Care Home: Beech Tree House

What the care home does well People have a thorough care needs assessment prior to their admission to the home and are encouraged to spend a day or longer period at the home before making a decision about admission. There are thorough care plans in place that include relevant risk assessments; both are reviewed on a regular basis to ensure that care plans are kept up to date. People are supported and encouraged to take part in the local community and to maintain interests that they had prior to their admission to the home. People are supported to stay in contact with family and friends, and family members tell us that they are involved in their relative`s care. The premises are well decorated, well furnished and well maintained, and are kept in a clean and hygienic condition. There is a robust recruitment and selection process in place and this results in only staff that are considered safe to work with vulnerable people being employed. Staff have thorough induction training followed by regular refresher training and this equips them with the skills needed to care for the people living at the home. The quality assurance systems ensures that the quality of the service provided is monitored and allows people to affect that way in which the home is operated. There are robust financial administration systems in place and this protects people from the risk of financial abuse. The health and safety systems in place protect people living and working at the home from the risk of harm. What has improved since the last inspection? Care plans, assessments and risk assessments are now reviewed on a regular basis. All senior staff have completed first aid training so there is now a trained first aider on most shifts. There are sufficient staff on duty to meet the needs of the people living at the home. The number of ancillary staff employed allows care staff to concentrate on the personal and social care aspects of their role. What the care home could do better: The provision of a treatment room/area would promote privacy and dignity when people are receiving treatment from district nurses and GP`s. Any hand written entries on medication administration records should be signed by two staff to ensure accuracy.Medication returned to the pharmacy should be signed for by a representative of the pharmacy to evidence that it has been collected/received. The provision of a mini-bus would enable people to access the local community on a more regular basis. Safety in the outside area of the home would be promoted by the provision of railings or similar on top of the low wall surrounding the patio, to prevent people from tripping. The kitchen is clean but would benefit from refurbishment, especially the flooring, which is becoming difficult to keep clean. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beech Tree House 240 Boothferry Road Goole East Riding Of Yorks DN14 6AJ     The quality rating for this care home is:   three star excellent 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: Diane Wilkinson     Date: 1 9 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Beech Tree House 240 Boothferry Road Goole East Riding Of Yorks DN14 6AJ 01405720044 01405763824 beechtree.house@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd care home 31 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 31 31 0 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 1 Category (PD) applies to one named service user. To accommodate a 61 year old male. Date of last inspection Brief description of the care home Beech Tree House is a care home that is registered to provide care and accommodation for 31 older people, some of whom may have dementia related conditions. The home is a large extended detached house that is set in its own grounds close to the town centre of Goole, in the East Riding of Yorkshire. There is good access to local amenities such as shops, public houses, cafes and hairdressers, and to the public transport network. Accommodation is provided in a range of single and shared rooms, some of which have en-suite facilities. All areas of the home are accessible to the people who live there via Care Homes for Older People Page 4 of 29 Brief description of the care home the provision of a passenger lift and ramps. There is an enclosed well maintained garden for people to use, and there is a large car park for staff and visitors to the home. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 21st May 2007, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day; it began at 10.00 am and ended at 4.40 pm. On the day of the site visit the inspector spoke on a one to one basis with two people living at the home, a relative, two members of staff, the homes administrator and the registered manager. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people Care Homes for Older People Page 6 of 29 using the service. As part of the inspection process we sent survey forms to people living at the home, staff working at the home and some health and social care professionals. Seven were returned by people living at the home, three were returned by staff and two were returned by health care professionals. Responses in surveys and comments from discussions with people on the day of the site visit were mainly positive, for example, family support encouraged by the manager and staff and the staff are kindness itself. Other anonymised comments are included throughout the report. At the end of this site visit, feedback was given to the registered manager on our findings, including recommendations that would be made in the key inspection report. The homes administrator told us that the current fee for residential care is from £352.04 to £459.00 per week. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The provision of a treatment room/area would promote privacy and dignity when people are receiving treatment from district nurses and GPs. Any hand written entries on medication administration records should be signed by two staff to ensure accuracy. Care Homes for Older People Page 8 of 29 Medication returned to the pharmacy should be signed for by a representative of the pharmacy to evidence that it has been collected/received. The provision of a mini-bus would enable people to access the local community on a more regular basis. Safety in the outside area of the home would be promoted by the provision of railings or similar on top of the low wall surrounding the patio, to prevent people from tripping. The kitchen is clean but would benefit from refurbishment, especially the flooring, which is becoming difficult to keep clean. 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 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a thorough needs assessment when they express an interest in moving into the home and a gradual introduction to the home is encouraged. Evidence: We checked the care records for two people who had recently moved into the home; one person had moved to the home permanently and the other was having respite care. In both instances, the home has completed a full care needs assessment (called a Care and Health Assessment Profile). This is a thorough assessment of a persons individual needs, including mobility and falls, nutrition, personal hygiene, skin integrity, sleep and pain control. There is a separate assessment for each of the areas covered in the document, and in addition to this, there are supporting assessments such as a malnutrition screening tool, a pain assessment chart and a resident handling profile. All areas of the assessment are reviewed on a monthly basis. Information about a persons care needs is received from the local authority when they Care Homes for Older People Page 11 of 29 Evidence: are commissioning the placement. This information, along with the assessment undertaken by the home, is used to develop an individual plan of care. The manager told us that they visit people who express an interest in moving into the home at their current place of residece, and that the assessment process commences at this stage. People are invited to visit the home for a day to help them make a decision about admission, and some people have respite care at the home as part of their decision making process. All of the people that returned a survey told us that they had received enough information about the home before they moved in to help them to make a decision. One person added, Invited to look around at any time of day and also able to read inspection report which was freely displayed. Also spoke to residents who were already living at the home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are a thorough record of a persons individual capabilities and needs and how these are met by staff, including the administration of medication. Privacy and dignity is respected by staff but the provision of a treatment room would enable nursing staff to treat people in private. Evidence: We examined three care plans on the day of the site visit - these were found to be a very thorough record of a persons individual care needs. All areas of care identified are accompanied by a thorough assessment that includes the capabilities of the person and the assistance needed by staff. The assessment and the care plan are reviewed on a monthly basis and, in addition to this, the manager checks the content of care plans to monitor that they are kept up to date. Individual risk assessments are undertaken for such topics as the risk of falls and use of the bath hoist. We observed that people sign their agreement to their individual plan of care when they are able to do so. There is a record of all contact with GPs and district nurses, and this includes the reason for the contact and the outcome. People living at the home tell us that they Care Homes for Older People Page 13 of 29 Evidence: receive the medical support they need. One person added, Regular visits by family GP whenever necessary as requested by staff and family. The manager told us that any mobility equipment and pressure care equipment is accessed via their own organisation or via district nursing services, and that continence products are accessed via district nursing services following an assessment undertaken by them. A health care professional told us in a survey, Staff do try hard to implement our suggested care for patients e.g. when dealing with patients who require additional input because of pressure areas etc. The manager told us that the organisation have a procedure in place to promote safe use of bed rails i.e. a risk assessment is completed, a bed rail risk monitor form is completed every month and the manager has to inform the head office every month if any bed rails are in use. Because of the risks involved, bed rails are only provided when considered to be essential and none of the current residents have been assessed as needing one. We saw that medication is stored in a locked room that includes a trolley for the storage of blister packs, a cupboard for storing spare medication and a controlled drugs cabinet that is fixed to the wall. We examined medication administration records and noted that there is a photograph of each person along with their medication records and that any allergies to medication are clearly recorded. There were no gaps in recording but we recommend that any hand written entries made on medication administration records are signed by two staff to ensure accuracy. We examined the controlled drugs register and checked a sample of medication held and found these to be accurate. There was some medication to be returned to the pharmacy and this had been listed in the returns book. On the previous occasion that medication had been returned to the pharmacy we noted that the driver had not signed the returns book and this was cause for concern, as a lot of medication had been returned. Training records evidence that staff that have responsibility for the administraiton of medication have completed appropriate training. Equipment used by district nurses is also stored in the medication room. However, the room is very small and could not be used as a treatment room. A health care professional told us in a survey, It can be very difficult at times to