Care Home: Belgarth Nursing Home

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What the care home does well One visitor said `the home is well run by the manager who is supported by caring and helpful staff`. People were given clear information about services offered at Belgarth to help them to decide whether it was the right place for them to stay. Detailed information was collected from various sources about new residents before they were admitted to the home; this would help to determine whether their needs would be met. People were happy with the care and support they received. Residents and their relatives said staff listened to them and acted on what they said. One relative said `my wife is well looked after by all the staff and could not get better care anywhere else` and another said `I am happy with the care, they look after my husband very well`. One resident said `I am looked after properly` and another said `I need a lot of help and the staff make sure I am comfortable`. Useful information had been collected about residents routines, preferences, likes and dislikes and residents said staff listened to them and acted on what they said; this would help to ensure they received the care and support they both needed and wanted. Records showed that residents were offered a choice of appetising and nutritious meals. Comments included `the food is always nice and hot`, `the food is satisfactory, I cant grumble`, `the food is not always to my liking but there is always something else to eat`, `I like the food` and `I enjoy the food, there is always a choice`. There was a clear complaints procedure and records of any complaints or concerns that had been raised. People knew who to speak to if they were unhappy and staff were aware of how to respond to complaints and concerns; this would ensure people would be listened to. Staff were competent, supported and provided in sufficient numbers to meet the needs of the current residents. Staff said staffing levels had improved and the staff team was `more stable`. Staff were provided with regular training that would help them to protect residents and recognise and respond to any reports or suspicions of abuse or neglect. The home was well maintained, safe, bright and comfortable with a development plan to support ongoing improvements; this would ensure residents were provided with a pleasant place to live. Residents were happy with their rooms which were clean and bright; some had brought in personal items to enhance the homely feel. Comments from residents included `my room is fine, everything I need is here` and `I like my room it is convenient to the lounge and bathroom`. Most staff had achieved a recognised qualification in care and others were working towards one; this would give them the skills and knowledge to meet peoples needs and showed the organisation was committed to improving standards of care. People made positive comments about the staff including `the staff are very good to me`, `the staff are very helpful` and `I have a good rapport with the staff`. Records supported that systems and equipment were safe and well maintained. Staff had been provided with regular training that would keep themselves and others safe. What has improved since the last inspection? The provision of suitable activities and entertainments had improved and would help to meet residents social needs and expectations. The way the home managed medicines had improved and would reduce the risk of error and mis handling. The adult protection procedures provided useful information for staff and would help them to recognise and respond to any reports or suspicions of abuse or neglect; staff had received training to support them with this. Staff and residents said routines were flexible and they were able to make choices in a number of areas such as meals, routines and how they spent their day. Comments from residents included `I can do mostly what I want` and `you can have a walk around and go where you want`. The recruitment procedures had been followed and reduced the risk of residents being cared for by unsuitable people. Residents were encouraged to participate in the annual survey and meetings had been arranged to allow relatives to air their views and opinions about the service. What the care home could do better: The lack of detail in the care plans could result in residents needs not being met and should reflect the care that was being given; this would ensure residents received the care they needed. Residents and their relatives should be involved in the development and review of the content of the care plan; this would ensure residents received the care they needed and wanted and would give them the opportunity to be involved in decisions about their care. There should be systems to monitor all aspects of staff practice and whether residents needs were being met; this would help to identify any shortfalls in record keeping and care practices and could be used to improve the service. Key inspection report Care homes for older people Name: Address: Belgarth Nursing Home Wheatley Lane Road Barrowford Nelson Lancashire BB9 6QP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marie Matthews     Date: 1 2 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Belgarth Nursing Home Wheatley Lane Road Barrowford Nelson Lancashire BB9 6QP 01282699077 01282619030 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bellgarth Care Home Limited Name of registered manager (if applicable) Mrs Lynne Margaret Markham Type of registration: Number of places registered: care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To people 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, Dementia - Code DE, Mental disorder, excluding learning disability or dementia - Code MD. The maximum number of people who can be accommodated is: 47. Date of last inspection 2 1 0 7 2 0 0 9 47 47 0 Over 65 0 0 47 Care Homes for Older People Page 4 of 28 Brief description of the care home Belgarth is an extended detached older building situated on the outskirts of Barrowford, approximately one and a half miles from Nelson centre. The home is registered to provide both nursing and personal care for twenty-two people who have physical and care needs and for twenty-five people with a dementia or a mental disorder. Facilities are on two floors with a passenger lift to access the first floor. The home has garden and patio areas for people to enjoy and provides a parking area for visitors. Information about the services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £438.00 to £587.00. Items not included in the fee include newspapers, hairdressing, chiropody and escorted hospital visits. 