Care Home: Bevan House

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Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bevan House Stackwood Avenue Barrow in Furness Cumbria LA13 9HQ     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: Marian Whittam     Date: 0 3 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Bevan House Stackwood Avenue Barrow in Furness Cumbria LA13 9HQ 01229894547 01229894550 Telephone number: Fax number: Email address: Provider web address: www.cumbriacare.org.uk Name of registered provider(s): Name of registered manager (if applicable) Miss June Patrice Fitzpatrick Type of registration: Number of places registered: Cumbria Care care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies 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: 40) Dementia - Code DE (maximum number of places: 15) The maximum number of service users who can be accommodated is: 40 Date of last inspection 15 0 Over 65 0 40 Care Homes for Older People Page 4 of 28 Brief description of the care home Bevan House is a care home registered to provide care for 40 older people, 15 of whom may have dementia. The home is in a residential area of Barrow in Furness, close to a local bus route into Barrow and to surrounding areas. The home has a car park to the rear of the building and there are patio areas for residents to use. All of the homes 40 bedrooms are single rooms and the home is divided into five units for residents. On the first floor are Langdale, Abbey and Furness units and on the ground floor are Piel and Ramsden units where up to 15 people with dementia live. Each unit has a non- smoking lounge and dining area with a small kitchen attached, a bathroom and 2 separate toilets. The home has a main kitchen and a large ground floor lounge for communal activities. Information is available to prospective residents in the combined Statement of purpose and service users guide; this is available in different formats and displayed in the home. A copy of the last inspection report is also available. The fees charged by the home range from 414.00 pounds to 504.00 pounds per week as at the date of the inspection and an additional charge is made for personal toiletries, newspapers, magazines, also hairdressing and private chiropody services and any personal travel expenses, according to information provided during the inspection. 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: Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 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 8 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. Bevan House has admission and assessment procedures in place to help make sure that peoples individual needs and preferences will be met when they come to live in the home. Evidence: All the people living at Bevan house are provided with information about the home when considering coming to live there. The home has a statement of purpose and service user guide available in the home and the most recent inspection reports are available. If requested the manager can provide this information in different formats to aid peoples understanding. Information is displayed in the foyer of the home that may be useful to people using social care including on fees and funding care, the Alzheimers Society, individual rights and deprivation of liberty. People considering living there, and their families, are encouraged to visit the home and look around. The home does take people for respite care and for some people this helps introduce them to the idea of residential care at a later date. Care Homes for Older People Page 9 of 28 Evidence: We looked at peoples pre admission assessments and five peoples in detail. This was to see if peoples needs were being fully assessed before they came to live there and the manager was sure the home had the facilities and resources to fully meet that persons needs. The manager and senior staff undertake the assessments of need and a copy of social services care management plans are kept on file and used in the overall assessment. The service has made improvements to its pre admission assessments and we could see that all relevant areas had been assessed and it had been completed with the person, their relatives and any professionals who are involved. They were sufficiently detailed and had information from the individuals perspective to give staff an insight into the persons needs and preferences about the support they require and how they like to live their lives. Care Homes for Older People Page 10 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. People living at Bevan House have their health and personal care needs met in a way that reflects their preferences and respects their privacy. Evidence: All the people living at Bevan House have an individual care plan based on initial needs assessments and risk assessments done before and on admission. The plans set out assessed health, personal and social care needs and we could see where they had been reviewed monthly and updated where needed. There have been continuing improvements in the care planning since the last inspection and they all now include a personal profile and more information about the individual, their interests, beliefs and personal background and how they preferred to be cared for and supported. Peoples particular wishes were included in their plans, some around the end of their lives and an all about me section had information on what was important to people in their lives. We asked people living there and their relatives about their care and the support people received from staff. People we talked with made positive comments about their Care Homes for Older People Page 11 of 28 Evidence: care and the support they received. One person told us they had a bath when they wanted or a good strip wash in my room and that they were quite satisfied and that staff were very helpful, I wont speak