Care Home: Beech Lawn Residential Home

What the care home does well Residents are cared for by well-trained staff, whose care and concern is appreciated by residents. One told us `they listen, show care towards us all`. Staff records confirmed they receive a range of training, which provides them with the skills and experience to meet the individual needs of the people using the service. Care plans confirmed that people are supported to access their general practitioner (GP) and other local health services relevant to them which specifically meet their individual health needs and general well being. What has improved since the last inspection? The information available to prospective residents, and those who come to live in the home, has been written in a clearer style, and issued to all residents. Copies have been placed in their rooms. Care plans are being regularly reviewed to ensure that residents` needs are met. They record choices made by them about how they spend their time, and how they wish their personal care to be carried out. A new system for obtaining the views of residents about the running of the home has been introduced. This involves an annual questionnaire, residents` meetings, and an invitation to relatives to join a forum. What the care home could do better: Fire doors must not be held open, as this reduces the safety of residents. The home should ensure that it updates the dependency review on a regular basis, as this indicates the level of staffing required to meet residents` needs. The use of the conservatory should be properly planned so that it can be used by residents, and safe flooring installed with comfortable ventilation. Although there is an adequate programme of staff training, less than half of the care staff have an NVQ Level 2 or above. The provider should consider how to encourage existing staff to study for this as it confirms their level of competence to provide quality care. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beech Lawn Residential Home Elton Park Hadleigh Road Ipswich Suffolk IP2 0DG     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: John Goodship     Date: 1 1 0 5 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 28 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Beech Lawn Residential Home Hadleigh Road Elton Park Ipswich Suffolk IP2 0DG 01473251283 F/P01473251283 beechlawn@guytoncarehomes.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Guyton Care Homes Ltd care home 26 Number of places (if applicable): Under 65 Over 65 0 26 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 1 0 One person over 65 years of age whose name was given to the Commission on 30 January 2007, who requires care by reason of mental disorder. Date of last inspection Brief description of the care home Beech Lawn is registered to provide care for a maximum of 26 older people and one person with a Mental Disorder, which excludes learning disability or dementia. Guyton Care Homes Ltd owns Beech Lawn, which is a large detached house situated in a private road on the outskirts of Ipswich. Accommodation is sited over two floors, providing one shared room and twenty-four single bedrooms, all with en-suite toilet facilities. There is a platform lift to the first floor. Communal facilities include two lounges and a spacious conservatory. Smoking is not permitted in the home. Care Homes for Older People Page 4 of 28 Brief description of the care home A statement of purpose, colour photographic brochure and a service user guide provides detailed information about the home, the services provided and access to local services. People living at the home are provided with a contract of the conditions of admission and terms of business. These reflect the fees charged by the home and how much each person is expected to pay per month. Fees at the date of this inspection ranged from #395.00 - #550.00 per week. People funded by Social Services have an Individual Placement contract, which reflects Social Services and/or the individuals own contribution. These charges do not cover additional services such as the hairdresser, chiropodist and personal items such as toiletries, daily newspapers and any other items of a luxury or personal nature. Care Homes for Older People Page 5 of 28 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 key inspection visit was unannounced and took place on a weekday. It lasted five and a half hours. The previous key inspection was on May 16th 2008. This visit focused on the outcomes for residents, under each Outcome group. The manager was present for the visit. This report includes evidence gathered during the visit together with information already held by the Commission. We inspected a number of records relating to people using the service, staff, training, the duty roster, medication, health and safety and a range of policies and procedures. We toured the home and time was spent talking with one person in the privacy of their room, as well as talking to residents seated in the lounge. Two visitors spoke to us about the home and the care of their family members. Care Homes for Older People Page 6 of 28 Prior to the visit, we sent the manager an Annual Quality Assurance Assessment (AQAA) form which asks for information and data to help us assess the quality of care. We also distributed survey questionnaires to a sample of residents, relatives, staff and health professionals. We only received one form back at the time of writing this report, which was from a resident. Relevant information and comments from the AQAA, the survey form, and the comments of people we spoke to have been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Care Homes for Older People Page 9 of 28 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 28 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. People who use this service are provided with information they need to make an informed choice about the home. They will have their needs assessed and will be given a