Care Home: Bay House

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What the care home does well A thorough assessment procedure is followed before anyone is considered for admission to the home, and any prospective resident is given clear information on the home and the facilities it provides. The care and support is tailored to individual preferences and needs, with a focus on person centred care, and is delivered to a high standard, with in put from community health care professionals, as necessary. Residents benefit from a proactive approach to ensuring residents have the opportunity to enjoy some form of leisure activity, either in or outside of the home. The atmosphere in the home is relaxed, and an open and approachable management structure promotes this environment, with staff saying they feel well supported and valued. The recruitment practice followed by the home is thorough, and ensures suitable staff are employed to meet the varying needs of the residents living at Bay House. Information gathered through the quality monitoring systems and any concerns raised is used to improve the service. Ensuring the home is continuously developing and striving for a better service. The management arrangements are well established, providing a clear leadership and direction for the home. What has improved since the last inspection? The last key inspection identified a number shortfalls and five requirements were made. The homes management responded positively to these matters, and has addressed all areas identified. The admission process now ensures that prospective residents are advised in writing, if the home is suitable to meet their individual assessed needs. The care documentation has been greatly improved with a focus on people as individuals, and take into account resident`s preferences and capabilities. Whenever possible the resident is consulted, and this is recorded within the care documentation. The complaints procedure has been entirely overhauled, and now ensures all concerns are appropriately recorded. The recruitment practice is now robust, and ensures only those suitable are employed in the home. Records held within the home evidenced that the staff training is well established and demonstrated staff are appropriately trained. The management has also continued to develop all other aspects in the home working toward providing an excellent service and facilities. The refurbishment programme has nearly been completed, and the service has worked hard on promoting a service that responds to the individual, and is resident focused rather than service focused. What the care home could do better: No requirements have been made following this inspection and the manager has undertaken to address some shortfalls, recorded within the body of this report. The AQAA recorded that the home will continue to strive for better results. `In particular we will focus on more detail surrounding the conditions our users have and further tailor the care they receive, to make it more personal and individualised`. Key inspection report Care homes for older people Name: Address: Bay House 2-3 Middlesex Road Bexhill-on-Sea East Sussex TN40 1LP     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: Melanie Freeman     Date: 1 9 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Bay House 2-3 Middlesex Road Bexhill-on-Sea East Sussex TN40 1LP 01424210202 01424210202 enquiries@bayhousecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr N Manji care home 36 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 36. The registered person may provide the following category/ies of service only: Care home only Nursing - (N) to service users of the following gender: Either Whose primary care needs on damission to the hoem are within the following categories: Old age, not falling within any other category - (OP) Date of last inspection Brief description of the care home Bay House is a converted Victorian property that was formerly a Guest House. It is situated in a quiet residential area of Bexhill close to the seafront, town centre and mainline railway station. Bay House Nursing Home is registered to provide general nursing care to older people, and is owned by Mr N Manji who was registered, by the CSCI as an individual on 7th August 2006. The home is registered to accommodate thirty-six residents. The home has undergone major refurbishment and now provides thirty four single bedrooms and one double Care Homes for Older People Page 4 of 27 Over 65 36 0 2 8 0 8 2 0 0 8 Brief description of the care home bedroom. Some bedrooms have en suite facilities, with additional toilet and bathroom facilities throughout the premises. There is a new passenger lift that serves each of the three floors. The home has specialist equipment including specialist beds, bath and lifting hoists and walking aids. There is a well maintained garden to the rear of the property that is accessible to residents. Unrestricted parking is available on the road on which the home is situated. Potential residents can obtain information relating to the home via the internet, CQC Inspection Reports, Care Managers, Placing Authorities, by word of mouth and by contacting the home direct. The range of fees charged at the time of this inspection report range from £650 depending on the individual care needs, with additional charges made for hairdressing, newspapers/magazines, transport 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: 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: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Bay House Nursing Home will be referred to as residents. This was a key inspection that included an unannounced visit to the home on Wednesday 19 August 2009, and follow up contact with a visiting health and social care professionals. The allocated inspector spent approximately five hours in the home, and was able to discuss matters with Mrs Claire Avery the registered manager, who received the inspection feedback, at the conclusion of the visit. All the communal areas were seen along with most of the residents rooms. A range of documentation was reviewed including the homes service users guide, pre-admission assessment procedures, the systems in place for handling complaints and protecting Care Homes for Older People Page 6 of 27 residents from harm, staff recruitment files, staff training records, quality assurance systems and some health and safety records. The care documentation pertaining to two residents were reviewed in depth and the inspector was able to eat a mid day meal with a group of residents, in the communal dining room. The required Annual Quality Assurance Assessment (AQAA) was very well completed by the registered manager returned when requested, and was used to inform this inspection report. At the time of compiling the report, in support of the visit, the Care Quality Commission received survey forms about the service from five staff members, and seven residents some of which, had been supported in completing these by a family member. 