a word against them, theyre really kind and when they speak to you they have a lovely tone in their voices. Another commented, The home and support workers maintain my independence and personal space. From what we saw of positive staff interaction during the day and what people told us about living there the indication was that people felt generally well cared for and supported by staff and their privacy respected. Surveys we received from people living there also indicated that overall they received the care and support they needed. We looked at all the care plans and four peoples care plans in more detail. We found their plans covered information for staff on moving and handling needs, skin condition, mobility, nutrition, personal care, continence, communication and information on specific conditions and needs. Care plans generally reflected peoples individual preferences and how they wanted to be supported and cared for by staff. Appropriate equipment to prevent pressure sores is in use and effective nutritional screening is being done with peoples weights recorded and monitored. We examined medication policies and procedures, the storage of medicines and the recording and handling of medicines kept for people in the home. Our checks of the records and current stock showed that medicines were being given to people properly and accurate records were being made. We saw that sometimes staff need to make written changes to the records of medicines due to changes or new medicines being started, such as antibiotics. We recommended that when this is done it is good practice to get a colleague to check and sign the change. This check can help reduce the risk of any addition or change being written down incorrectly. We saw examples of some good practice in medication handling such as the use of protocols for medicines that need to be taken only as required. Good information on what the medicines are, what they do and when they should given helps make sure people only get them when they need them for a specific reason. Supervisors administer the medicines and had received training to do this and the home used a system whereby another staff member acts as a checker for medication rounds to help reduce the risk of any mistakes being made. people who wish to and are able are supported to be responsible for their own medicines which helps them retain their independence in this area of their life. We spoke with a person doing this and saw how they stored their medicines securely. They had a detailed risk assessment in place to support them and a record of the medical agreement with their doctor. The risk assessment had been reviewed and recently updated. The person told us they preferred to look after their own tablets but knew that the supervisor checks to make sure. Care Homes for Older People Page 12 of 28 Evidence: Referrals to doctors, district nurses and specialised services, such as the community mental health team are good and records are kept of what has been done or advised. This was evident for wound care and one person with particular dietary needs where staff had additional written information on appropriate foods. Care Homes for Older People Page 13 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. People living at Bevan house are able to take part in activities that suit their lifestyles and preferences. Evidence: Bevan House has open visiting and encourages relatives and friends to visit and people living there say there are no restrictions on when people can visit them. People are able to go out with friends and family and one person went out during the visit using their motorised scooter. The care plans show that information has been gathered about peoples preferred social, religious needs and general interests and what is important to them. This is useful information for promoting a person centered approach to supporting social activities, especially when a person has difficulty telling staff what they think or feel. The manager is aware of the need to continue develop the homes activities programme. The homes last satisfaction survey, done in April this year, highlighted that activities and recreation was an area that had a lower score in terms of peoples satisfaction. Our own surveys indicated this too and people commented on it when we talked to them. More than one person commented that they wanted,more activities, more stimulation. Some people we talked to preferred their own company and did not Care Homes for Older People Page 14 of 28 Evidence: want to take part in organised activities but told us they were always asked. We discussed social and recreational provision with the manager who was already addressing this need following the homes survey and trying to get families involved as well. The manager and staff had been working to improve the activities provision and put into practice the things people ask for, where they could. The manager has introduced chair aerobics provided through the links made with Age Concern. Themed evenings have also been started, one with Indian meals and the next planned as a Pizza night. These followed requests from people living there. Recently people living on the dementia unit had gone out for lunch at a nearby pub with one to one support from staff. This is positive as it allows people to still be part of their local community. Another day out was being planned to visit a local zoo, this takes some planning for the numbers, transport and to make sure people will be safe during the trip. People have access to the library for books and there are board games available on the units and main lounge. Some people had their own scrapbooks and some were working on their own life stories with staff. The manager has purchased a Wii interactive game for people to try to promote greater activity and involvement. More than one person told us they were looking forward to trying it out. We spoke