Care Home: Birch Trees

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Key inspection report Care homes for older people Name: Address: Birch Trees Hollist Lane Midhurst West Sussex GU29 9AD     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: Lesley Webb     Date: 0 5 0 5 2 0 0 9 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 29 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Birch Trees Hollist Lane Midhurst West Sussex GU29 9AD 01730813260 01730810923 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Teerose Ltd care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 19 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Birch Trees is a care home with nursing, which is registered to accommodate up to 19 persons over the age of 65 not falling within any other category. The service is located near Midhurst, and has contacts with the local community. The service is operated by Teerose Limited, for whom the responsible individual is Mrs Samy. The registered manager is Mr Teelaga Samy. The premises are a detached residential property which has been adapted for its Care Homes for Older People Page 4 of 29 Over 65 19 0 Brief description of the care home present purpose. There is parking on the property and a garden area which is accessible to people accommodated. Fees currently charged for living at the home vary from £570.80 to £670.00, inclusive of nursing care costs. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. We also looked for evidence that the home has met the Requirement made at our last key inspection. During our visit to the home we talked to the Registered Manager, 5 residents and 3 care staff. We also case tracked 3 residents and looked at the care plans of a further 2 residents, examined staff records, policies and procedures and other documentation. In addition to this we looked around the home, sat and had a meal with residents and indirectly observed interactions between residents and staff. The home sent us its Annual Quality Assurance Assessment when we asked for it. Information from this was also used when forming judgments on the quality of service provided at the home and outcomes for residents. Care Homes for Older People Page 6 of 29 At the time of writing this report we have received 6 residents surveys. Information from these is also included in this report. Care Homes for Older People Page 7 of 29 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 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 Care Homes for Older People Page 8 of 29 order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed prior to moving into the home so that the home can be confident that it can meet their needs. Evidence: The home sent us the Annual Quality Assurance Assessment (AQAA) prior to our visit. With regard to pre admission processes it states Each and every prospective service user is offered the choice to visit the home and to spend some time within the home and have a meal if they so wish to have a feel of the real atmosphere in the home. If a service user is in hospital, the home manager or the senior nurse will visit the person and carry out a pre admission assessment and answer any questions the service user or their relatives may have. Normally we will also receive a package of care prepared by West Sussex County Council Social Services Care team and or a Decision Support Tool document from the Primary Care Trust highlighting the special nursing care needs required by the prospective service user. We will then plan a provisional individualized holistic package of care to meet the identified needs. The Care Homes for Older People Page 11 of 29 Evidence: ensuing care plans will be implemented and evaluated regularly during their stay in the home. We always offer a four week trial period to give the new resident the chance to settle in and to get to know us and more importantly to make sure that they have made the right choice. During our visit to the home we spoke with residents, the registered manager, staff and a relative visiting the home. We also looked at the admission records for three residents. Conversations with people and examination of records confirm the contents of the AQAA as accurate. For example pre admission assessment forms were found to be completed in full, identifying the potential residents individual health and social care needs. The home uses a proforma assessment sheet, which takes into account peoples level of mobility; self help skills, medical history, health care needs, etc. One resident that we spoke to expressed their satisfaction with the care they receive, stating, right from the start I liked it, its the silly little things like being able to bring items from home, when I arrived my own bedspread had been put on the bed, it was lovely. A member of staff confirmed prospective residents can visit the home to decide if it will meet their needs. They gave an example that a prospective resident came to visit yesterday, had lunch and stayed for supper. Six residents completed questionnaires and returned them to us. All state they received enough information about the home to help them decide if it would be the right place for them. The home does not provide intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of residents are being met consistently and safely. Medication systems offer safeguards to residents although improvement with regard to storage of prescribed creams will enhance this further. Residents are treated with respect and their rights to privacy upheld. Evidence: With regard to health and personal care the homes AQAA states We have a comprehensive individual programme plan of care for each service user, identifying their individual needs and also how these needs are to be met in the home. We practice both a person centered and a relationship approach to our nursing care practices in the home, the service users are supported in making their own decisions and also their relatives