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: The key unannounced inspection, including a visit to the home, took place on 12th May 2010. The last inspection on this service was completed on 21st July 2009. The inspection process included looking at records, a tour of the home, discussions with the registered manager, deputy manager, one care staff, two visitors and seven residents. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the last twelve months and where further improvements were needed. Information was also included from surveys completed by five residents and two staff. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? The provision of suitable activities and entertainments had improved and would help to meet residents social needs and expectations. The way the home managed medicines had improved and would reduce the risk of Care Homes for Older People Page 7 of 28 error and mis handling. The adult protection procedures provided useful information for staff and would help them to recognise and respond to any reports or suspicions of abuse or neglect; staff had received training to support them with this. Staff and residents said routines were flexible and they were able to make choices in a number of areas such as meals, routines and how they spent their day. Comments from residents included I can do mostly what I want and you can have a walk around and go where you want. The recruitment procedures had been followed and reduced the risk of residents being cared for by unsuitable people. Residents were encouraged to participate in the annual survey and meetings had been arranged to allow relatives to air their views and opinions about the service. 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 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 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 9 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 were provided with information about the home that helped them to decide whether their needs would be met. Residents needs were assessed prior to admission and staff had the skills and experience to look after people properly. Evidence: People were given clear information about services offered at Belgarth to help them to decide whether it was the right place for them to stay; the manager advised that the information could be made available in other formats. There was also a web site where people could see the facilities on offer at Belgarth. Each resident had a signed copy of their contract or terms and conditions with the home; this would ensure residents and their relatives were aware of their rights and responsibilities whilst living at Belgarth. Detailed information was collected from various sources about new residents before Care Homes for Older People Page 10 of 28 Evidence: they were admitted to the home; this would help to determine whether their needs would be met. Residents and their relatives were involved in the assessment process; this would ensure all aspects of their needs were considered. The manager confirmed that prospective residents and their relatives would be invited to visit the home, view the facilities and meet with staff and other residents before making a decision to live there; this would help people to decide whether Belgarth was the right place for them. Records showed that staff had received appropriate and regular training to give them the skills and experience to meet the needs of the residents in the home. Three staff said they were given relevant training whilst one said the training was not relevant. Care Homes for Older People Page 11 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. The care plans did not always reflect the care that was being given and the lack of detail could result in residents care needs not being met. Medication procedures provided staff with safe guidance and practices had improved. Evidence: Four care plans were looked at in detail. It was clear from observation of care practices and discussion with staff, residents and their visitors that staff knew what care and support residents needed but the records did not always reflect the care that was being given to meet residents needs. The care plans had been reviewed each month but it was not clear whether residents and their relatives had been involved in the development and review of their care; people should be involved in decisions about their care to ensure they receive the care they both need and want. Staff had started to collect useful information about residents routines, preferences, likes and dislikes although this was not always filtered into the care plans; this information would help to ensure they received the care and support they both needed and wanted. Care Homes for Older People Page 12 of 28 Evidence: Residents were provided with a range of aids and adaptations to improve their comfort and safety and to help maintain their independence wherever possible. Consideration had been given to providing residents with appropriate equipment to meet their needs in a safe way. The use of bed rails was assessed and kept under review but the resident or their relatives had not agreed