Care Home: Bourne House

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What the care home does well The staff ing levels seen during this visit were high and ensured that there were sufficient staff on duty to meet the changing needs of people living in the home. The deputy manager told us that staff levels were altered if the dependency levels of individual increased due to illness. Feedback from visiting professionals confirmed that there were always sufficient staff on duty to meet care needs and that the staff had a good knowledge and understanding of individual care needs. Staff told us that rotas had been altered to ensure that more staff were on duty when needed. One member of staff said, "The manager has altered the rota`s so that we have five carers on. This gives us the opportunity to spend more time with residents to support them to engage in activities". During this visit there were six carers on duty,one senior staff and the deputy manager. Staff demonstrated a good understanding of care practice and had an up to date knowledge and understanding of the individual needs of each person living in the home. There was a strong focus on providing care that met the needs of the individual. One member of staff said, " We provide excellent care for every individual that lives here. All care we do provide is person centred and carried out in the best interest of our resident". This provided evidence of a staff team that valued each person as an individual with their own specific care and support needs. All staff spoken to, and feedback in surveys from staff provided evidence of a well motivated caring team. Feedback from people in the home and their relatives were positive about with way in which the staff team provided care and support. Comments included: "I think it is a wonderful home, the detail to care and the way staff go out of their way to give individual care is wonderful. They are flexible in providing care in an individual way". "There are always plenty of staff on duty". "They do a lot of activities including on a one to one arrangement". There was an extensive activity programme in place and the home employed an activity organiser to co-ordinate activities in the home. There was evidence to show that activities included one to one and small group activities, trips out and `in house` entertainment. Meals served in the home were of a high standard and offered a wide choice. Meals were home cooked and were tasty and well presented. People told us how much they enjoyed the meals served. There were robust procedures in place for the recruitment of staff including regular annual checks on the Criminal Record Bureau (CRB) disclosures. This means that people in the home can be confident that their interest and well being is protected. There was evidence of a supportive management structure and staff told us they could approach the manager at any time and that there were good systems in place tosupport them with their training and development needs. Staff were seen providing support in a caring and sensitive manner. There were several examples of good care practice seen, especially where staff consulted with people about what they wanted to do. We saw that staff listenend to their responses. What has improved since the last inspection? Training programmes for staff had improved and most staff had completed National vocational Qualifications. The on going programme of refurbishment and decoration had improved the environment. This meant that people could enjoy pleasant surrounding which were bright, cheerful and well maintained. Information about the home was currently being reviewed and this will ensure that people using the service will have up to date information to enable them to make an informed choice about their future care arrangements. What the care home could do better: Some procedures for auditing key care practices in the home such as medication and care plans would benefit from further development. This would help to improve practices in the home by ensuring that all aspects of care practice are monitored, and action plans put into place when shortfalls are identified. Consultation needs to take place with the local fire department regarding the practice of wedging doors and use of automatic door closures. The manager needs to ensure that local safeguarding procedures are used when any allegation of abuse is reported, so that people in the home can be fully confident that allegations of abuse are managed appropriately and the interests of individuals living in the home are safeguarded. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bourne House Taunton Road Ashton-under-Lyne Tameside OL7 9DR     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: Ann Connolly     Date: 1 3 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 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: Bourne House Taunton Road Ashton-under-Lyne Tameside OL7 9DR 01613307911 01613307011 bournehouse2@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Medincharm Limited care home 33 Number of places (if applicable): Under 65 Over 65 33 33 33 3 dementia old age, not falling within any other category physical disability sensory impairment Additional conditions: 0 0 0 0 Service User to include up to 33 OP up to 33 DE (E) up to 33 PD (E) and up to 3 SI (E) Date of last inspection Brief description of the care home Bourne House is a two storey detached property that has been adapted and extended over the years to provide care and accommodation to 33 older people. The bedrooms are single and over half have en-suite facilities, for which there is an additional charge. They are situated on two floors of the building. There is a passenger lift to the first floor. On the ground floor there are three lounges and two main dining areas. Adapted bathrooms and toilets have been provided through out the home. Set in pleasant grounds, the home also has an accessible decked area that is available for the residents to use in the better weather. The home provides a smoking area. Car Care Homes for Older People Page 4 of 28 Brief description of the care home parking is available on the road or in the car park to the rear of the building. Bourne House is located in a residential area towards the outskirts of Ashton under Lyne. Fees for accommodation and care at the home range from three hundred and ninety eight pound and eleven pence to four hundred and thirty pounds and eleven pence. Additional charges are also made for hairdressing and chiropody services, newspapers, personal toiletries and trips. 