriately recorded and filed; and accident audits are carried out each month to determine if there are any patterns which can be prevented. 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. 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