ensure privacy and dignity when carrying out some nursing tasks. Provision of a suitable room/space downstairs to obtain bloods or do some simple dressings would be beneficial. We saw that there is a letter in place to send to GPs requesting advice about homely remedies; this is sent out on an individual basis as needed. All of the people that returned a survey told us that their privacy and dignity is respected. We observed that there was a notice on a bathroom door that stated, Care in Progress - please knock. The manager told us that she had recently undertaken training on Dignity with other managers from the organisation. Following the training, the manager has produced a Dignity Board that explains to people the importance of maintaining a persons dignity through person centred care. Managers have also been asked to set a Dignity Challenge. At Beech Tree House the challenge is about a persons appearance - making sure people have had their hair done, are wearing Care Homes for Older People Page 14 of 29 Evidence: suitable clothing etc - the Regional Manager will be monitoring the homes progress. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live their chosen lifestyle, to stay in touch with family and friends and to take part in the local community. Meal provision at the home is good. Evidence: On the day of the site visit we observed that routines of daily living and activities are flexible and varied to suit the needs of people living at the home. Some people were out in the morning at a local singing group where they meet with a group of school children. Five other people attend a group in the community for people who have been registered as blind or partially sighted; they are picked up by the organisation (Hull and East Riding Institute for the Blind) and taken to the venue. In the afternoon, the activities coordinator ran a movement to music session and a good number of people joined in. No pressure was put on people to take part; some people seemed to enjoy observing the session and taking part in the conversations, and others enjoyed doing the exercises. Other staff also joined in the session. The manager told us that the activities coordinator works on five afternoons a week plus on two mornings. One of her duties is to take the snacks trolley around the home - this gives her the opportunity to chat to those people who choose to stay in their own room throughout the day. Activities are based on discussions held with people about their hobbies and Care Homes for Older People Page 16 of 29 Evidence: interests and there is a notice advertising weekly and forthcoming events on the homes notice board. Five residents and five staff are soon due to have a holiday in a hotel in Wales. The residents have agreed to pay for the staff and this has also been agreed with the residents families. In addition to this, Four Seasons are paying the staff for an agreed number of hours per day. People that we spoke to on the day of the site visit told us about their previous holiday taken with the home and how much they had enjoyed it. One person said, the staff were kindness itself. The provision of a mini-bus would enable people to access the local community on a more regular basis; the home currently has to obtain transport from private providers. The activities coordinator has started to put together a memory box for each person living at the home. These include a written account of the persons past life, including schooling, interests and special memories and is accompanied by photographs, books, posters etc. This is good practice. We spoke to a relative and saw other relatives and friends visit the home on the day of the site visit. We were told that family members are always made welcome and are encouraged to take part in any activities or outings. Family members are kept informed about important events in their relatives life and their involvement is encouraged - they are also invited to the residents meeting. One relative told us, family support is encouraged by the manager. Most people are accommodated in single rooms so are able to see visitors in private. We observed that some people have their own telephone in their room to enable them to keep in touch with family and friends - some people with sight problems have telephones with large numbers to assist them with dialling independently. We also saw that some people had been provided with a talking book machine. Meal provision at the home is good. There is a four week menu in operation and there is a choice of meal at most meal times. On the day of the site visit we observed that people were asked which meal they would like, and people confirmed that they also have a choice at breakfast and tea time. The manager told us that diabetic meals and culteral requirements are catered for and we observed that this information was recorded in care plans. We observed that appropriate assistance was offered by staff and that meal times were unhurried; some people stayed in the dining room to chat after they had finished their meal. Drinks are offered at mealtimes and throughout the day. We observed that information about advocacy was displayed on the homes notice board - this enables people to obtain this information without having to ask for help, and promotes privacy and independence. We observed that people are able to bring some of their own possessions into the home, including small items of furniture, so that their rooms are personalised. Care Homes for Older People Page 17 of 29 Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People tell us that they know how to express concerns or make a complaint and any complaints made to the home are dealt with appropriately. Staff have annual training on safeguarding adults from abuse and this protects people living at the home from the risk of harm. Evidence: We noted that the homes complaints procedure is displayed in the entrance hall and the manager told us that there is a copy of the statement of purpose in each bedroom; this includes information about the complaints procedure. All of the residents that returned a survey to the Care