Care Home: Beechmore Court

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What the care home does well It was well evidenced that residents are provided with choice in their day and enabled to be as independent as possible. The home had an abundance of staff not only care assistants and domestics but extra staff are brought in to assist residents during mealtimes which is a busy period. Residents were well groomed and looked well cared for, by staff that genuinely cared and understood their specific needs. The home retains a consistent and dedicated staff team who work collaboratively for the best interests of residents. The home has supportive management committee as well as relatives. What has improved since the last inspection? The care plans had more comprehensive information included in them and this would assist staff to deliver care to residents. The medications had improved with better recorded keeping auditing and stock checks. Recording of complaints had improved and the home has purchased an appropriate book for such information. Staff had a better understanding of adult protection procedures and whistle blowing. Regulation 26 visits had been conducted with a report on the findings left in the home . What the care home could do better: The home should consider employing a male care staff to address gender care issues . This was brought up at the previous inspection although the manager stated that no residents requested it. One comment card did however referred to this as an issue which should be addressed. The home offers a variety of activities, although with such a wide range of abilities and dependency, it may be appropriate undertake a review of activities to ensure all residents have some leisure time. Policies and procedures need to be updated in light of changes to legislation and good practice or annually in any case. Efforts to obtain views on the services provided should be expanded upon, and continued to ensure that all parties have opportunities to input into the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beechmore Court 267 Southlands Road Bickley Bromley Kent BR1 2EG     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: Rosemary Blenkinsopp     Date: 1 7 0 6 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 30 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 30 Information about the care home Name of care home: Address: Beechmore Court 267 Southlands Road Bickley Bromley Kent BR1 2EG 02084687778 02082950596 admin@cedarmoreha.fsnet.co.uk 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) : Cedarmore Housing Association Limited care home 36 Number of places (if applicable): Under 65 Over 65 16 20 dementia old age, not falling within any other category Additional conditions: 0 0 The maximum number of service users who can be accommodated is: 36 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 20) Dementia - Code DE (maximum number of places: 16) Date of last inspection Brief description of the care home The home is part of Cedarmore Housing Association Limited, which is a Christian organisation. Beechmore Court is a purpose-built two-storey home providing care for older people. The upper floor is accessed via two lifts. The home is generally well maintained and has a vast array of equipment for those residents who have physical impairments Care Homes for Older People Page 4 of 30 Brief description of the care home including overhead hoists. Residents are able to personalise their rooms and this was evident during the inspection. There is access to a telephone and residents are able have their own telephone in their room at their own expense. For safety purposes all the radiators and hot pipes are guarded. There are grab and hand rails on stairs and passageways. Toilets, showers and bathrooms have specialised bathing, toilet equipment and lifting aids. All toilets, showers, bathrooms and bedrooms are accessible from the outside in case of emergency. The home is well staffed with care, ancillary and administrative personnel. The home is managed by a qualified nurse. Fees range between £471.00 to £622.00 per week. Care Homes for Older People Page 5 of 30 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 inspection was conducted as an unannounced visit. We were accompanied by an expert by experience, Janis Bryan who spent the majority of her time with residents and relatives. She talked to several people during the her time in the home. She made observations on the environment , activities and routines. She gave feedback at the end of the inspection. Her findings are incorporated into this report. Prior to the inspection the Manager had completed the AQAA and forwarded this to the CSCI. Eleven comment cards were provided and returned during the inspection. The comment cards were from residents, relatives and staff who worked in the home. During the visit the expert by experience met with several relatives, residents and observed staff interaction and engagement with residents. Care Homes for Older People Page 6 of 30 Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans staff personnel files as well as health and safety records. Feedback was provided to the person in charge at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. 