Care Home: Bramblings Residential Home

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What the care home does well The home provides a relaxed and friendly environment for the residents. Survey responses included the following observations: "all the staff are marvellous, nothing is too much for them"; and "the staff are very caring, and residents are respected"; and (from a relative) "the staff are very good at helping my mother, and trying to ascertain what she needs". Care plans contain good documentation ensuring that health and personal needs can be met in the home; and promoting individualised care. The food is well prepared and residents said that they enjoy it. Staff training is given a high priority, and the majority of care staff have completed NVQ 2 or 3 training in Health and Social Care. Mandatory training is kept up to date; and staff are encouraged to develop their knowledge and skills with additional training. What has improved since the last inspection? The home has made improvements as a result of the last inspection, and this includes moving the manager`s office to the front of the building where she is more easily accessible; and improving medication storage. A full time activities co-ordinator has commenced employment during the last year, and residents said that there is now a much greater amount and variety of activities available. An enclosed garden area is being developed for the safety and enjoyment of residents who may be at risk if they wander in the extensive grounds of the home. Staff training programmes have been developed further, to include subjects such as palliative care and understanding dementia. (Residents with a diagnosis of dementia are not admitted to the home, but this training is helpful for caring for residents who develop old age confusion or dementia after their admission). What the care home could do better: A recent safeguarding investigation has highlighted some concerns in regards to the security and safety of residents, as it is apparent that residents can go out of doors through a variety of exits. The providers and management are in the process of considering the best action to take in order to safeguard residents who may lack full mental capacity; whilst also enabling other residents to have their freedom to come and go from the home. We are confident that this situation is being addressed, and have therefore not issued any requirements in regards to this. We noted that handwritten entries on medication administration records (MAR charts) had not been signed by two suitably trained staff. This was a recommendation at the last inspection. It is important for ensuring the accuracy of handwritten entries, so that incorrect medication is not given to any residents. We have no evidence of any medication errors since the last inspection, and so no requirement has been given; however we again stress the importance of this action for the ongoing safety of medication administration. We noted during the inspection that one of the staff toilets did not have liquid soap and paper towels available, and dispensers should be fitted for the management of good infection control. We are confident that this will be carried out, and so a requirement has not been given. Key inspection report Care homes for older people Name: Address: Bramblings Residential Home Hartley Road Longfield Kent DA3 7PE     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: Susan Hall     Date: 2 5 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Bramblings Residential Home Hartley Road Longfield Kent DA3 7PE 01474702332 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bramblings (Kent) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 42 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 42. The registered person may provide the following category/ies of service only: Care home only - (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 (OP). Date of last inspection Brief description of the care home Bramblings Residential Home is a privately owned home providing accommodation and twenty-four hour care for up to forty-two older people. It is situated in a quiet close which provides a rural setting, and is within walking distance of the village of Longfield. Public transport is available nearby. The home is surrounded by extensive gardens and there are car parking facilities on site. Care Homes for Older People Page 4 of 28 Over 65 42 0 1 4 0 1 2 0 0 9 Brief description of the care home Accommodation is provided on two floors in single bedrooms. Some of these have ensuite toilet and bath or shower facilities. A passenger lift provides easy access between floors. There are a variety of communal lounges and a separate dining room. The current fee levels range from £342.00 - £482.00 per week, depending on the room being used. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The home is assessed as having a rating of Good, 2 stars. This was a key inspection, which includes assessing all of the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. The last completed AQAA had insufficient information to provide CQC with enough evidence to be sure the home was continuing to deliver good standards of care. We therefore brought forward the previously planned date for this key inspection. We sent out CQC survey forms for residents and staff to complete prior to the Care Homes for Older People Page 6 of 28 inspection visit, and received eleven replies. Ten of these were from residents and relatives, and one was from a staff member. These contained very helpful information about peoples views of the home. All of the surveys contained positive comments, particularly about the staffs willingness and abilities in caring for the residents. The inspection visit commenced at 09:40, and finished at 13:40. During this time, we (i.e. CQC) viewed all areas of the home; talked with eight staff, and five residents; observed interaction between staff and residents; and inspected documentation such as care plans, medication charts, staff recruitment files, and activities records. The previous manager resigned from her post during March 2010, and is now acting as a support manager. She was on duty throughout the morning, and co-operated fully with the inspection. Feedback was given to a senior carer at the end of the inspection. The managers post is now being covered by the previous deputy manager; and she will be referred to as the manager for the purpose of this report. The Social Services safeguarding team are in the process of completing an investigation in regards to one resident. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: A recent safeguarding investigation has highlighted some concerns in regards to the security and safety of residents, as it is apparent that residents can go out of doors through a variety of exits. The providers and management are in the process of considering the best action to take in order to safeguard residents who may lack full mental capacity; whilst also enabling other residents to have their freedom to come and go from the home. We are confident that this situation is being addressed, and have therefore not issued any requirements in regards to this. We noted that handwritten entries on medication administration records (MAR charts) had not been signed by two suitably trained staff. This was a recommendation at the last inspection. It is important for ensuring the accuracy of handwritten entries, so that incorrect medication is not given to any residents. We have no evidence of any medication errors since the last inspection, and so no requirement has been given; however we again stress the importance of this action for the ongoing safety of medication administration. Care Homes for Older People Page 8 of 28 We noted during the inspection that one of the staff toilets did not have liquid soap and paper towels available, and dispensers should be fitted for the management of good infection control. We are confident that this will be carried out, and so a requirement has not been given. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 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. The home provides good information for enquirers and prospective residents; and a pre-admission assessment is completed prior to confirming admission. Evidence: The statement of purpose and the service users guide have been amalgamated into one comprehensive folder, and contain all the required information for enquirers and new residents. Each resident is provided with their own copy. The statement of purpose includes information about the provider and manager, and includes information about the provision of staff, and the facilities available in the home. The service users guide includes details such as residents rights, data about receiving medical care, and details of services such as hairdressing and chiropody. Day to day information is included, such as meal times, laundry services, use of telephones, Care Homes for Older People Page 11 of 28 Evidence: activities, and meeting spiritual needs. The address for CQC was incorrect, but the support manager said that she would amend this the next day. All residents have a pre-admission assessment, and these are carried out by the manager or the support manager. We viewed a recently completed pre-admission assessment, and saw that it was very detailed, and included all aspects of daily living, such as communication, mobility, nutrition, management of personal care, and the persons preferred lifestyle. Residents and relatives are invited to visit the home and view the premises as part of the decision-making process. All residents are provided with a contract and the terms and conditions of business. 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. Residents personal health and care needs are attended to reliably and sensitively by the staff. Evidence: Care plans are discussed with residents and are reviewed monthly. We viewed three care plans, and found them to be well written and suitably detailed. They contain clear personal details and a photograph of the resident, and any allergies are recorded. Care plans are included for all aspects of daily living, such as the management of personal care, mobility, nutrition, communication, elimination, social and spiritual preferences, and sleep and rest. There are good details for individualised care, such as offering a bath or shower, preferred toiletries, if the resident likes to choose their own clothes, mouth and denture care, nail care, and hair care. Mobility care plans show if a resident is at risk of falls, and any aids used e.g. zimmer frame, assisted bath. Nutrition care plans show food likes and dislikes, if the resident needs a soft or special diet, and if they need help with cutting up food etc. Social care plans show if people prefer their own company or like to socialise; and residents are advised of activities Care Homes for Older People Page 13 of 28 Evidence: even if they usually prefer to stay in their own rooms. Preferred bedtimes and getting up times are noted; and night time choices such as if they like a hot drink before bed, or the light left on. Medical profiles include the medical history and ongoing health concerns. Skin integrity assessments (Waterlow assessments) are carried out monthly, and risk assessments are in place for moving and handling, and these were seen to be very detailed. There is a list of medication in each file, with the reason for the medication. Senior care staff who administer medication are also familiar with any side effects to look out for. Daily records are written for the day and night shifts. These contain good information. We advised that it would be helpful to note the time of the daily entry (not just the date and signature), and the senior carer who took feedback said that she would take this back to the manager for action. Visits from the GP or other health professionals are recorded. Wound care and dressings are carried out by district nurses from the community. Medication storage has been moved since the last inspection visit, so that there are now separate areas for storing dressings and for storing internal medication. This is now stored in a small separate storage area, which includes a storage cupboard, a controlled drugs cupboard, and a medication trolley. The storage cupboard and medication trolley were seen to be in good order, with evidence of stock rotation. There was no overstocking, and no out of date medication was seen. Most medication is administered via a monitored dosage system. Some residents self-medicate (usually for applying external creams or for inhalers). These residents have a detailed assessment to check that they are fully able to manage the processes of their own medication. We viewed the Medication Administration Records (MAR charts) and noted that these were generally well completed. Additional medicines (as necessary) are recorded on the back of the MAR chart, with the reason for giving it. There is a policy in place for all handwritten entries to be signed by two appropriately trained staff, but there were several handwritten entries noted with no signatures or only one signature. We have not given a requirement in respect of this, as we are confident that this will be addressed. Controlled drugs are clearly recorded with two staff for each item of medication. The drugs fridge is stored in a separate secure area, and the temperature is checked and recorded daily. Residents said that the staff look after them very well; and we observed staff caring for residents with patience, and with caring and friendly attitudes. Survey responses stated that their privacy and dignity are always upheld. One resident said that the care staff are so good that they spoil her; and another said that nothing is too much for them; all of them are great. Care Homes for Older People Page 14 of 28 Evidence: Care plans include information about residents wishes for when they are dying, and state if residents do not wish to discuss this subject. The home has good links with a local hospice for additional advice and support if needed. The plans also show if residents have full mental capacity and are able to understand information and make their own decisions. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit from an improved activities programme, which provides them with more choice. Food is well managed, and the residents enjoy it. Evidence: A full time activities organiser has been employed by the home during the last year. Residents said that this had made a significant improvement in the home, as they now have a varied programme of activities to join in with, and opportunities for outings. The organiser has taken time to find out what the majority of residents in the home like to do, and arranges for a different activity each morning and afternoon. This includes items such as crafts, reminiscence, singalongs, card games, board games, armchair exercises and bingo. These are gradually being developed into a weekly programme, so that residents can look forward to specific days for the activities which they enjoy. Most group activities are carried out in a lounge on the first floor, so that residents who do not wish to join in can still use the other two lounges on the ground floor. The organiser also spends one to one time with each person in the home each week, ensuring that residents who do not wish to take part in group activities are able to share any items they wish to carry out with her individually e.g. garden walks, reading books. We enjoyed looking at photographs on display in the home, showing Care Homes for Older People Page 16 of 28 Evidence: how residents had made Easter bonnets; and staff taking part in pancake races. Residents said that they look forward to some outings in the Summer months, which may include visiting seaside towns and places of interest. These are under discussion with the manager. There are also events such as a Summer fete, and Christmas items. Entertainers are invited into the home on a regular basis. Residents are enabled to visit places of worship, and ministers of religion are welcome to visit. A church service with Holy Communion is held in the home each month, for those who wish to attend. New residents are encouraged to bring in some of their own possessions and small items of suitable furniture to personalise their own rooms; and we saw some rooms attractively presented with residents own belongings. Residents said that the food is good, and that there is plenty of it. A cooked breakfast is available any day, and snacks are available at any time. The cook is familiar with residents likes and dislikes, and usually prepares one main meal, with alternative choices for those who do not like the main dish, or for anyone who prefers something different. There are always soft options for residents who require a soft diet. The menus were seen to be suitably varied to provide a nutritious diet. The care staff ensure that residents who need assistance with eating are given due time, and are attended to sensitively. The kitchen was seen to be clean and well organised. A kitchen assistant works alongside the cook each day. Care Homes for Older People Page 17 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. Residents are confident that their viewpoints are listened to and acted on; and that any concerns will be appropriately addressed. Evidence: The complaints procedure is included in the service users guide, and each resident is given a copy of this document. The procedure is also displayed in the home where visitors can view it. People are encouraged to approach the person in charge in the first instance, then the home manager. They can also contact the homes director, or other parties such as Social Services if necessary. The procedure states that complainants will receive a response about the complaint investigation within two weeks. We viewed the complaints log, which was not in good order, and so was not very easy to view. We pointed out that this would be easier to follow if complaints were filed in order. There have been no formal complaints to date during 2010. The manager and the support manager have a daily presence in the home, and usually pick up any concerns and deal with them immediately. They also have an open door policy, and encourage people to ask them for any help or information as they need it. The complaints log showed that complaints are taken seriously and are addressed appropriately. This includes a frank apology where the situation warrants it. The senior care staff showed a good understanding of the recognition and prevention Care Homes for Older People Page 18 of 28 Evidence: of different types of abuse, and the staff are familiar with the homes whistle blowing policy. The management co-operate with the Social Services safeguarding team, and were currently assisting with a safeguarding investigation by responding to the team as requested. All staff are trained in the prevention of abuse, and the training records confirmed that there are ongoing updates with this training. Care Homes for Older People Page 19 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 provides a pleasant and comfortable home for the residents. Evidence: The home is set in extensive grounds, which provide a rural setting, even though the home is within walking distance of local shops and bus routes. Accommodation is provided on two floors, with a passenger lift providing access between floors. There are three lounges and one dining room, and these provide a good choice of sitting areas for the residents. One of the lounges is set up as a reminiscence room, with old furniture etc. There are tea and coffee making facilities in the lounges, but they are rarely used by residents or visitors. Residents have risk assessments if they wish to use these. Residents can also sit outside on patio areas, and some bedrooms have patio doors to the outside. Individual risk assessments are carried out for residents using these rooms, to check if they are able to manage the patio door keys. The management are currently developing an enclosed area of garden