to the use of this method of restraint. Any risks to residents had been assessed and appropriate action had been taken to keep them safe; however the information in the care plans did not always reflect the care being given. Residents health had been monitored and appropriate advice and support sought as needed. Registered nurses were available twenty-four hours a day and care staff were trained in health care matters; this would ensure that any changes to residents health and well being would be recognised and responded to. One resident said they call the doctor if I need him. People were happy with the care and support they received. Residents and their relatives said staff listened to them and acted on what they said. One relative said my wife is well looked after by all the staff and could not get better care anywhere else and another said I am happy with the care, they look after my husband very well. Two relatives said they were kept up to date and informed of any changes. One resident said I am looked after properly and another said I need a lot of help and the staff make sure I am comfortable. There were no systems in place to monitor the content of the care plans; the manager advised that an audit system was due to be introduced (see standard 33). The manager advised that the medication procedures had been reviewed to provide staff with safe guidance and to respond to concerns raised at the last key inspection. Storage was secure and appropriate and records were accurate which showed that residents medicines were managed safely. It was recommended that permission, to take over the management of residents medicines, was obtained from the resident or their relatives. It was also recommended that as directed instructions were removed from the medication administration record and replaced with clearer instructions where necessary. There were still no systems in place to monitor whether residents medicines were being managed safely; the manager advised that an audit system was due to be Care Homes for Older People Page 13 of 28 Evidence: introduced (see standard 33). Staff had received training to help them to understand rights, privacy, respect and dignity. Staff were observed responding to residents and visitors to the home in a friendly and respectful manner. Care Homes for Older People Page 14 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. The provision of suitable activities had improved which would help to ensure that residents social needs and expectations were met. Residents were provided with a nutritious and healthy diet that met their dietary needs and expectations. Evidence: An activities person provided a range of suitable activities to meet residents social needs and expectations either individually or as a group. The activity records had improved although they still indicated that residents went long periods without any activity; it was suggested that entertainments and activities provided by external visitors should also be recorded. Useful information regarding residents preferences, routines and interests was being collected and should be included in a plan of care; this would help to plan suitable and meaningful activities for individual residents. Information from resident and relatives surveys indicated that the provision of activities had improved; comments included I enjoy my TV from 6pm and staff make sure its turned on, there are plenty of things going on but I sometimes like to watch rather than join in. Comments from staff included the activities have improved, there is more going on, Care Homes for Older People Page 15 of 28 Evidence: its much better and the scope of activities could be improved. On the day of the visit residents on both units were enjoying large floor games, watching TV, one to one chats and reading newspapers or reminiscence magazines. Some residents were able to make choices and decisions and some said staff listened to them; other residents had to rely on staff to make the right decisions for them. Staff and residents said routines were flexible and they were able to make choices in a number of areas such as meals, routines and how they spent their day. Comments from residents included I can do mostly what I want and you can have a walk around and go where you want. Since the last inspection visit the care practices, staffing numbers and working patterns had been reviewed to allow residents more choice and flexibility. Residents were able to stay in their bedrooms or sit with other residents in lounge or dining areas. One staff said residents were offered more choices. Visitors were made to feel welcome and staff responded to them in a friendly and respectful manner. Two visitors said they regularly visited and were always welcomed by staff and were offered a drink or a meal. Records showed that residents were offered a choice of appetising and nutritious meals; residents and staff confirmed this and said there were also alternatives to the menu. Residents were happy with the meals and comments included the food is always nice and hot, the food is satisfactory, I cant grumble, the food is not always to my liking but there is always something else to eat, I like the food and I enjoy the food, there is always a choice. Two residents said they enjoyed the weekly fish and chip supper from the local chip shop. There was a small kitchenette where visitors were able to make their own drinks and which was fully stocked each day to ensure residents had enough to eat throughout the night. Hot and cold drinks and snacks were served throughout the day and night and there were records to support this. The lunchtime meal was hot, nutritious and well presented and residents said they enjoyed it. Staff gave residents unhurried assistance and support ensuring they had time to enjoy their meals. Special diets were catered for and staff were aware of residents food preferences; this ensured residents