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: No requirements have been made following this inspection and the manager has undertaken to address some shortfalls, recorded within the body of this report. The AQAA recorded that the home will continue to strive for better results. In particular we will focus on more detail surrounding the conditions our users have and Care Homes for Older People Page 8 of 27 further tailor the care they receive, to make it more personal and individualised. 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. Prospective residents receive good information on the home to enable them to make an informed decision over whether the home is the right place for them. The admission procedure allows for the needs of prospective residents to be assessed by a competent person, before admission. Evidence: The statement of purpose and service users guide was displayed in the front reception area. These documents were professionally presented, informative and are provided to prospective residents, following their initial enquiry. The reception area provides a range of information and some where to sit, to read or discuss the home. A small brochure was also available that gave key information on the home that can be taken away by any visitor. Prospective residents are invited to visit the home to meet the staff, view the facilities, and to have a meal with other residents if they would like. Feedback from surveys indicated that people received appropriate information about Care Homes for Older People Page 11 of 27 Evidence: the home before any admission was progressed. An assessment of the admission process included a review of the documentation used in respect of the last two admissions to the home. This confirmed that a robust assessment process is followed to ensure people are only admitted if their needs can be met. The assessments are completed by either the manager or head of care, who are accompanied by a member of the care team. They take into account information from other agencies and family members, who are involved in the individuals care, and the facilities and skills of staff working in the home. Once the assessment is completed the home confirms in writing to the prospective resident/representative, enclosing a copy of the needs assessment which was carried out, stating whether the home is able to meet their needs. Although intermediate care is not provided Bay House offers respite care, and staff work with residents to ensure their stay is a good experience, with their independence promoted. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Plans of care set out residents individual care needs and are reviewed and updated regularly. Health care needs are supported by community professionals as necessary. The homes practice ensure residents medicines are administered and stored safely. Care is delivered in such a way that promotes and protects the residents privacy, dignity and individuality. Evidence: Two individual plans of care and related care documentation were reviewed in depth as part of the inspection process, these confirmed that residents are assessed before and following admission. The care documentation was found to include extensive plans of care that were individual and covered the physical, psychological and social care needs of residents. The plans of care are reviewed and updated regularly and there was evidence that the resident is involved in this process whenever possible. If not, or a representative is included in the process. Specific care needs are recorded and expanded on to give staff clear guidance on what care and support is required. Care Homes for Older People Page 13 of 27 Evidence: Daily records are maintained and these are meaningful and recorded the involvement of other community health care professionals. Nutritional screening, moving and handling and pressure area risk assessments are used routinely, other risk assessments are used as needed. Base line observations are completed regularly to monitor changing health needs. The care documentation was comprehensive, and supported an individual approach to care that was seen to be delivered in practice. All feedback about the care and support provided was positive, with the delivery of a high quality nursing care being a priority for the home. Comments received included My husband is very well cared for staff are always ready to help in anything that is neededThey never seem to give up on anyone. My mother was extremely poorly recently, but with their help the seems to have had a new lease of life!. The nurse are wonderful as are all the staff. Direct observation and a review of the medicine records held in the home confirmed that all medicines are handled in a safe way, with residents receiving their prescribed medicines from a registered nurse. It was however noted that some gaps were evident in the Medicine Administration Record (MAR) and the manager was aware of this, and had implemented regular audits to pick up on these quickly, so that they can be addressed. As a matter of good practice it was recommended that any medicine prescribed on an as required basis is done so in accordance with individual guidelines. Staff were seen to have a friendly and respectful relationship with all residents, who they interacted with as equal adults. Many of the staff have worked in the home for some time providing a stability, and allowing for caring relationships to evolve. Residents rooms were seen as their own space, with staff only entering with permission. Rooms seen were attractive and personalised. 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. Links with friends, relatives and the community are encouraged and choices made are respected. Residents benefit from regular entertainment and leisure activity that meets their individual preferences and expectations. The meals are varied and suit individual needs and preferences. Evidence: The home has an experienced leisure co-ordinator who works every day and has an excellent rapport with residents. Residents benefit from a family activity approach that takes into account residents abilities and lifestyles. The AQAA reflects that residents are treated individually with an acknowledgment that everyone is different. Any activities and entertainment are tailored to the residents, taking in to account different likes and preferences. Profiles are used to build a picture of each person and how they used to spend their time when more independent, and recognising current expectations and desires. The records seen confirmed that the social activity in the home is focused on what is appropriate and enjoyed by each resident. Some prefer group and social interaction by participating in games or competitions. Some choose to have one to one time playing a game of chess or being read to, and some residents enjoy being taken