where appropriate are encouraged to be involved in the drawing up of care plans to meet their health and social care needs. We work in close collaboration and co operation with the General Practitioners, Social Workers and other health Care related professionals, such as physiotherapists, dietitians, Speech and Language Therapists. Care Homes for Older People Page 13 of 29 Evidence: The AQAA also states All staff members are trained to respect the care values of the home for older people and we take great pride in our ability and capability to respect the privacy, the rights, the individuality, the choice, the independence, the dignity and fulfillment of all our residents at Birch Trees. We respect the human rights of our service users with fairness, equality, respect, dignity and autonomy underpinning the care and support we provide. With regard to risk taking the AQAA states We have various risk assessment tools in place to identify the hazards and the level of risks our service users are exposed to while they are in our care. Following the risk assessment we are then able to take the appropriate outcome measures to either reduce or eliminate the risks. The current tools used are as follows - Pressure ulcer Judy Waterlow Risk Assessment Score with appropriate plan of care to reduce or eliminate the level of risks, e.g. effective use of pressure relieving cushion and mattresses. Falls Care plans in place to avoid slips, trips and falls as appropriate. Malnutrition Use of Malnutrition Universal Screening ToolMUST Use of BMI Score with appropriate care plans in place to encourage service users to eat a well balanced nutritious meal or to take fortified meals or drinks or dietary supplements. Manual Handling Risk Assessment of loads Use of sliding sheets, safety and transfer belts, transfer boards, mechanical mobile hoists, Mobile Stand aids and ceiling track hoists. During our visit to the home we spoke with resident and staff, indirectly observed care practices, examined care records and looked at the system for the management of medication. Evidence from all of these sources confirms the contents of the AQAA as accurate. For example each person records that we examined contained individualized plans of care for specific needs such as mobility, nutrition, skin integrity and behaviour. Where appropriate risk assessments have also been completed that work in conjunction with the various care plans. All residents that we spoke to expressed satisfaction with the support they receive to manage their health care needs. For example one resident stated When I first came here my legs were in a terrible mess. The difference since been here they are really clearing up, its perfect how they dress them, they do all they can and another I use wheelchair, I had stroke, lost action in my hand. They use hoist, its no problem, its safe, its the best way to be moved. I feel well here, the home arrange any appointments I need, quiet recently optician came and did test. We also had the opportunity to speak with a relative visiting the home. They also Care Homes for Older People Page 14 of 29 Evidence: expressed satisfaction with the care and support given by the home. As they explained, My wife is very ill, I count myself lucky she is here, they are unbelievably kind. If you are desperately ill this is the place to be, if I get ill this is where I want to come. Six residents completed questionnaires and returned them to us. Five state they always and one they usually receive the care and support they need. All say the home always makes sure they get the medical care they need. Throughout our visit staff were observed treating residents with dignity and respect. For example staff were seen to knock on residents bedroom doors before entering, addressing individuals by their preferred name and obtaining their views and agreement with regards to personal care. We looked at the systems for management of medication. The home uses a monitored dosage system for the administration of medication. All areas including medication entering, being administered and recorded were found to be accurate. The only area needing improvement is that of storage of prescribed creams. When asked we were informed that no residents currently self medicate. However all residents who are prescribed creams have these stored in their individual rooms. We viewed a number of rooms, none of which included secure storage facilities for the prescribed creams. We discussed this with the registered manager who produced documentation that evidences this issue had already been identified by the home. The registered manager agreed this area for improvement would be given priority for action. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 Birch Trees have a lifestyle which suits them, and are able to maintain contact with family and friends, the local community and their faith. Residents are supported to exercise choice and control over their lives, which assists them in leading fulfilling lives. People receive meals they enjoy, have a varied and nutritious diet and eat in pleasing surroundings. Evidence: All residents that we spoke with confirmed their satisfaction with activities provided by the home. For example one person explained they have keep fit person come here, thats good for us. They do quizzes and bingo. Also when weather better I go out, more than happy with whats provided. Six residents completed questionnaires and returned them to us. Five state the home always arranges activities that they can take part in. One states the home usually does this. When asked the question what could the home do better one person has recorded perhaps more entertainment. Another person expressed satisfaction that they are able to continue expressing their Care Homes for Older People Page 16 of 29 Evidence: religious beliefs. They informed us Im Catholic, a lady comes every week to give me holy communion, we have long chats, its