for the safety of residents who may be at risk if they wander in the large grounds. They are also working to provide a more secure environment for any residents who may lack full mental capacity, and can leave the home through side doors. This may include putting an alarm on these doors. We were informed that the providers are taking advice from the Fire Safety Officer in this matter. However, they also wish to ensure that other residents are able to come and go from the home with the minimum of disruption. We Care Homes for Older People Page 20 of 28 Evidence: have not issued any requirements in regards to security in the home, as we are confident that the providers are addressing this issue. All bedrooms are for single use, and are provided on both floors. If residents wish to share a room, they can have one room as a bedroom, and an adjacent room as a sitting room. Some rooms have en-suite toilet facilities, and some also have an ensuite shower or bath. There are additional assisted bath and shower facilities on each floor. There is a also a sluice disinfector on each floor. Radiators are fitted with individual thermostatic valves. Bedrooms are provided with divan beds, and the manager will arrange for a hospital bed on loan if anyone needs this for care purposes. The home is equipped with suitable hoisting facilities, including an electric hoist and a stand aid. This is proving to be so useful, that they are looking at purchasing a second stand aid. The home also has other moving and handling equipment, such as handling belts, slide sheets and a turntable. The home has an ongoing programme for redecoration and replacing carpets as needed. There is a full time maintenance person who oversees this and carries out checks such as PAT testing. The laundry is sited in a separate building at the rear of the home, and is equipped with two washing machines and two tumbles dryers. There are dedicated laundry staff from Mondays to Fridays, and care staff assist with the laundry work at weekends. We noted that one of the staff toilets did not have a soap dispenser and paper towels available, and these should be fitted for the management of infection control. We are confident that this will be done, and so a requirement has not been given. Care Homes for Older People Page 21 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 staff team are competent and efficient, and are well trained. Evidence: Staffing levels are well maintained in accordance with residents dependency levels and the layout of the building. There are usually seven care staff on duty in the mornings; five or six on duty in the afternoons and evenings; and three at night. There is always a senior carer on duty; and the manager and support manager may also be on duty. Ancillary staff include the cooks and kitchen assistants; a team of housekeepers and laundry staff; and the maintenance person. A contractor is paid to carry out the gardening. Most of the care staff have completed NVQ levels 2 or 3 in health and social care, and some are in the process of completing this training. This accounts for approximately 95 per cent of the care staff, which is excellent. We viewed two staff recruitment files, and noted that good procedures are in place. The files viewed were a little untidy, but included the required data, e.g. full employment history, two satisfactory references, police and safeguarding checks (CRB and ISA); a health questionnaire, and interview and training records. Care Homes for Older People Page 22 of 28 Evidence: We viewed the staff training matrix, and discussed staff training with the support manager, who is an NVQ Assessor, and has a teaching qualification. She is one of the trainers. Records confirmed that there is a good induction programme in line with Skills for Care training; and this has been put into a better format since the last inspection. There are good records for mandatory training in subjects such as moving and handling, prevention of abuse, basic food hygiene, infection control, and fire prevention and awareness. The training includes videos and questionnaires to check staff have fully understood the training. Staff are also trained in understanding and applying the Mental Capacity Act 2005. Medication training is carried out by senior carers, and this includes a 14 week ASET course, and practical checks for competency and understanding. Care staff are also encouraged to carry out additional training and many have completed a palliative care course lasting 16 weeks, and a 12 week course in understanding dementia. Care Homes for Older People Page 23 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. There are good systems in place to ensure that the health and safety of the residents and staff are maintained. Evidence: The previous manager has recently resigned for this post for personal reasons, and is now a support manager working part-time hours. The previous deputy manager is now working as the manager, and we were informed that she intends to apply for formal registration. She has suitable training and experience for this role, and has worked in the home for several years. The staff team work well together, and support each other. The support manager stated that the staff have occasional evening events to help them to get to know each other better, as well as staff meetings in the home. These are generally well attended, and staff said that they feel confident to share any issues or ideas. The home has processes in place to enable residents and relatives to share their Care Homes for Older People Page 24 of 28 Evidence: views. The manager has an open door policy, and visitors are also welcome to join in with activities, and are invited to attend residents and relatives meetings during the year. A yearly survey is carried out, enabling residents to share their views anonymously if they wish. Small amounts of residents pocket monies may be stored in the home. These are kept in individual amounts, and all debits and credits are recorded, and all receipts are retained. Staff receive one to one supervision every two to three months, or more often if needed. The manager or support manager carry out a series of health and safety checks each month. These include checking items such as the decor and carpets in each room for any hazards; assessing the general cleanliness in the home; checking if any doors are being propped open (contravening fire safety); checking that windows are safe; and checking accident records. The health and safety checks are very detailed and well recorded. 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 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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