out to the Care Homes for Older People Page 15 of 27 Evidence: seafront for ice cream, or visiting the library or doing some gardening. Some residents benefit from the community resources like lunch clubs, and are helped to attend local clubs and performances. Observation and discussion with residents demonstrated that they benefit from regular engagement with staff, and some form of entertainment or leisure. Residents said how much they enjoyed the recent events in the home that have included an Elvis evening, and a Bar-Be-Que. The relationship observed between staff and residents was productive kind and appropriate, residents knew the staff well and one staff member who had finished work took a resident shopping. Contact with family and friend is actively encouraged and is seen as important part of residents life. The AQAA confirmed a true commitment to encouraging regular contact with visitors, and involving them in the different aspects of the home including social events. During the inspection visit it was noted that two visitors stayed for a meal, and a new visitor who had just turned up on chance that she had come to the right home, was warmly received. A meal was eaten by the inspector with a group of residents in the communal dining room. This included a soup starter and a choice of main meal and a choice of dessert. The menus in the home provide choice and a good variety, with residents specific needs being provided for. The chef has regular individual contact with residents that ensures individual needs and preferences are responded to. Residents are also given a choice to have an alcoholic drink to accompany the meal. All feed back about the food reflected a high satisfaction with the provision. The tables were well set up with condiments and linen table clothes and the dining experience for residents was a good social event. Residents were able to use serviettes or a clothes protector depending on their personal choice. 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. Residents benefit from an open culture where they are able to express their views, and are confident that any complaint made would be listened to, and responded to appropriately. The homes management and information in the home ensures that any Safeguarding Vulnerable Adult issue would be responded to appropriately when identified. Evidence: The home has a clear complaints procedure and a copy of this is available within the service users guide and displayed on the wall in the reception area. The management are keen to gain residents and their representatives views, and blank complaint forms are available in the reception area along with a suggestion box. Records held in the home demonstrated that all complaints are responded to appropriately and pro-actively, with all concerns being recorded. Any formal complaint is responded to in writing in accordance with the complaints procedure. All records are kept confidentially and provide information on how the service can be improved. The AQAA records that the complaints procedure gives staff confidence in the handling of complaints in an effective way. Staff training with regard to safe guarding issues is given a high priority. Training is provided in house by the manager who is a qualified and accredited trainer. The AQAA Care Homes for Older People Page 17 of 27 Evidence: confirmed that this training is tailored specifically to meet the needs of the residents, and the programmes consist of in-depth discussions about types of abuse and incorporate role playing exercises, to enhance the impact on how serious this topic should be treated. The manager has an in depth knowledge of abuse matters, having raised alerts in the past and worked with social services in planned investigations. Although the home has a comprehensive Safeguarding Vulnerable Adults procedure that identifies different types of abuse, it did not clearly record the correct reporting procedures following a suspicion or allegation of abuse. The home does however have the relevant local policies and procedures, and now need to update their own procedure to reflect these. The manager agreed to progress this matter. Staff recruitment files confirmed that staff have a Protection of Vulnerable Adults (POVA) check completed along with a Criminal Records Bureau check (CRB). 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. Residents benefit from the comfortable, clean, well equipped, accessible and homely environment provided at Bay House. Evidence: Bay House is a converted premises that has undergone major refurbishment over the past three years. That has included an extension to provide single accommodation with en suite facilities, and a large communal room. It now provides a very attractive environment where the needs of people who require nursing and have poor mobility can be met. A new lift has been installed and this can accommodate a resident in a wheelchair and care staff attendant. The garden area has been landscaped with disabled access and an attractive pergola where residents can sit and enjoy the garden, and fresh air. Residents staff and relatives were very positive about the environmental improvements, and how this is improving the home for everyone. A written comment included A lot of money is being spent to make residents patients lives more interesting ie opening up the garden terrace. The only area that still needs to be upgraded is the laundry, and the manager assured that this is planned for completion at the end of September 2009. Once competed this will provide a laundry facility that promotes high standards of laundering and infection control. Care Homes for Older People Page 19 of 27 Evidence: The home was found to be clean and fresh throughout, and staff were seen to be adhering to good infection control practice with the use of appropriate protective clothing as required. Suitable hand washing facilities were evident throughout the home. Discussion and observation in the home confirmed that residents staff and relatives are consulted about the planned changes, and alterations are made in response to their views. For example one resident had blinds instead of curtains, and the parking spaces at the front of the property are reserved for visitors to the home only, ensuring easy access. Residents rooms are attractive and seen as peoples individual personal space. All rooms are now for single occupancy apart from one ground floor room. The home has a good sized communal room and the bathing facilities are well adapted. The manager is particularly aware of the mobility problems for residents, and there is a good provision of mobile hoists, some rooms have also been fitted with over head hoists. Each floor has a sluice room and two of these have an electrical disinfector. Although these rooms are small, practice followed promotes the suitable cleaning of bedpans and urinals. The home also has guidelines for staff to follow with regard to infection control. 