with a group of people living at Bevan House whilst they sat in their unit lounge area. They told us there is much more going on than there used to be , there were arm chair exercises on Wednesday and bingo and music. They told us they had enjoyed the Indian curry night and the singing afterwards. There are multi denominational religious services on a monthly basis for anyone who want them and some people go out to worship in their own church. One person told us they had been baptised whilst in the home and had regular visits from their priest. They told us about the music and bingo and they played Scrabble and did crafts such as for their Easter bonnet competition. One person said they had not been on any trips out yet but it was being worked on. A relative we spoke with was pleased their relative had been able to go out for lunch and felt that ,The activities have definitely improved with the new manager. Records are kept of the things people have done and enjoyed and photographs are taken and displayed on the units for people to enjoy. We looked at the menus in use and these showed a variety of nutritious food and choice. Individual food preferences are recorded as well as special diets. The menus and food people want are regular topics at residents meetings. One person told us they had asked to have beetroot and this was served now, another said they had complained about lumps in the mashed potato and that had improved. Survey responses to us about meals indicated that overall peopleusually liked the meals in the home. We asked people what they thought about the meals provided we received a range of comments these included, The foods not bad and Its Ok and The food is not poor but it is mediocre and Get a better meat supplier. We suggest the Care Homes for Older People Page 15 of 28 Evidence: manager continues to consult with people on the menus. Dietary needs and preferences are clear in peoples care plans and peoples diets and food intake are monitored and records kept of food served. There is always at least two hot meals on offer at both lunch and tea and people told us they always had a choice. We saw staff going around in the afternoon asking people what they wanted next day. We observed different groups of people during lunch, which is served from hot trolleys on each unit. The mealtime was a relaxed social occasion with staff supporting people as their needs dictated. Some people had aids in place to maintain their independence at mealtimes such as plate guards. The range of support provided by staff ranged from verbal encouragement to assisting in feeding someone. However, whatever level of support a person required this was done in a calm manner that encouraged people to be independent. The service received a 5 star rating on its food safety performance from their last inspection. 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 living at Bevan House are being protected by effective complaints and safeguarding procedures, which are understood by staff. Evidence: The home has an appropriate complaints policy and procedure in place. This is in the service user guide and is available in the home for anyone to look at. It clearly explains the complaints process and timescales involved. However we could not see the procedure being displayed generally around the home on the units and recommend that this important information is made more widely accessible and in different formats on units. There was one recorded complaint and this is still ongoing and being investigated . One referral had been made to social services under protecting vulnerable adults procedure to uphold peoples welfare and interests. The manager is aware of her responsibilities and has worked closely with other agencies to maintain peoples safety. The home had also received compliments cards and letters from friends and families of people who had stayed in the home. Survey feedback to us confirmed that overall people living there are aware of how to complain or raise a concern and that staff listened to them. Care staff have been given safeguarding training helping them to identify potential or actual abuse and how to report it. We spoke with with staff individually as we went around the home and they confirmed they had been given training on abuse and protection and were able to explain their responsibilities in safeguarding people. Care Homes for Older People Page 17 of 28 Evidence: There are also procedures in place on whistle blowing to highlight poor practice or concerns. Staff we talked with felt the manager was approachable and would support them if they whistle blew on colleagues or managers. One staff member told us the manager listens and seems to get things done. 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. Bevan House is a clean and comfortable home for the people living there and has the equipment people need to help them be independent and mobile. Evidence: There is an annual programme for maintenance and upkeep of the premises. The organisation has an accommodation manager who works with the homes manager to complete an annual buildings survey and agree a programme of repairs and renewal to maintain the building. in the last year carpets and curtains have been replaced around the home and some units have been redecorated. Abbey unit has had a new kitchen and some new furniture has been provided. All areas of the home we visited were clean and hygienic and free from hazards or lasting unpleasant odours. Dedicated domestic staff make sure the home is kept clean and hygienic. People living there told us the home was kept clean and the surveys we got back supported this. There is a small laundry with industrial quality machines that ensure clothes are appropriately laundered and free from infection. The laundry was generally tidy and the walls and floors easily washable. There is sluice facility adjacent but it is separate from the