Quality Commission (CQC) told us that they know how to make a complaint, and this was confirmed by the people we spoke to on the day of the site visit. Staff were asked in a survey, Do you know what to do if anyone has concerns about the home? and all responded positively. One of the health care professionals that returned a survey told us that the home responded appropriately if concerns were raised about a persons care. On the day of the site visit we examined the complaints log and noted that no formal complaints had been received by the home since the last key inspection. One complaint was received from a relative by the CQC in June 2008 about poor staffing levels and this was investigated appropriately at the time by the registered provider. Staff receive appropriate training on safeguarding adults from abuse. The manager told us that this training is mandatory and that staff are required to attend on an Care Homes for Older People Page 19 of 29 Evidence: annual basis. The training calendar evidenced that this training had been provided in February and March of this year. The manager told us in the Annual Quality Assurance Assessment form that the oranisation have now introduced a confidential whislte blowing line. No safeguarding alerts have been sent to the local authority and no referrals have been made to the Protection of Vulnerable Adults (POVA) list by the home. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and hygienic and is well decorated, well furnished and maintained in a safe condition. Evidence: The location and layout of the home is suitable for its stated purpose. It is maintained in a clean and hygienic condition; there are two domestic staff on duty from Monday to Friday and one on duty over the weekend, and a maintenance person is employed on a full time basis. Some feedback received by CQC indicated that any repairs that can be done by the homes maintenance person are completed quickly, but work that needs to be referred to head office is sometimes delayed. There is a maintenance programme in place and the home is well furnished and decorated to provide a comfortable home for the people living there. The Environmental Health Officer has undertaken a food hygiene inspection since the last key inspection and made some minor recommendations; the manager said that these have all been actioned. We observed that the kitchen was clean, but that it is dated and would benefit from refurbishment, especially the flooring; we were told that this is becoming difficult to keep clean. This had also been commented on by the Environmental Health Officer. There is a conservatory at one side of the home and this provides people with ample access to sunlight. The garden area is accessed via the dining room and is private and Care Homes for Older People Page 21 of 29 Evidence: well maintained; this provides a safe area for people to take a walk as it is fully enclosed. There is a low wall along the edge of the patio area and safety would be improved if railings were fitted on top of the wall to prevent someone from accidentally tripping over it. Laundry facilities are satisfactory and there are two laundry assistants employed; this enables care staff to concentrate on caring duties as well as reducing the risk of cross infection. The manager told us that staff undertake training on infection control on an annual basis; this is one of the mandatory training courses at the home. We observed good hygiene practices being followed by staff on the day of the site visit and noted that disinfectant gel is readily available. Most of the residents that returned a survey told us that the home is always fresh and clean, although one person commented that the toilet sometimes gets blocked and starts to smell. The manager told us that this did happen on one occasion but that it was quickly repaired. Another person told us in a survey that clothing sometimes gets lost in the laundry room. The manager told us that relatives are always asked to label clothing but that they dont always do so. We saw that every effort is made to ensure that peoples own clothing is returned to them. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited in a safe way and then receive induction training and ongoing training to provide them with the skills needed to carry out their role. Evidence: There is a staff rota in place for care staff - this records the role of each person employed and evidences that there are four staff on duty throughout the day and three staff on duty overnight; staff now work 12 hour shifts and the manager said that they feel that people have benefited from the continuity of care throughout the day. A health care professional told us in a survey, Overall, it is a pleasant home, staff are always polite and usually very helpful when we visit. Because a high number of ancillary staff are employed, care staff are able to concentrate on personal and social care tasks with people living at the home. The manager told us that there are two domestic staff on duty Monday to Friday and one on Saturdays and Sundays. In addition to this, there is a cook and a kitchen assistant employed each day, a full-time maintenance person, an activities coordinator working 20 hours per week and two laundry assistants. Ideally, all of these staff members should be recorded on a staff rota. The AQAA records that almost 50 of the staff group have now achieved NVQ Level 2 in Care and that some staff are working towards this award. In addition to this, some staff are continuing with training to work towards NVQ Level 3 in Care. New staff Care Homes for Older People Page 23 of 29 Evidence: complete appropriate induction training that meets Skills for Care requirements. We examined the recruitment and selection records for two new members of staff. These evidenced that prospective employees complete an application form that records the names of two referees and their employment history. We noted that the application form does not ask applicants if they have any criminal convictions, but the manager told us that people are asked this information at interview and