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. Staffing numbers and skill mix provides a competent and well-motivated staff team that meets residents health and personal care needs. Staff training is well structured and ensures staff have the appropriate skills to care for all residents safely. Residents are protected by the recruitment practice followed. Evidence: At the time of this inspection visit 29 residents were living in the home and the level of dependency was mixed, with some residents receiving a high level of nursing care. A duty rota is maintained and confirmed that staffing levels are maintained throughout the week, with a registered nurse being on duty 24 hours a day. Six care staff work in addition in the morning with four carers in the afternoon, and two cares at night. The manager is not included in the caring hours and the head of care also has some management time during the week. At weekends one of the management team work in the home for part of the day to deal with any management issue, and to support the staff working. This was not reflected on the duty rota and was recommended to the manager. Observation and discussion with residents indicated that staff were available when needed, and were able to provide the support and care required. Staff surveys did Care Homes for Older People Page 21 of 27 Evidence: however raised the request for further staffing. This was discussed with the manager who said that staffing arrangements are constantly under review, and an increase in staffing is being considered, but this would be completed with specific care needs being taken into account. All feedback about the staff was very positive comments recorded with resident surveys included The staff are so caring and helpful and make my mother very happy I cannot praise them enough But the main thing is the is the good nature of the staff My husband is very well cared for staff are always ready to help in anything that is needed. Feedback from staff within surveys and directly on the day of the inspection recorded that they felt well supported by the management, and are well trained to do their job. One senior staff commented on how the home dealt positively with diversity and equality issues, with residents and staff. The staff training matrix retained in the home confirmed mandatory training was in place and that additional training is provided in accordance with the varying needs of residents. The manager confirmed that individual training files are in place for each staff member, and these are discussed with staff at the regular supervision sessions. There is a good team spirit within the staff team who work well together and said that they looked out for each other. The recruitment files pertaining to two staff were reviewed as part of the inspection process and these demonstrated that robust recruitment procedure is followed. They included an application form, health checks, terms and conditions of employment, evidence of two references and the individual identity and the required Criminal Records Bureau (CRB) and POVA checks on all staff. Staff selection is also based on ensuring a suitable person that will provide a caring approach to care. Once recruited staff are closely monitored and provided with a starter pack, which includes information on the homes code of conduct and an induction training schedule. Following the first formal supervision usually after 4 to 6 weeks, staff start the skills for care common induction programme. The AQAA recorded that the home intends to ensure 75 of staff have completed an National Vocational Qualification in Care at level 2 or above by next year. 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 management arrangements provide clear leadership and an appropriate management structure. Systems for monitoring the quality of the service takes into account residents views. Residents finances interests are safeguarded. The health, safety and welfare of residents and staff are generally promoted and protected. Evidence: The registered manager is a fully qualified and experienced registered nurse. She holds a relevant Registered Managers Award qualification and has begun her Degree Certificate in Management Studies course. Direct observation and contact with staff and residents in the home confirmed that she works closely with staff on a day to day basis, and has a good rapport with them, and the residents. She has developed an atmosphere of openness and respect and makes time so that everyone feels that they are being listened to, and valued. There is a clear management structure in the home that has been strengthened since the last key inspection by the appointment of a head of care. Care Homes for Older People Page 23 of 27 Evidence: The registered manager holds the position of general manager and working with her are four departmental heads namely, the head of care, catering manager, head of housekeeping and facilities manager. These departmental managers have their own areas of concern and report directly to the registered manager. The manager has good working relationship with the registered provider who also has a hands on approach and takes an active role in developing the service. All feedback about the homes management was very positive with both residents and staff commenting on the approachable staff and relaxed atmosphere in the home. Comments included Bay house makes everyone feel welcome-family as well as patients and gives a real feel of caring the home is very well run all round. The AQAA was very well completed and was used by the manager as an audit tool. The home has also established further good quality monitoring systems, including the use of questionnaires completed by residents and other interested parties. The contents of these have been audited and reported on. This report is displayed in the front reception area and it was clear that it was being used to improve the services at Bay House. The management team are all also involved in completing full audits of the services and facilities, that are used to inform an annual action plan for the home. The home dose not hold any monies for residents and valuables are only held temporarily. The home has a safe facility to do this, and the manager confirmed that receipts are used for this process. Health and safety checks are maintained and records were seen that confirm this. It was however noted that records for the environmental risk assessments did not record each room or window safety. This was raised with the manager and head of facilities, they said that more thorough risk assessments would be recorded as a priority. A fire risk assessments had been completed by an outside agency. The AQAA recorded that all relevant safety checks have been completed and ongoing health and safety measures have been adopted by the home. 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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