lovely. During our visit some residents were observed spending time in the main lounge watching television and others reading newspapers in the dining room and their bedrooms. One resident confirmed that the home arranges for their newspaper to be delivered every day and that they are invoiced for this on a monthly basis. The registered manager informed us that relatives are welcome to visit at any time. He informed us that staff are trained to respect the views of residents and their relatives. A relative that we spoke with confirmed these comments, stating Relatives are made welcome, very amendable, can come any time. I come every day, staff always on hand to answer any questions. The homes AQAA informs us of improvements that have been made with regard to meals. It states We have added nuts and died fruits in our cooking as recommended by our local NHS dietitian, thus making sure the residents receive the daily requirements of vitamins to keep them healthy. We are monitoring those residents who are not eating well or who are found to be at high risk of malnutrition as scored by the MUST tool. We are providing extra nourishment to those who are underweight with frequent snacks in between meals in the form of cubed cheese, extra fruits, chocolate, biscuits and milky drinks. All residents that we spoke with stated they were happy with meals provided by the home. Comments include I usually have toast and tea for breakfast and banana later, they always bring fresh fruit and They are very good and food is brilliant, the cook is very good, foods nicely presented and Im a fussy eater and Im always happy. We sat and ate lunch with residents during our visit. Everyone appeared to enjoy what was provided. One resident was assisted to eat by a member of staff. The member of staff undertook this task with sensitively whilst promoting the residents dignity. For example they positioned themselves so other residents could not observe the full extent of assistance given, gave encouragement throughout the process and offered fluids to ease swallowing. We discussed the dietary needs of residents with the cook who demonstrated knowledge and understanding of risk factors associated with malnutrition. She also demonstrated understanding with regards to promoting residents dignity in this area, explaining that a red napkin is put on the trays of residents at risk of malnutrition as this indicates discreetly to staff that the resident is at risk and that staff need to be Care Homes for Older People Page 17 of 29 Evidence: aware. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Birch Trees are confident that their complaints will be listened to, taken seriously, and acted upon. Arrangements are in place whereby people can expect that they will be safeguarded from harm. Evidence: All residents that we spoke with confirmed they would feel confident to raise concerns both formally and informally. Comments include I feel safe here, if you press bell someone always come Im very happy here. Would say if not. Staff always take time to listen and Im very happy here, staff do anything. I would say something if unhappy, speak to manager, he is like a friend. I told him in France we have toast and coffee, the next day he brought toaster specifically for me. Six residents completed questionnaires and returned them to us. All confirm they know of someone they can speak to informally if they are not happy and also that they know how to make a formal complaint. We saw the complaints procedure on display in the home. The registered manager informed us that there have been no formal complaints received by the home. Policies and procedures for safeguarding adults are in place and the registered manager informed us all staff receive training in this area both as a group and on a one to one basis. Care Homes for Older People Page 19 of 29 Evidence: The homes AQAA informs us of improvements that have been undertaken in this are over the past twelve months. This being We have supported our staff to attend local forum held by Social Services regarding Mental Capacity Act, Deprivation of Liberty Safeguards and Safeguarding Vulnerable Adults in Worthing and in Chichester. We have on site the latest Code of Practice book on Mental Capacity Act to enable staff to develop a greater understanding of the principles involved when dealing with vulnerable adults. We have received favorable feedback from our internal service users satisfaction surveys. We are satisfied that we have helped to maintain the human rights of the older people who use our services with fairness, equality, dignity, respect and autonomy underpinning the care and support we are providing. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, well maintained environment which meets their needs. Evidence: The homes AQAA informs us of improvements that have been made to the environment since our last visit. It states We have purchased five electric profiling beds with high risk mattresses to enable residents to adopt different postures in bed and thus facilitating nursing care activities. We have new electric portable mobile hoists and stand aids and new pressure relieving mattresses and cushions. We have just installed new ceiling track hoists in four bedrooms on the middle floor. We have redecorated eight bedrooms 3, 4, 7, 8, 10, 11, 14 and 15, the dining room, the staff toilet, the ground floor corridor, the first floor corridor, the shower room and the small lounge on the ground floor. We have installed a new P.I.R lighting system for security lights in the front of the building. We have recently installed a complete new nurse call system which has made a great impact in the quality of support and attention given to the service users. We have redecorated the bathroom on the middle floor with tiles on all the four walls. We have replaced the wooden ramp in the front entrance of the building with concrete permanent ramp with hand rails to ensure easy access to