laundry and there was no clean linen stored there. All care staff take responsibility for making sure the laundry is done and returned to people. The service has policies and procedures in place for infection control and health and safety and we saw staff using appropriate protective clothing for providing personal Care Homes for Older People Page 19 of 28 Evidence: care. The furnishings and decor on the units and communal areas are being maintained to a generally good standard and provide a safe and homely atmosphere. There is ample communal space in the home for people to use and for activities. There is also a smoking room on the ground floor for people who wish to smoke to use. The smoking room has a fan in to help ventilate the room and is away from areas used by people who do not smoke The grounds are kept tidy and the addition of a secure garden area to the rear of the home has provided secure outdoor space for people to enjoy the summer weather. All the bathrooms and toilets examined were clean and accessible and were suitably equipped to enable peoples personal care needs to be met. One assisted bath on Furness unit was out of order and this reduces the available bathing facilities for people. We recommend that the manager makes sure this is repaired promptly so people have easy access to an assisted bath. We saw as we walked around the home that in some toilets and bathrooms on the elderly frail units there were no plugs in the sinks. This meant that if people wished to wash their hands or have a wash they could not fill the sink to do so. We discussed this problem with the manager who knew this had been a problem and was trying to address the matter sensitively. The home has a range of moving and handling equipment to aid peoples mobility and independence. Servicing records showed these were serviced under contract to make sure they are safe and suitable for use. There is also a passenger lift so people living there can move between floors safely. The lift records indicated it was appropriately serviced and maintained. Records for servicing of other equipment and testing were up to date and water temperatures to help make sure the home was safe and suitable for the people living there. We found one person was in a bedroom that was too small to adequately meet their individual needs and allow them to use the equipment they needed easily. We discussed this with the new manager who had already recognised this when she took up her post. The manager had already taken steps to address it and provide accommodation better suited to the persons needs. A larger room was being prepared for the person to move into and a date set for the move. When this is done for that person the standard will be met. 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. People living at Bevan House are supported by a team of trained staff who know them well and who have gone through a recruitment process to help make sure they are suitable to work with them. Evidence: We examined the staff rota, staff training records and talked to the manager, staff and people living in the home. These indicated that overall there were usually sufficient numbers of staff in place to meet the needs of the people currently living in the home and that staff had received appropriate training to support them. There are times when staff levels are stretched, such as break times, and having one carer on each elderly frail unit means it could be difficult for staff to fully practice person centered care based around delivering preferred outcomes. The staffing rota structure is based on available staff resources made available to the manager rather than individual outcomes. However responses to our surveys and speaking with people indicated that people living there were generally satisfied with the ways their individual needs were being met. The manager who has used the staff resources available to them effectively. The rotas were clear and easier to follow than at our last visit. The new manager has been reviewing the deployment of staff to allow where possible overlaps during shift changes so there is more time for activities. The manager has also introduced staff rotation so staff are familiar with the needs of all people living there not just on one unit. Three staff cover the EMI units and there is one carer on each of Care Homes for Older People Page 21 of 28 Evidence: the other three units and two night staff. With the present levels of dependency of the people living there this was adequate. The home currently has a full compliment of staff and has a relatively stable staff team, with acceptable levels of staff turnover. We spoke with some staff who had worked in the home for many years who have developed good relationships with people living in the home. NVQ training and assessment is well established in the home and over 50 of staff have completed their National Vocational Qualification level 2 (NVQ), with more staff working toward the qualification in care. A comprehensive five day induction training period is provided for all new staff in line with Skills for Care standards. Staff receive basic instruction in the principles of care, moving and handling, health and safety, emergency aid, safeguarding procedures and dementia awareness Feed back from staff surveys returned to us indicated that staff felt that induction covered most of what they needed to know when they started work. All staff have their own personal development file where training and development is recorded. records indicate staff have updates of mandatory training as needed. Records indicated that there are robust recruitment procedures and security checks in place. This helps make sure all new staff are suitable and safe to work with vulnerable adults and that they are aware of their roles and responsibilities in the home. People living in the home are not involved in the recruitment process to give their perspective. Staff surveys and what they told us indicated that they had been through an effective recruitment process. A new member of staff was staring on the day of the visit. We saw the supervisor going through relevant procedures with them. They were working alongside an experienced carer shadowing them . All staff are provided with a handbook with relevant procedures and information they can refer to. 