contract, which clearly tells them about the service. Evidence: Following a requirement made at the previous inspection, the Statement of Purpose and the Service User Guide had been updated and issued to all residents. We saw that copies had been put in each room in a clear plastic holder. The documents contained the information that a prospective resident would need to make up their minds if they wished to live in the home. They described how the home was managed and run, how it was staffed and the qualifications of the staff, the arrangements for meals, activities and other aspects of daily living. They also contained a copy of the complaints policy and procedure. We had noted in the previous report that these had been long and wordy documents. They had now been rewritten in a user friendly style, and were Care Homes for Older People Page 11 of 28 Evidence: clear and comprehensive. They were reviewed in August 2008 but had also been updated recently to include the change of name of the Commission to the Care Quality Commission. Although the Guide did not include the range of fees payable to the home, people living at the home were provided with a contract of the conditions of admission and terms of business. We saw that these reflected the fees charged by the home and how much each person was expected to pay per month. People funded by Social Services had an Individual Placement contract, which reflected Social Services and the individuals own contribution. The range of fees at the time of this inspection was £395.00 to £550.00 per week. The actual amount was dependent on the size of the room. The AQAA told us that prior to moving into the home each person had a pre-admission assessment completed. These provided detailed information about the individuals health, social and personal care and determined if the home was able to meet the persons individual needs. We examined the file for two recent admissions, which showed that the people had been assessed about two weeks before moving in. During that time, one had been able to visit the home. The relatives of the other person had visited on their behalf. During our visit, a prospective resident visited the home for the day. We spoke to them at lunch time when they were not sure yet about the home. Later in the day, they were more positive, but they did not have to make a decision that day. Care Homes for Older People Page 12 of 28 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. Residents can expect staff to identify and review their care needs to ensure appropriate care is given. Their safety is protected by the homes medication procedure. Evidence: We examined two care plans of people who had been admitted in the last year. Each contained a current photograph of the person together with their personal details including next of kin and other important contacts. The plans were well organised and provided detailed information covering all aspects of the individuals health, personal and social care needs. The records showed us that the plans were reviewed monthly. The files were divided into headings which mirrored those in the pre-admission assessment. These included mobility, personal care, medication, sight and hearing, mental state, diet and social interests. Under each heading, on the proforma, were statements about the service to be provided, and the objective to be achieved. For one resident, there was an objective to improve their independence by maintaining their Care Homes for Older People Page 13 of 28 Evidence: current level of mobility. The manager told us that staff sometimes had to be reminded to encourage this person to walk with assistance and not to use a wheelchair unless they wished to. The care plans included risk assessments which identified the hazards for various activities of daily living such as walking, nutrition, pressure areas and continence, and guidance for staff on reducing or eliminating the risks. Care plans contained charts confirming people were being weighed on a regular basis. The home had a weighing chair which made it possible to weigh all residents even if they were unable to weight bear. We saw that fluctuations in individuals weight were being monitored and, where appropriate, advice had been sought from a nutritionist. The risk for the two people whose plans we examined was rated as low, but the manager told us of two residents whose weight loss had given cause for concern. They had been referred to the dietitian and appropriate measures taken. A visiting relative told us that, since their family member had come to live in Beech Lawn, they had put on weight and look happier than they have been for a long time. Care plans included records of visits by the GP and district nurse as well as other health personnel. The AQAA told us that the home was hoping to link up with a visiting dentist to reduce the need to take residents to the clinic. One diabetic resident was visited by the district nurse during our visit to attend to a leg ulcer. They advised the manager that they had taken a blood test, and that the home should check the persons shoes for better fitting. The AQAA told us that hearing and eye testing was carried out annually by visiting specialists. We found a bottom set of dentures in a mug in one of the bathrooms. The manager told us that they were keeping them for the dentist. It was poor practice to leave them where other residents could see and access them. We noted that the care plans were reviewed monthly with summaries of changes to care needs being highlighted for staff. These were discussed with staff at handover times. The daily record also noted changes during each shift. Some residents chose to spend most of their day in their rooms. For these residents, staff maintained a Resident Care Check record in each bedroom which recorded when staff had been to see the person in their room during the day. It also recorded checks made by the night staff. When we visited the room of one of the people whose plan