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 Care Homes for Older People Page 8 of 30 7535. Care Homes for Older People Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admissions procedures provide residents with the information they require prior to any decision regarding placement being made, to establish whether the service is right for them. Staff have good information to ensure that they can meet individual residents needs and on which to base an initial care plan. Evidence: At the time of the inspection there were 35 residents in the home and one person was in hospital. Residents files were inspected as part of case tracking and as part of this their assessment information was sampled. Assessment records included personal information and the medical history, as well as an outline of the presenting problems. In one file the resident had problems with his vision and there was good information on this. In another assessment conducted by the manager, this was in the form of hand written notes and these were brief. The manager explained that this resident was well known to the home, and staff knew his care needs. This resident had attended the Care Homes for Older People Page 11 of 30 Evidence: home for respite care for several years and had needed full time care hence his admission. In all files there was a needs assessment form completed. The Community Care Assessments are received from the Local Authority prior to any residents being admitted. Those looked at provided good information on all areas of daily living. Contracts are issued through the funding authorities detailing fees and service level agreement. Private contracts are provided to those people who are self funding. Terms and conditions of residency are supplied. Introductory visits are encouraged including overnight stays. Many of the residents know the service as they have either visited the home or live in one of the Housing Association flats which is adjacent to the home. Information including the Statement of Purpose and Residents Guide are provided. All residents are on one months trail basis. Within the resident comments cards all of them indicated that they had received information prior to placement and had been issued with a contract. Care Homes for Older People Page 12 of 30 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 be confident that their needs will be met by staff in the home supported by members of the multi disciplinary team. Care plans are in place, to assist staff to deliver the care. The practices and supporting records in respect of medications ensure that residents receive the correct medication at the correct time. Evidence: Residents health care is well met by staff in the home and the multidisciplinary team who work alongside them. There are good staffing levels in this home with additional support staff such as those who assist at mealtimes and with activities. The home is well supported by then multi disciplinary team and records of their visit were in residents files. The home has no male care workers, which may pose problems for gender care preferences. This had been commented upon at the last site visit . The manager advised us that there were no residents who wanted male workers to address their Care Homes for Older People Page 13 of 30 Evidence: care needs There are other male staff in the home, although not employed for care work. This should be reviewed to ensure choice can be provided in the event that a resident wants a male carer. The lack of male carers was referred to in one comment card as follows having a male carer to do the more personal hygiene I think would be more acceptable. We observed the care given to residents during our visit. It was obvious that residents were well cared for as they were well presented, staff were attentive, caring and showed patience. The expert by experience spent a long time observing and engaging with the residents and relatives who were visiting, and made the following comments: A resident we met in the corridor told me happily Its lovely here. One step short of heaven. Another resident, told me The staff are nice here, they listen to you. We were pleased to observe carers rushing to help a resident on Florence who was coughing, by altering the tilt of their hydrotilt chair to sit them more upright. We also watched another carer, on Isobel interacting with a resident with dementia, who was a little restless. The staff member was very pleasant toward the resident and we later saw the residents daughter and grandson who both said how much they liked the home. The resident said Its lovely here. So clean and tidy. The wife of one resident was extremely fulsome in praising the carers and the home. The care plans set out a summary of needs, which was in the form of a statement of the actual issue with supporting risk assessments. This is not the standard way that care plan are usually presented although this format works in the home and is well established. Staff are well used to the format and know how to get the information they need to deliver the care. The issues were set out using the activities of daily living with the interventions to address the problem. There was good information in the interventions section from which staff could deliver the care . Some problems had very detailed care interventions to meet the residents specific needs. The care plans had good information included in the reviews and updates were made when new problems were identified. Risk assessments covered issues relating to manual handling, nutrition and behavior. These were reviewed as residents care dictated. The daily events were completed although even in those care plans where the resident had a diagnosis of Dementia then there was little reference to psychological needs. Care Homes for Older People Page 14 of 30 Evidence: This needs to be included as it is an important part of the residents presenting problems. Care logs are used to record the actual care given, those seen were completed. The following were two comments included in comment cards we received : The care and service is very good .The staff seem to be highly respectful to the resident , giving encouragement to do as much as they are able, for themselves. All the staff are beautiful and they care for my mother with dignity and respect. The medications were inspected. These had significantly improved from the previous site visit. There is a medication policy that is available to all staff. Only staff who are trained in medication administer medications. Recently all staff had been updated in medication procedures and this had included a review of the current policy. Medication administration charts were completed with the residents allergies and a clear photograph was attached. Those records inspected showed no gaps in them. Eye drops were dated on