dietary needs and preferences were met. Care Homes for Older People Page 16 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. People were protected by the organisations procedures and staff knowledge. Evidence: There was a clear complaints procedure which was issued to people at the time of admission and displayed around the home; this informed them how to make a complaint and what to expect. Records had been maintained and showed that any concerns or complaints had been responded to properly; in the past twelve months there had been five complaints, two of them had been upheld. Complaints were monitored each month by the regional manager and the information was used to improve the service. Information from surveys and discussions with residents and visitors supported that people knew who to speak to if they were unhappy with the service. Staff were aware of how to respond to complaints and concerns; this would ensure people would be listened to. The adult protection procedures provided useful information for staff and would help them to recognise and respond to any reports or suspicions of abuse or neglect; staff had received training to support them with this. Safeguarding adults had been Care Homes for Older People Page 17 of 28 Evidence: discussed with staff at meetings which would help keep them up to date with current guidance. Thorough recruitment checks were in place which would help to protect residents from being cared for by unsuitable people. There were procedures to support staff with reporting any poor practice within the organisation; this would help to protect residents from harm or neglect. There were procedures to support staff with dealing with aggression and the use of restraint measures. The use of bed rails had been assessed and kept under review which would help to determine whether this form of restraint was appropriate. However records did not support that any discussions had taken place with residents or their relatives; people should be involved in decisions about their care (see standard 8). Staff had been provided with training in the Mental Capacity Act and Deprivation Of Liberty Safeguards; this would help them to understand and make appropriate decisions for some how residents in their care. There were no procedures to support staff with the management of residents finances; the procedure would support staff with safeguarding residents monies. Care Homes for Older People Page 18 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. The home was safe, clean, comfortable and well maintained. Evidence: During a tour of the home it was clear it was well maintained, safe, bright and comfortable with a development plan to support ongoing improvements; this would ensure residents were provided with a pleasant place to live. It was recommended that the requests for repairs book was dated when work was completed; this would help to ensure work was completed in a timely fashion. The radiator covers need to be replaced on the first floor as they are damaged and do not provide residents with protection from hot surface temperatures. Grounds were safe and accessible and seating was available for residents and their visitors to enjoy the gardens in the warmer weather. The home complied with the requirements made at the last visits from the fire safety officer and environmental health officer. The home comprised of a general unit where residents received nursing or personal care support and a dementia unit for residents with deteriorating mental health. Key codes were in use to provide residents with a secure and safe environment; some residents and their visitors were able to access all areas. Care Homes for Older People Page 19 of 28 Evidence: Comfortable, spacious communal areas and quiet seating areas were provided around the home; this gave residents and their visitors a choice of where to sit and chat. There was a seperate sensory room on the dementia unit where residents could sit quietly and enjoy the benefits of calming music and lighting. A number of bedrooms were equipped with en suite facilities however there were bathrooms and toilets located close to bed rooms and communal areas. All rooms were fitted with a nurse call unit which enabled residents to call for assistance from staff; any calls were answered promptly and one resident said I press the buzzer and staff come quickly. The home was equipped with specialist equipment and adaptations to meet residents individual needs and maintain their comfort. Residents were happy with their rooms which were clean and bright; some had brought in personal items to enhance the homely feel. Bed room doors were fitted with suitable locks and each room had a secure drawer for storage of valuables; keys were available and this respected residents rights to privacy. Comments from residents included my room is fine, everything I need is here and I like my room it is convenient to the lounge and bathroom. The home was warm, clean and bright; residents said the home was fresh and clean. There was a suitably equipped laundry and residents were dressed appropriately in their own clothing. Care Homes for Older People Page 20 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. Staff are suitable, competent and provided in sufficient numbers. Evidence: Staffing rotas were clear and showed there were sufficient staff to meet the needs of the current residents and shortfalls had been covered, where possible, by existing staff; this would ensure residents were looked after by staff who knew them. Staff, residents and visitors said there were enough staff and any requests for assistance were responded to. Staff said staffing levels had improved and the staff team was more stable. People made positive comments about the staff including the staff are very good to me, the staff are very helpful and I have a good rapport with the staff. Three staff files were looked at in detail and