we examined, we noted that the Care Check form had not been completed for a month. The manager explained that staff were no longer concerned about the safety of that person. However the care plan did not give any reason or instruction to staff for stopping the Check. Care Homes for Older People Page 14 of 28 Evidence: The manager told us that each resident had one shower or bath a week unless, for example, they had soiled themselves. One resident was able to shower themselves every day. We noted that the schedule for bathing was on the managers office wall. We saw that some residents were bathed more frequently. The manager said that this was at their request. A sample check of the medication administration system was undertaken. We saw the giving out of medication, the checking of the records and the security of the medication which was on a medicine trolley. All was satisfactory. There were no gaps in signatures for medication, and the amounts in the blister packs tallied with the records of receipt and administration. We were told, and staff confirmed, that medication was only given out by senior staff or night staff, who had all been trained. The procedure for the administration and recording of controlled drugs was correct. We saw staff knocking on residents doors before entering. They told us that when NHS staff visited, residents were always seen in the privacy of their own room. Residents had access to a portable phone so that calls could be taken in private. Mail was given to each resident, or kept for their representative. The AQAA told us that the resident or their representative could sign a form allowing senior staff to open post which comes from the NHS regarding for example appointments. Care Homes for Older People Page 15 of 28 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. Residents can choose how they interact with other residents, and can maintain contact with their friends and relatives. They can be assured that their nutritional needs will be met. Evidence: We were told that a senior carer was responsible for the arranging of in-house activities and entertainment and any trips outside the home. This person was not on duty on the day of our visit. The manager told us that this person was booked to attend a course at a local college on the provision of activities for people with dementia. There was a programme of that weeks activities on the noticeboard. They included arts and crafts, talking games, bell ringing, bingo, card games, sing-a-long, and card making. However, we did not see any of these activities taking place during our visit. Also on the noticeboard in the hall were photos of residents taking part in Red Nose Day earlier in the year. The AQAA told us that the mobile library service had started visiting the home again on a fortnightly basis. There was also a monthly Communion Service held in the home. There were nine residents sitting in the lounge in the Care Homes for Older People Page 16 of 28 Evidence: morning. One person was knitting. They told us that they had been in the home for some years. They were taken by friends to church and to clubs. The tea trolley was going round at this time. Staff were aware of the preferences of each person, and they were able to drink the tea unsupported. All the residents who attended the recent residents meeting were happy with the activities provided. There was a suggestion of visiting the local supermarket for shopping and coffee. A visitor had offered to find a wheelchair adapted vehicle to enable some residents to go out for the day. During the morning, we noted a carer going into a residents room after knocking to offer them a cup of tea, and to tell them the choice of main course for lunch. That day it was liver and bacon, or roast beef and gravy. Dessert was pineapple sponge, or trifle, or fruit and custard. This person spent all day in their room. They told us they were well cared for and comfortable. The meals are good. They had regular family visitors. People are provided with the option of having three cooked meals a day from a fixed four-week rolling menu. The cook was aware of the dietary needs of each of the people living in the home as well as issues relating to their health. They always provided a vegetarian option and puree food for people requiring a soft food diet. The lunchtime meal was observed. Tables in the dining room were nicely laid with tablecloths and vases of flowers. The manager told us that a staff member and a resident had been round the garden to cut the flowers and then arrange them on the tables. People had a choice of where to eat, some had chosen to eat in their room. Meals were served quickly; these looked appetising and were nicely presented, Meals taken to rooms were covered and the plates were warmed. Staff were aware of peoples likes and dislikes. Food was served on plates of different sizes to match the persons appetite. All the people in the dining room were able to feed themselves. One person told us: The food is good and there is more available if wanted. Care Homes for Older People Page 17 of 28 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 can be assured that their views will be listened to, taken seriously and acted upon. There is a proper policy, procedure and training programme in place to give residents confidence that they are protected from abuse. Evidence: We examined the policies and procedures for dealing with complaints and safeguarding the people living in the home. They were displayed in the corridor, together with a copy of the latest inspection report. The procedure was included in the Service User Guide which was in each persons room. The record of complaints showed the action taken in response to the complaint. There was also a summary sheet at the front of the file. This showed that the home had received several minor concerns this year. Topics included lack of room cleaning, a cup of tea being cold, and a member of staff not knocking before entering a residents