opening. Records for medication disposal and those received into the home were available. There is a double check of medications received int the home, where by the prescriptions are checked upon receipt, then these are cross checked with the medications once they are delivered. This is time consuming but lessons the likelihood for errors to occur. Storage of medication is provided in a clinical area which is equipped with a drugs fridge and sufficient storage for medications. The temperatures of the fridge are checked daily to ensure medications are stored at the correct temperature. Since the last inspection a new controlled drugs cupboard has been provided. Those medications which were stored in the cupboard were found to be correct with accurate supporting records in place. Full instructions were recorded when as required medications are to be given, and two signatures confirmed this information when hand transcriptions are used on drug charts. Care Homes for Older People Page 15 of 30 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. There are a wide range of entertainment provided including group activities with sufficient staff to undertake them. Choices are provided which means residents are enabled to input into their day. This promotes residents independence and enhances individuals well-being. Evidence: Activities are provided in this home including regular sessions, trips out and any others organised by families. It was evident during the observation periods that staff enabled, supported and assisted residents to maximise their independence whilst promoting choices and preferences. It is accepted that there are residents who do not wish to participate in activities and this is their choice. It is not possible to provide one to one activities to all residents, but the home endeavours to provide a wide and varied choice of entertainment which is age appropriate. Visiting is open, and many came and went throughout the course of the day. The expert by experience spent the majority of her time with residents on the different Care Homes for Older People Page 16 of 30 Evidence: units in the home she gave the following report. I observed lunch being served on Florence, where the residents are dementia clients in later stages. All the meals served were pureed or soft, and one resident was assisted solely by their relative. They commented that the food was always imaginatively presented even when it was intended for late stage clients, and they complimented the cook for this. Both carers who were assisting feeding residents at lunchtime, were extremely patient with the residents, soft toned and gentle. I would have been happy for any relative of mine to be in their care. I thought their manner toward the residents was excellent. The mealtime was unhurried and the residents made good progress with their lunches. Gentle classical music was playing in the background, which was pleasant. I believe it would have been better for more carers to be helping at this meal as both carers had two residents to feed and one resident was fed by their relative. I was impressed by the way in which the carers at lunchtime interacted with residents. The manager showed me a weekly activity programme for Beechmore. The home has its own minibus, which is used to transport residents to church on Sunday and for other trips. A recent trip had visited Knole Park, but the manager said that Outings are a problem, people dont want to go. On the day of the visit, Bible Study was programmed for the morning and I understand about eight residents attended this. Hand massages were scheduled for the afternoon. There seems to be a reasonable amount of variety in the activity programme, but I would suggest that more needs to be done for those residents who do not wish to attend an activity such as bible study or for whom this activity would be too difficult, such as some of the residents with dementia. I did not actually see any organised activity taking place during my visit of some hours, but volunteer who comes in one day a week, had been out shopping for grapes for a resident and for some decorative garden windmills. On her return she came into the Brooker lounge and chatted to the resident. The relative of a resident s on one of the units told me that she thought there was enough activity there at least for the late stage clients. They were extremely pleased with the home and could not praise it highly enough saying The staff are very good here, so caring. Care Homes for Older People Page 17 of 30 Evidence: Another resident said I dont ask for much but it is sufficient for my needs. When you come to a home you do not expect much. You put up with it or you go elsewhere. I wonder if more could be offered for this resident. They seem to have rather low expectations and was putting up with rather than heartily enjoying their time, it seemed. Another resident, said there was not much for them to do now that their sight had deteriorated. I just listen to the radio and go to sleep. When I was a hundred there was a party for me. I was speaking to them in the lounge area at the time of this remark. There was no music playing at the time or anyone else talking to them. An elderly gentleman sitting in the lounge area wanted to read his daily newspaper but was not helped to do this. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with information on how to make a complain and records are retained. Staff had sufficient knowledge in respect of adult protection and whistle blowing to afford sufficient protection to residents Evidence: Residents and relatives are provided with information on how to raise a concern although this home has very few complaints. The home has policies and procedures in place to deal with concerns and complaints. The policy provides information on what do do if you have a complaint and indicates that complaints will be responded to within 28 days. The information also gives details of external bodies where complaints can be referred to this included the CQC. It must be made clear that the CQC does not lead on complaints as it is the Regulator of the service. and this may cause a conflict of interest. The policy needs to be reviewed to reflect this. The residents and relatives spoken to felt they were able to raise complaints without fear of reprisal. They indicated that they would refer these to staff in the home whom they felt were very approachable. Care Homes for Older People Page 19 of 30 Evidence: The home has a book specifically designed for logging all complaints This includes all of the sections required to audit complaints including details of the concern, action taken and outcome. There are also policies and procedures for dealing with abuse an whistle blowing. These were last updated 2005, and will need to be reviewed as practises and reporting of such matters has changed. It must be made clear in circumstances where suspected or actual abuse has taken place then the safeguarding procedures must be put into operation and the home must not start to investigate the matters. It will be the safeguarding team who will decide on who should undertake the investigation. The staff were asked about how they would action suspected or actual abuse and also what they understood whistle blowing to mean. The staff all demonstrated an adequate knowledge of the subject some having considerable more than others,all did know that they must report these matters to senior people. During supervision sessions the manager advised us that staff have the procedures for protecting vulnerable adults continually reinforced. Training on the subject has been conducted by an external trainer and the topic is also covered at induction. All staff are subject to POVA first and CRB clearance prior to them starting work Care Homes for Older People Page 20 of 30 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 are provided with a good standard of accommodation. Sufficient equipment is provided to meet residents needs. Communal space provides residents with comfortable homely areas where they can spend time. Evidence: The home was pleasant, clean, tidy and hazard free in all areas that we viewed. Residents said they liked their surroundings and several choose to spend time in their bedrooms instead of the communal areas. There is a significant amount of equipment provided, particularly items for mobility and transfer of residents and pressure relieving mattresses. There are several areas where residents can spend time, lounges, quiet areas as well as their own bedrooms. Communal areas are homely and domestic in style where residents and their families can spend time. The following is the report made by the expert by experience: The bedrooms all looked light and pleasing and the large dining room come lounge on Brooker unit looked spacious and yet well proportioned. At the edge of this room a small conservatory adds extra space for the residents and provided a good growing Care Homes for Older People Page 21 of 30 Evidence: room for some tomato plants! More a comment than a criticism: I think the conservatory would become very hot when the sun shines and I wonder if any thought has been given to putting in some blinds or other shading material? This should be reviewed . On Florence and Isobel Units the living areas are smaller and more personal, which I think would be welcome for people with dementia. In the living room on Florence there were some hydro lift armchairs in use, which provided comfortable adjustable support for frailer residents and could also be wheeled around the home and into lifts. These chairs look like a significant improvement on other alternatives and I was pleased to see them in Beechmore. Upstairs on Brooker there is a small lounge which is used for serving breakfasts, I believe. This room seemed over-crowded with armchairs and other equipment. During the morning one resident was sitting watching television, but with some thought and re-arrangement of furniture, the room could be made more inviting for other residents too. Some of the other chairs in use looked rather tired, and could do with refurbishing, but overall the impression of the surroundings in Beechmore was very favourable. Care Homes for Older People Page 22 of 30 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 provided in sufficient numbers to meet all of the residents needs and address care in a personal unhurried manner. Staff are subject to robust recruitment procedures which means that they are safe to work in the home. Staff are provided with sufficient training and induction to enable them to undertake the work they perform and provide residents with the support they need. Evidence: We met with staff during our visit and observed their care and attention when dealing with residents. As previously detailed staff were seen to be very caring particularly as this home has some very heavily dependent residents. The staff team in this home are fairly stable many have been in post for several years. If vacancies do occur then the home has a pool of bank staff and on rare occasions uses agency for cover. During staff interviews they were asked on various topics relating to their work in the home and residents conditions,topics discussed included infection control and dementia. The level of knowledge was variable some staff had a very in depth Care Homes for Older People Page 23 of 30 Evidence: knowledge others basic,although sufficient to carry out their day to day roles. One staff member was particularly hard to communicate with and this may be a problem when dealing with elderly resident who have impairment. The manger was aware of this staff member and had decided because of their very caring and capable manner with residents, then support for them would be provided in respect of extra language tuition. Staff felt that training had improved and apart from the mandatory topics and updates subjects such as Challenging Behaviour, Dementia , Mental Capacity Act, End of Life Care and POVA were recent courses. One staff member said about staff,that they were constantly training . An agency worker confirmed they had received a short induction on their first shift and had been asked for her photographic identity. They were unaware of what other checks the home had made in respect of their working in the home. The home must satisfy itself that any staff member working in the home is safe and suitable to do so and therefore should not rely on other agencies to confirm this. They should look at a way of verifying the staffs ability to work in the home, and satisfy themselves of the checks made through the agency. The management team are the people who provide supervision to the staff . The supervisor home asked us about doing group supervision with staff. As long a as the principals of standard 36.3 are applied and nothing relating to confidential matters is discussed then this may be a more workable option for the number of staff employed. 