that their response is recorded; the application form does inform people that a Criminal Records Bureau (CRB) check will be obtained. We noted that two written references and a Protection of Vulnerable Adults (POVA) first check are in place before people commence work at the home. There is a training matrix in place that records the training programmes completed by staff as well as the date that training should be updated. This includes all core training such as moving and handling, first aid, food hygiene, infection control, fire safety, safeguarding adults and medication. NVQ training is also recorded on the matrix, along with some more specialised training that people have undertaken, such as dementia care mapping and customer care. On the day of the site visit we saw the training calendar on display - this gave details of training courses booked for the year and included person centred care, deprivation of liberty, delivering dignified care and safeguarding. Staff records include information about individual training achievements and needs and a copy of training certificates is retained. We noted that some training is classed by the organisation as mandatory training and when staff receive information about these training programmes they are informed that the training is not optional. Staff told us that they felt that they had appropriate training but a health care professional commented that staff would benefit from more in-depth training in areas such as pressure care, continence and diabetes. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed including the accounting systems in place and the monitoring of health and safety systems. The quality assurance system measures the quality of the service provided and gives people the opportunity to affect the way in which the home is operated. Evidence: The home is well managed by an experienced and qualified manager; she has achieved NVQ Level 4 in Care and Management and is currently undertaking further management training. She is taking part in a five day management training course with other managers from the organisation that covers such topics as time management, customer care, conflict resolution and delegation. The manager told us that she attends management meetings with other managers from the organisation and the regional manager on a regular basis and that she uses the CQC website to help keep her practice up to date. As previously recorded, the manager is currently involved in an initiative to involve staff and others in promoting the concept of dignity Care Homes for Older People Page 25 of 29 Evidence: within the care home. There is a quality assurance system in place at the home that includes twice yearly audits; the cook is responsible for undertaking the catering audit and domestic staff are responsible for undertaking the cleaning audit and so on. Surveys are distributed every year to people living at the home and their relatives/friends. The responses are collated and any issues identified are dealt with at the time; the organisation call this system, Tap and Wrap. As a result of the last round of surveys, a remedial action plan was developed and the manager told us that they informed all interested parties about the outcome, including details of the action plan. The manager told us that the outcome of surveys and audits is used to form an action plan for the following year. Staff meetings and resident meetings are held, and relatives are also invited to residents meetings. One of the people that we spoke to on the day of the site visit told us that they had been asked to suggest some new ideas for the menu and that these would be prepared by the cook to see how popular they are. The homes administrator showed us the systems in place to record any financial transactions made on behalf of people living at the home. Receipts are handed to anyone that hands money over for safekeeping; a receipt is given to the family member and a copy of the receipt is saved with financial records. There are two receipt books in use - one for money paid into the home and one for money paid out. There are separate financial transaction sheets in place for personal allowances, any transactions made by cheque and for bank account details. All of these records are sent to the head office every month for reconciliation; we noted that written records are cross referenced against records held on the IT system; this provides a very safe system for the holding of peoples money. We examined health and safety records held at the home. We noted that equipment and services had been serviced appropriately, i.e. the fire alarm system, the nurse call system, portable appliance tests, the passenger lift and hoists. The homes maintenance person undertakes weekly tests of the fire alarm system, the nurse call system and water temperatures in bedrooms; this protects people living at the home from the risk of harm. As previously recorded, staff have training at the time of their induction to the job on health and safety topics, and then refresher training is organised on an annual basis. We noted that all senior staff have undertaken first aid training so there is now a qualified first aider on each shift. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 9 9 10 Two people should sign any hand written entries on medication administration records to promote accuracy. Medication returned to the pharmacy should be signed for at the time of collection. The provision of a treatment room/area would enable people to receive treatment from health care professionals in private. The provision of a mini-bus would enable people to take part in the local community on a more regular basis. Safety for residents when using the patio area outside the dining room would be improved if railings were provided on top of the low wall. This would prevent anyone from accidentally tripping over the wall. The kitchen would benefit from refurbishment, especially the flooring, which is becoming difficult to keep clean. 4 5 13 19 6 19 Care Homes for Older People Page 28 of 29 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!