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 new manager is providing clear leadership and support and ensuring the home is run in the best interests of the people living there. Evidence: Bevan House has a new manager in post, June Fitzpatrick, who is in the process of becoming the registered manager with CQC. She has suitable care experience and is working toward completing her NVQ level 4 management course. She displayed to us an awareness of the need to continuously improve the quality of life for people living there and an understanding of her role and responsibilities and the legislation she needs to work to. Care staff, people living in the home and their relatives we spoke to said the manager was accessible and approachable. Comments made to us and on our survey responses from people living there and their relatives indicated that the new manager was being effective in her role. These included, A large improvement since the new manager arrived and June has been very good, I feel she will listen and respond. Care Homes for Older People Page 23 of 28 Evidence: Staff we talked with confirmed they had regular supervision and we saw that this was recorded and if any training and development action was needed. Staff we talked with said they signed their supervision notes but were not given a copy. The organisations own procedures indicate it is good practice to offer staff a copy of their supervision notes to keep and the manager should consider doing that so what is said and agreed is noted for action and outcomes. Comments in staff surveys noted that some staff felt feedback given to them was not constructive and that information not always passed to everyone at the same time to support practice resulting in a feeling of not being valued. We discussed the comments made with the manager and also the importance of supervisory approaches that promote mutual team respect amongst all levels of staff and so good staff morale. The manager is keen to promote effective staff relationships and is going to look at this. An annual quality assurance survey takes place for people living in the home and the last one was done in April this year. We looked at the results and the manager had already begun addressing areas where people had asked for change or improvement, such as activities. There are regular residentss meetings which give people a chance to put their views and ideas forward, including what is working well and suggestions to improve things such as menus. These meetings have been held more frequently on a monthly basis as the new manager as been getting to know the people living there. Internal and external audits including financial audits and audits of policies and procedures are being carried out and the home has Investors in People. There is an overall organisational development plan that the service is part of with its own annual performance objectives to achieve. Only small amounts of personal finances are held by the home with clear records maintained of all transactions and clear procedures in place to guide staff. People may manage their own finances if they want to and are able. We looked at random sample of individuals spending money. We found these to be generally in order but recommended that any checks and transactions are always signed by 2 people for good practice and that all staff, including relief staff, are made aware of the procedure. Generally the standard of record keeping is good and confidential information is stored securely. The service has clear policies and procedures for the home in relation to Health and Safety and safe working practices. We could see, from records and speaking to people living and working there, that the home has systems, training and practices to promote welfare and safety. Records show that the testing and servicing of moving and handling equipment, electrical and gas installations and emergency equipment is being done as required and that staff have been given fire training and had fire drills. We examined a range of risk assessments including the fire risk assessments which Care Homes for Older People Page 24 of 28 Evidence: follow changes in fire regulations. Information in the AQAA and the training matrix indicated that not all staff had done basic food hygiene training and we recommend staff do this. Care staff give out meals to people on the units and prepare snacks and light meals so they need this training to make sure they are aware of current best practice. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 9 When staff make written changes to the medication record charts it is good practice to get a colleague to check and sign the change. This check can help reduce the risk of any addition or change being written down incorrectly. We recommend that the manager makes sure the complaints procedure is made more easily available on the homes units and in different formats that suit peoples needs. We recommend that the manager makes sure the assisted bath on Furness unit is repaired promptly so people have easy access to an assisted bath. When staff have their formal supervision they should to promote best practice, openness and transparency be offered a copy of their notes to keep for their information and actions. The manager should make sure that all care staff handling food are given training in basic food hygiene and record this. 2 16 3 21 4 36 5 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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