room. The record showed what action had been taken and the reaction of the complainant. One resident told us that: I know that I can tackle the owner with any complaint. The home had a policy on the protection of vulnerable adults. This had been updated as required after the previous inspection to be in line with the current policy of the local authority as the lead safeguarding agency. Proper recruitment checks were made Care Homes for Older People Page 18 of 28 Evidence: on applicants for staff positions before appointment. All staff had received training in this area during the last twelve months. This included all ancillary staff as well as care staff. The training used a distance-learning module that was assessed by an external tutor. The manager told us that she made sure that training was put into practice through supervision, both formal and informal. The staff we spoke to confirmed the training they had had, and were able to describe the different kinds of situations which could be defined as abuse. The manager had reported to us and to the Adult Safeguarding service that she had disciplined a member of staff for verbal abuse of a resident. The manager had also reported her concern about the way a visitor was treating their relative. This showed that the home was aware of what could constitute abuse, and that the correct procedure was followed to protect the resident. Each bedroom had a brochure giving information about the new Deprivation of Liberty Standards which came into force recently as part of the Mental Capacity Act. The manager was due to attend a training session in May 2009 by the local authority which would explain what action the home needed to take to comply with the regulations. Care Homes for Older People Page 19 of 28 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 can be assured that they live in a safe and well-maintained home, and that they will be encouraged to personalise their rooms as much as they wish. Evidence: Beech Lawn is a large detached house situated in a private road on the outskirts of Ipswich. Accommodation is sited over two floors, providing one shared room and twenty-four single bedrooms, all with en suite facilities comprising a toilet and hand basin. Additionally people have the use of two lounges, a spacious conservatory and dining room. Furnishings and lighting throughout the home were domestic in character and were sufficient for their purpose. At the rear of the house there was a large garden mostly laid to lawn with a patio area providing seating for use in the better weather. It was not clear how often this area was used by residents. It was used by staff at their breaks, as evidenced by the very full ashtray on the table. The home had no separate staff room. The garden and car parking to the front of the property was well maintained. Additional security lighting had been installed at the rear of the property to increase the safety of residents. The private road leading to the home had been improved by the owner of the home to reduce the potholes and make it easier to push for wheelchair access. Care Homes for Older People Page 20 of 28 Evidence: We noted that alcohol gel dispensers were placed around the home for the extra protection of staff. One of them was empty. There was no soap dispenser in the wet room although there were paper towels and protective gloves in there. The boiler room door was ajar as there was a cable coming out of the room to a plug socket on the wall outside. The manager explained that they had needed to put the immersion on while repairs were done to the main boiler. Arrangements must be made to enable the immersion heater to be plugged in without reducing the integrity of a fire door. The cable was later unplugged. There was a large conservatory attached to the main lounge. On the day of our visit, it was stiflingly hot, and being used partly to store wheelchairs, games and books. The carpet was very rucked up and dangerous for residents. No residents used this room during our visit although we have seen it used on previous visits. The manager told us that they planned to replace the carpet soon. A staff member told us that the conservatory was often very hot but, if you opened a window, residents said it was too draughty. Peoples rooms were nicely decorated and personalised reflecting their individual character. People had brought items of their own furniture and other personal possessions, such as photographs and ornaments. Several bedrooms had been refurbished with new furniture and matching accessories, enhancing the environment for the occupants. One resident told us my room in particular is always very well cleaned. At the residents meeting in March 2009, the minutes stated that residents were satisfied with the cleanliness of the home. One person remarked that the window cleaner had not been lately. The manager said she would look into this. The laundry facilities were clean and tidy with appropriate equipment to launder clothing and bedding. The soaking and sluicing of soiled garments before washing had ceased. The dirty laundry was put into red dissolvable bags using the sluice cycle on the washing machines. A check of the water temperatures confirmed there was plenty of hot water, which was found to be close to the recommended temperature of 43 degrees centigrade. The temperatures were tested regularly by the maintenance man and we were shown the records of these checks. Care Homes for Older People Page 21 of 28 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. Residents can expect to be supported by staff who are safely recruited, and trained to meet their needs. Evidence: The AQAA told us that only two staff had left the home in the last year. There were no current vacancies. A new deputy manager was about to start. The previous one had been moved to another of the providers homes. The AQAA told us that the home had not used any agency staff in the previous three months. The duty roster reflected that each morning