showed that a safe recruitment process had been followed; this would help to ensure that residents were protected from unsuitable people. Most of the staff had achieved a recognised qualification in care and other staff were working towards one; this would give them the skills and knowledge to meet peoples needs and showed that the organisation was committed to improving standards by providing competent staff. Care Homes for Older People Page 21 of 28 Evidence: There were records to support that all staff were provided with a range of relevant training and support to give them the skills and knowledge to help them meet residents needs. Two staff confirmed they were given relevant training although one staff survey indicated the training could be improved. New staff received an introduction to the home and were initially supported by staff until they had the skills and confidence to work safely and independently. Staff met with their manager on a regular basis; this would help to monitor their care practices and to identify any need for additional training and support. Staff met regularly as a group to ensure they were kept up to date and given the opportunity to air their views. Care Homes for Older People Page 22 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. The home is safe and there are systems to measure whether peoples needs and expectations are being met Evidence: The registered manager is Mrs Lynne Markham; she has the required qualifications and experience to run the home. Mrs Markham is supported by a senior manager and her practice is monitored at regular intervals. She is able to meet and discuss any issues with other registered managers within the organisation and is kept up to date with changes to legislation and the organisations plans for the future. One visitor said the home is well run by the manager who is supported by caring and helpful staff. Relatives and residents were due to participate in an annual survey; the results of the last survey had been made available to visitors to the home. Also a meeting had been held for visitors and any residents who wished to participate; this allowed people to air Care Homes for Older People Page 23 of 28 Evidence: their views and opinions and to become involved in decisions about how the home was run. The home had achieved the Investors In People award; this is an quality assurance award accredited by an outside body and demonstrates a commitment to staff training and development. Policies and procedures had been reviewed and updated to provide staff with safe guidance; staff were also issued with company handbooks to support them with their work at Belgarth. The organisation was due to introduce systems to monitor all aspects of staff practice and whether residents needs were being met; audits would help to identify any shortfalls in record keeping and care practices and could be used to improve the service. There were records to support regular visits from a senior person in the organisation; records supported that the management of the home was monitored. Financial records were clear and showed that residents finances were managed safely; although there was no procedure to support staff with safe practice (see standard 18). Records were stored safely and were generally accurate; any concerns regarding records had been referred to under individual standards. Requirements and good practice recommendations made following the last key inspection visit had been responded to; this showed that the home was committed to improving standards. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the past twelve months and where further improvements were needed. Records supported that systems and equipment were safe and well maintained. Staff had been provided with regular training that would keep themselves and others safe. Care Homes for Older People Page 24 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 25 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 7 15 The care plans must set out in detail the action to be taken by staff to ensure all aspects of residents needs are met. This will ensure that staff will fully understand how residents needs will be met. 21/06/2010 2 8 13 The care plan must include details of any action to be taken to reduce or remove any identified risks. This will ensure residents are protected. 21/06/2010 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 7 The care plans should include information about residents routines, preferences, likes and dislikes; this would help to ensure they received the care and support they both needed and wanted. Care Homes for Older People Page 26 of 28 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 2 7 Residents and their relatives should be involved in the development and review of their care; this will ensure they receive the care they both need and want. The use of bed rails should be agreed with the resident or their relatives. Residents or their relatives should give their permission for staff to take over the management of reisidents medicines. As directed instructions should be removed from the medication administration record and replaced with clearer instructions. Information regarding residents preferences, routines and interests should be included in a plan of care; this will help to plan suitable and meaningful activities for individual residents. There should be a procedure to support staff with the management of residents finances; the procedure would support staff with safeguarding residents monies. The maintenance book should be dated on completion of any work requests; this will help to ensure that work is completed in a timely fashion. The damaged radiator covers on the first floor need to be replaced; this will help to protect residents from any harm. 3 4 5 8 9 9 6 12 7 18 8 19 9 25 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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