1 : 1 supervision can be time consuming and become repetitive and this may be a better way of addressing it. The expert by experience had very positive feedback regarding the staff as follows: It felt as if the carers I saw were high quality and many of the residents have been living there for over ten years. I am not surprised that there is a waiting list for places here. There was universal satisfaction from the relatives to whom I spoke and I could see why they liked it. Several of the staff we spoke to had completed their NVQ training. The manager advised us that 80 per cent of staff had completed this qualification. We sampled staff personnel files for inspection, including that of a newly appointed care workers.In the files that we viewed there were the application forms, records relating to interview notes, equal opportunities monitoring, two references and Care Homes for Older People Page 24 of 30 Evidence: identification checks. A selection of training certificates were included in the files, and reflected recent mandatory updates as well as other training topics. The CRB and POVA first were available to view although securely stored at all times. Once a sample of these have been checked by the CQC then they should be carefully disposed of as these are confidential documents. Personnel files were organised and the information easily accessible, these too were safely stored. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced individual who is a qualified nurse. The home operates an open door policy to promote transparency and openness. Health and safety servicing and maintenance are addressed to ensure the home is safe for residents to live in and staff to work in. Quality assurance measures have improved which will benefit residents and all those who have input into the service. Evidence: The Manager has been on the staff for about fourteen years, seven years in charge. She is a qualified nurse. In addition she has completed the NVQ assessors course D32/33. She has a good knowledge in the workings of the home and care of the elderly and is very experienced. The supervisor has been on the staff for nine years, three years in her current Care Homes for Older People Page 26 of 30 Evidence: position, and has almost completed her RMA . She works in support of the manager to ensure that sufficient management cover is provided. The home has a supportive management committee as well as relatives who regularly visit the home and assist with activities and fund raising events. All areas in the home appeared safe and hazard free. There were first aid boxes available in different areas with appropriate items in them. A selection of health and safety maintenance records were inspected and found to be satisfactory. All equipment in the home is on a service contract for regular maintenance. Recent service visit reports for the gas, electrical and lifts were available. Those records for fire prevention included service records for the fire alarm, emergency lighting and extinguishers and these were current. The fire risk assessment was reviewed May 2009. Weekly fire alarm tests, as well as checks to fire doors, were recorded. Fire training records showed regular training and staff attendance confirmed by way of the staff members signature. The Regulation 26 visits are conducted by the Chairman and the reports were on site. We were advised that these visits are unannounced. The reports included residents views on the home, staff comments, and a tour of the premises. There were minutes of a residents meeting held May 2009 - this, we were advised is usually an annual forum. Only two meeting held with staff had the minutes available although the manager advised many informal meetings took place. Relatives meetings are not held as the management offer an open door policy at any time. In addition the manager is on call seven days a week for any queries. The manager had conducted a residents /relatives and health professionals survey between January and May 2009. A report was produced outlining the findings which were very favourable. A sample of the questions asked was available ,and it indicated that there were different questions for residents, relatives and members of the multi disciplinary team. The quality assurance measures have improved and this should be continued to ensure opportunities are provided for input into the service. Care Homes for Older People Page 27 of 30 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 28 of 30 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 18 13 The policies and procedures must be updated to reflect current practice To enable staff to take the correct course of action should this occur 30/10/2009 2 24 23 Adequate shade and heat controls must be in place in all parts of the home To ensure that residents areas are kept at an ambient temperature for residents comfort. 30/09/2009 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 33 Quality assurance measures should be further developed so that views on all aspects of the service are obtained. Care Homes for Older People Page 29 of 30 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. 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