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: This was a key inspection that included a site visit to the home. The manager was not told beforehand that we were coming to inspect, this is called an unannounced inspection. This inspection looked at all the key standards and included a review of all available information received by the Care Quality Commission (CQC) about the service provided at the home since the last inspection. During the site visit a selection of records, care plans, policies and procedures were examined. Discussions took place with the manager, staff working in the home, and some relatives and visiting professionals. Discussion took place with them to find out what they thought about the home and what they felt about how the staff supported them. A tour of the building took place and people living in the home were asked for their comments and views about the environment. Care Homes for Older People Page 6 of 28 Before the inspection, we also asked the manager of the service to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This is one of the ways that we get information from the manager of the service about how they are meeting outcomes for people using the service. The information provided on this occasion was detailed and comprehensive and showed us that this was an organisation committed to the ongoing development of the service and staff team so that residents in the home benefit from positive outcomes. Surveys were sent out to residents and staff and there was a good response which gave us more information about this service. Since the last inspection visit which took place on 21st November 2006, the Commission has not received any recent complaints about the service. What the care home does well: The staff ing levels seen during this visit were high and ensured that there were sufficient staff on duty to meet the changing needs of people living in the home. The deputy manager told us that staff levels were altered if the dependency levels of individual increased due to illness. Feedback from visiting professionals confirmed that there were always sufficient staff on duty to meet care needs and that the staff had a good knowledge and understanding of individual care needs. Staff told us that rotas had been altered to ensure that more staff were on duty when needed. One member of staff said, The manager has altered the rotas so that we have five carers on. This gives us the opportunity to spend more time with residents to support them to engage in activities. During this visit there were six carers on duty,one senior staff and the deputy manager. Staff demonstrated a good understanding of care practice and had an up to date knowledge and understanding of the individual needs of each person living in the home. There was a strong focus on providing care that met the needs of the individual. One member of staff said, We provide excellent care for every individual that lives here. All care we do provide is person centred and carried out in the best interest of our resident. This provided evidence of a staff team that valued each person as an individual with their own specific care and support needs. All staff spoken to, and feedback in surveys from staff provided evidence of a well motivated caring team. Feedback from people in the home and their relatives were positive about with way in which the staff team provided care and support. Comments included: I think it is a wonderful home, the detail to care and the way staff go out of their way to give individual care is wonderful. They are flexible in providing care in an individual way. There are always plenty of staff on duty. They do a lot of activities including on a one to one arrangement. There was an extensive activity programme in place and the home employed an activity organiser to co-ordinate activities in the home. There was evidence to show that activities included one to one and small group activities, trips out and in house entertainment. Meals served in the home were of a high standard and offered a wide choice. Meals were home cooked and were tasty and well presented. People told us how much they enjoyed the meals served. There were robust procedures in place for the recruitment of staff including regular annual checks on the Criminal Record Bureau (CRB) disclosures. This means that people in the home can be confident that their interest and well being is protected. There was evidence of a supportive management structure and staff told us they could approach the manager at any time and that there were good systems in place to Care Homes for Older People Page 8 of 28 support them with their training and development needs. Staff were seen providing support in a caring and sensitive manner. There were several examples of good care practice seen, especially where staff consulted with people about what they wanted to do. We saw that staff listenend to their responses. 