shift was covered by a senior and three care staff between 8am - 2.30pm. A senior supported by two carers between 2.30 9pm covered the afternoon shift. There were two waking night staff between the hours of 9pm - 8am. A staff member queried whether the late shift had sufficient staff. A resident told us that there usually staff available when they needed them. The AQAA told us that there were three residents who required two staff to attend to their personal care. The manager had compiled a dependency level survey and staffing review in December 2007 which the manager said was to be reviewed three times a year. It was past the time for this review to be updated and the needs of some residents would have changed. Care Homes for Older People Page 22 of 28 Evidence: Records confirmed that staff were provided with the training they needed to gain the knowledge and skills to perform their work role and meet peoples needs. Recent training had included Common Induction Standards, for a new employee, which covered principles of care, the role of and development of the worker, maintaining safety at work, effective communication, recognising and responding to abuse and neglect. Other training courses undertaken by staff included first aid, food hygiene, fire safety, moving and handling, infection control, fire safety and administering medication. The provider used an external training company to deliver this training. We saw the training plan for the year ensuring all staff received the appropriate training. Only seven out of seventeen staff had achieved NVQ Level 2 or above. We examined the files for a recently appointed staff member. It contained the full application form, two references, identification documents, and records of the Protection of Vulnerable Adults check and the Criminal Records Bureau disclosure document. Training certificates were also filed there. We were concerned that staff did not have a separate staff room available to them for their breaks. They often sat outside on the patio as smoking was allowed there. Otherwise they still used the conservatory. Staff should not have to use a residents communal area with the dangers of lack of confidentiality. Care Homes for Older People Page 23 of 28 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. Residents can expect to live in a well run home where their best interests and safety are protected. Evidence: The registered manager had been in post since 1995. They held a National Vocational Qualification (NVQ) Level 4 in Care and Management. She told us of training sessions she had done and was booked to do to maintain her skills and knowledge. Previous reports had commented on the absence of a planned quality assurance programme, in particular how the home gathered the views of residents. This had now been rectified with a quarterly residents meeting, a residents annual questionnaire and a residents forum open to friends and relatives. We saw the questionnaire for November 2008 and the analysis of the replies. Ten residents had completed the survey with nine out of ten satisfied with all aspects of their care. We have already quoted from the residents meeting of March 2009. Topics discussed were meals, level Care Homes for Older People Page 24 of 28 Evidence: of care, activities, environment, laundry (two items gone astray), medication and privacy. The manager was disappointed that few relatives replied to the invitation to attend the first forum in January. A tea party to raise funds for cancer research was being held in the summer to which relatives would be invited. We saw the record and the schedule of staff supervision sessions, which took place about six times a year. Although the AQAA said that staff meetings were held, there had been none recently. Although the home did not manage peoples finances, for their convenience the manager did hold a small amount of personal cash for nine people. This was held separately for each person and a record of transactions of all monies spent and received were logged. We checked the records of one resident. The amount in the cash wallet was one penny more than the receipts and entries in the cash book said there should be. We were concerned that staff did not have a separate staff room available to them for their breaks. They often sat outside on the patio as smoking was allowed there. Otherwise they still used the conservatory. Staff should not be required to take their breaks in the same rooms residents are using. This detracts from the homeliness of the environment. It is also difficult for staff to observe confidentiality in those circumstances. Equally staff should not have to take their breaks outside, unless it is their choice. We saw the maintenance and accident records. The latter had monthly summaries which showed a variety of causes but in small numbers and not linked to any individual. The fire risk assessment had been updated in October 2008, and the last fire safety training session had been on 4th February 2009. We noted earlier that the door to the boiler room had been blocked open to allow an electrical lead to be plugged in outside the room. The Certificate of Registration and the Certificate of Public Liability were displayed in the hall. Care Homes for Older People Page 25 of 28 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 26 of 28 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 1 38 23 The homes fire safety 09/06/2009 procedures must be adhered to. Residents must be assured that safe fire procedures are in place and understood by all staff. 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 8 There should be a clear policy on checking residents who spend time in their room, using the Care Check if appropriate. Residents should be able to use all the communal areas safely and in comfort. Staff should not have to take their breaks in residents communal areas. 2 3 20 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. 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