the building and to facilitate the wheel chair users to use the community facilities. We toured the premises and found the contents of the AQAA to accurately reflect the improvements made. Care Homes for Older People Page 21 of 29 Evidence: The is a maintenance person employed 30 hours per week to undertake general tasks and repairs. This person is also responsible for undertaking a variety of health and safety checks such as weekly testing of the fire alarm system and monthly water temperature checks. The grounds and garden are well maintained and accessible, and people said they enjoyed going out into the garden on good days. The premises are decorated and furnished to a good standard and are homely and comfortable. All radiators seen had radiator guards which provide safety for residents. All areas of the home visited had good but unobtrusive forms of lighting. All areas of the home visited, including bathrooms, laundry areas and the kitchen were found to be clean, hygienic and odour free. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by the numbers and skill mix of staff. Residents are protected by the homes recruitment policy and practices. Evidence: At our visit the registered manager informed us there is always a registered nurse on duty and that of a morning there are three care staff, of a afternoon two care staff and during the night one care assistant. In addition there are ancillary workers including cleaners and cooks employed. Six residents completed questionnaires and returned them to us. Five state staff are always and one that they are usually available when needed. All say staff always listen and act on what they say. When asked the question what does the home do well comments have been recorded of the staff are all very caring at all times above all, they are all very kind to the patients and all staff support us well. When asked the question what could the home do better one person has recorded have more staff available. The homes AQAA states that At present we have five health care assistants with an Care Homes for Older People Page 23 of 29 Evidence: NVQ at level 2 in health and social care or equivalent at the home. We also have three health care assistants who are currently being trained for NVQ at level 3 in health and Social care with Chichester College. Two of our registered nurses are also undergoing training in management at NVQ level 4 with Chichester College. The Home Manager has successfully completed his NVQ Assessors course NVQ AS1 with Chichester College and is now supporting the College tutors with the training of his health care assistants in the home. Furthermore, we have our fulltime domestic staff who has recently completed successfully his NVQ at level 2 in housekeeping with the HIT Training Organisation. During our visit to the home the registered manager confirmed the contents of the AQAA as accurate. All residents that we spoke with praised the staff working at the home and the support they receive. Comments include staff seem to really care its really good here, well looked after, staff take care of you and staff friendly. We examined the recruitment records of the two newest members of staff to commence employment at the home. Both contained all the required documentation including two references and Criminal Records Bureau (CRB) disclosures. Staff have received training in areas including fire, first aid, moving and handling and cross infection. Training has also been provided in areas associated with old age such as tissue viability, dementia and pressure care. Sampling of staff records indicated that induction training is in place which will assist new staff in getting to know the service and how they are expected provide safe care. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of the home is meeting residents needs safely. Quality monitoring systems are in place that allow the home to measure if it is meeting its aims and objectives. Evidence: The registered manager at Birch Trees is also one of the registered owners/proprietors. The registered manager is a qualified nurse and hold the Registered Manager Award at NVQ level 4 in Health and Social care. The registered manager was present throughout our visit and demonstrated knowledge and commitment in providing a quality service to older people. With regard to quality services the homes AQAA states All staff members have one common aim in the home to provide the best practice of health and social care in a quality home environment for older people to enjoy a good quality of life. The registered manager reinforced this statement throughout our visit, confirming this as the main aim for everyone including himself. Care Homes for Older People Page 25 of 29 Evidence: There are a number of quality monitoring tools in place at the home. These include internal health and safety audits, six monthly residents and relatives questionnaires and meetings for residents, relatives and staff. The home sent us its AQAA when requested. The contents of this are detailed, informative and demonstrate quality monitoring and reviews undertaken by the home. We sampled a number of health and safety records, finding generally all to be in good order and up to date. Records seen indicate that fire safety checks, hazardous substances assessments and electrical equipment testing are being carried out. During lunch we did observe residents being escorted to the dining room in wheelchairs that did not have footrests in place. We examined risk assessments and this practice was not included. The registered manager said that he would address this immediately. The registered manager informed us that the home does not manage the finances of anyone living there, and does not hold cash for anyone. There is a system in place whereby expenses such as chiropody treatments and hairdressing are met by the provider, and relatives are then billed for the cost. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!