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 9 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 10 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. There is a good system to introduce people to the home, with information provided and needs assessments done, so that they know their needs can be met by the staff in the home. Evidence: Information about the home was available in the entrance hall. This included a guide to the facilities in the home which were provided in two different formats. One provided a detailed version, the other was made available in large print with photographs. The administrator told us that these were currently being updated to reflect the changes and improvements recently made in the home. A notice in the entrance hall told people that they could request a copy of the service user guide and the most recent inspection report. This meant that people making enquiries had up to date information on the facilities and services offered. This would Care Homes for Older People Page 11 of 28 Evidence: help them make an informed choice about their future care arrangements. The information in the Annual Quality Assurance Assessment (AQAA) stated that individuals were encouraged and supported to be fully involved in the admission process and to visit the home before making any decisions about the placement. Three care plans were looked at and all of them contained an assessment of care and support needs. Staff told us that the information obtained in the assessment was used to develop a comprehensive care plan. Care Homes for Older People Page 12 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 health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice so people living in the home can be confident they will be well cared for. Evidence: Three care plans were looked at in detail along with several others. The quality of care plans varied, some were very person centred and focused on how people wanted to be supported. Two were very task focused in the way that they were written and in some cases did not provide clarity on how the identified need could be met. The deputy manager told us that care plans were being reviewed to promote a person centred approach. This means that staff will know exactly what they need to so to help the person and to meet needs in a way that they prefer. During discussion with staff, relatives and from observations made, it was evident that staff had a good understanding of individual care needs and of the importance of consulting daily with people on how they wanted to be supported. One relative told us Care Homes for Older People Page 13 of 28 Evidence: that the way that care was provided was based on a day to day approach and that it took into account how people were feeling. An example that was given was a person who sometimes felt like being social, and dining with others, whilst on other occasions feeling that they would prefer to spend time alone. Staff took time in listening to peoples preferences and responding in an appropriate manner. People in the home were supported to access health care services. During this visit we saw people receiving visits from General Practitioner and other medical health care support services. Two medical healthcare professionals told us that this service had established a good working relationship with their healthcare practice and that staff were pro-active in making referrals when appropriate. One medical healthcare professional said that staff supported people in a way that made sure that all their healthcare needs were met. People in the home and their relatives were complimentary about the care and support provided by the staff. One relative said, I think it is a wonderful home. The detail to care and the way staff go out of their way to give individual care is amazing. They are flexible to providing individual care in a very caring way. There are always a lot of staff on duty and theres always a member of staff in each lounge at all times. Feedback from staff in the surveys was very positive about the way they felt they provided support and care people living in the home. The feedback showed an excellent awareness of good practice. One member of staff said, The staff provide excellent care for every individual that lives here. All the care we provide is person centred and carried out in the best interests of our residents. Medication records were checked and these showed that good systems were in place for administering medication. Medication Administration records (MAR) were filled in appropriately with no gaps and these recorded the receipt of medication received into the home. There were sample signatures of staff which could be used in any audit trails carried out by the manager to ensure that individual practice followed safe procedures when administering medication. Some systems were in place for checking the medication practice in the home which included spot checks on MAR sheets. It was recommended that these were formalised and documented so that the home could demonstrate that systems to manage safe practice in administering medication were robust and promoted good practice. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals are both well managed and provide variation and interest for people living in the home. Evidence: There was an open visiting policy in place and visitors were seen coming and going throughout the day. Visitors who were spoken to told us that there was always a warm welcome from staff and that they were always available to answer any queries. Visitors told us that they could visit at any time. There was evidence to show that people in the home were supported to live their life in a way that suited them. Staff were seen helping people to maintain independence. Information in the AQAA stated that there was an emphasis on one to one support to go out on trips that suited and met ther individual preferences and the diverse interest of people. There was a full time activity co-ordinator in post, and the remainder of the staff team worked to support her to arrange activities. Some staff supported people to go out on trips using their own time. One relative told us that there were activities available Care Homes for Older People Page 15 of 28 Evidence: every day and that a pub lunch was arranged once a fortnight, and a big trip approximately six times a year. Meals were served in three dining areas. Tables were set in small group settings providing a homely feel to the occasion. During the mealtime there were sufficient staff available to provide discrete and sensitive one to one support for those people who required extra help. The meal served during this visit was sampled, and was a good standard offering excellent choice. The lunch time meals offered soup to start with, and a choice of shepherd pie with vegetables or pork steak with potatoes and vegetables. A choice of dessert was available. There was a wide range of choices for the evening meal which included bacon hotpot or quiche. All people spoken to told us that they enjoyed the meals served in the home. Feedback from staff in the survey responses showed that staff had a good understanding of good practice and supporting people to live a life that met with their individual expectations. 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. There are good procedures so people who live in the home are able to express their concerns and be listened to, their rights are protected and they are safeguarded from abuse. Evidence: There was comprehensive guidance and procedures in place for helping people to make a complaint. A copy of the complaints procedure was available in the entrance hall to the home and a copy was provided in each bedroom. The information in the AQAA informed us that the home had received eleven complaints in the last twelve months and that all of them had been investigated within twenty eight days. A record of complaints was logged and details described the nature of the complaint, the action taken and the outcome. A copy of the reply to the complainants was seen. Some of the complaints were of a minor nature, and the information showed that all of these were taken seriously. One complaint in the home had been investigated, a full comprehensive response was made to the complainant, and as a result of the investigation training had been arranged for a member of staff to avoid a recurrence of the incident. Although the Care Homes for Older People Page 17 of 28 Evidence: outcome for this person and the complainant was positive, this should have been referred to the social services using local safeguarding procedures. Reporting this through the correct channels ensures that people using the service are fully protected. Staff spoken to had a good understanding of safeguarding procedures and knew what to do in the event of an allegation of abuse. Most staff had received training in safeguarding and plans were in place for this aspect of staff training to be ongoing. People in the home and relatives said they felt confident in raising any concerns. One relative said that any concerns were quickly addressed. She said, If there are any concerns they are immediantly addressed. The care Quality commission has not received any recent complaints about this service. 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 is appropriately maintained, decorated and cleaned to ensure that people living there are provided with a safe, pleasant and hygienic environment. Evidence: This was an unannounced visit to the home. As part of the visit a tour of the building took place. All communal areas and bedrooms were found to be cleaned to a high standard. The home employed a maintenance person who was responsible for monthly safety checks and assessments to ensure that the building complied with the requirements of fire regulations, the local fire department and environmental health service. The information in the AQAA stated that policies were in place for infection control. During the tour of the building it was noted that some bedroom doors were wedged open. As this could present a fire hazard the deputy manager was advised to fit automatic door closures and to contact the local fire department for their guidance and advice. There was evidence of a rolling programme of decoration and refurbishment which ensured that a pleasant environment was provided for people in the home and their visitors. Since the last inspection visit three lounges and dining areas, hallways and Care Homes for Older People Page 19 of 28 Evidence: corridors had been refurbished, decorated and new furniture had been bought. The floors in the dining areas had been fitted with wooden flooring and a new conservatory had been installed for those people who wanted to smoke. The external patio space provided people with a safe and pleasant environment in which to enjoy the outdoor space. There was evidence that bedrooms had been personalised to reflect individual tastes and preferences. People in the home and their relatives were complimentary about the standard of accommodation at Bourne House. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff meet the needs of people living in the home and they are protected by robust recruitment procedures. People are supported by a well trained staff team who know the individual needs of the people living in the home. Evidence: During this visit there was a high ratio of staff to the number of people in the home. The deputy manager told us that this was due to dependency levels of some people changing and therefore requiring additional support. This flexible and pro-active approach to managing staffing levels provided evidence that this was a service that was committed to making sure that individual needs were met by providing sufficient numbers of staff to meet current care needs. The high level of staff seen during this visit means that people in the home were benefiting from staff having the time to spend with individuals. Visiting professionals commented on the quality of the staff team and told us that there were always plenty of staff around to provide support, and that they never had the problem of having to find a member of staff. One relative reflected this finding by saying, When I visit there are always enough staff. When my mother was ill they arranged for a member of staff to sit with her. A visiting General Practitioner told us that he always felt that the staff had a good knowledge of the individual person, he said, They seem to know the people well. Care Homes for Older People Page 21 of 28 Evidence: Staff who were spoken to told us that they had access to training and development opportunities. Some staff were scheduled to attend training on Vetting and Barring Scheme and Independant Safeguarding Authority on the day of this visit. One staff member said, I feel we are consulted about our training needs, its important to go on training as things can change so much. The home employed a training co-ordinator who was responsible for monitoring staff training and to provide support for staff with their personal development plan. This provided staff with the opportunity to discuss and explore any training needs. Information in the AQAA stated that nearly all staff hwere trained to National Vocational Qualification (NVQ) level two to four. The remaining four staff have been enrolled to commence NVQ training this year. There was evidence to show that the training co-ordinator supported staff with their NVQ training and used induction material that was linked to Skills for Care. The training matrix/record demonstrated that staff were in receipt of regualr updated training. The recently completed monthly training planner showed that nearly all staff had received specialised training in key areas of care practice in January, February and March. Three staff files were looked at and these included the most recently recruited staff member. All files were well organised and contained the documentation required by legislation. Information in files included references, employment history and Criminal Record Bureau (CRB) disclosure. There was additional evidence to show a robust approach to safeguarding the people in the home. The administrator had set up a system to evidence that no changes had taken place to affect the status of the CRB disclosure. All staff were required to complete an annual declaration to confirm that there had been no changes to their circumstances that would alter the status of the CRB. Comments from people living in the home and their relatives were positive about the staff team and the way in which staff provided care and support. 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. Bourne House is being run in the best interests of people who live there and their welfare is promoted and protected. Evidence: The registered manager has the skills, experience and qualifications to manage the care home. The manager has demonstrated a commitment to the ongoing training and development of herself and the staff team. Staff who were spoken to said that they found the manager approachable and could talk to her about any concerns. Information in the AQAA provided evidence that good standards were in place for the maintenance of equipment and the building and confirmed that a maintenance man was employed to carry out these duties. Care Homes for Older People Page 23 of 28 Evidence: Individual financial records were in place to support people in managing their finances. These were well documented and systems were in place to protect people, for example a detailed audit system of personal allowances and records of two staff signatures for any transactions made on behalf of the people living in the home. Records were detailed and comprehensive and provided evidence of a robust accounting system. Some audit systems were in place to monitor care practices in the home, for examplea record was seen where accidents and falls were monitored. The deputy manager told us that there were systems in place to audit medication and care planning practices but that these were not formalised with written documentation. Comments from General Practitioners and other medical professional were very positive about the overall conduct of the home. Most comments were that the staff knew the people well and that there were always sufficient staff on duty to meet individual care needs. These findings and comments show that the manager is committed to running the home in a way that benefits the individual. 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 18 13 All allegations of abuse must 10/06/2009 be reported to the relevant bodies using local safeguarding procedures. This is so that people in the home can be confident that their interest and well being is promoted and that they are protected from abuse 2 19 13 Consultation must take place 10/06/2009 with the local fire department for guidance on automatic door closures and the practice of wedging door open. This will ensure that people living in the home are provided with a safe environment 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 26 of 28 1 9 Systems for monitoring medication practices should be formalised and documented so that the home can demonstrate safe practice in administering medication. Systems in the home should be developed to monitor key areas of practice including the safe administration of medication and recordings in care plans. 2 31 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. 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. 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