Care Home: Briardene Care Home

What the care home does well Makes sure that anyone who wishes to move into the home has their differing and diverse care and support needs properly assessed so that everyone is sure they can be met. Have service user plans that reflect the wishes, choices and preferences of people who live in the home, how they wish their care to be provided and by whom. Lets people know some of the limitations they may experience when they move into a care home for the first time ie., set meal times. Promotes independence, choice and respect of people who live in the home, whilst being sensitive to some of the problems people may have. Provides a daily menu choice of nutritious, home cooked food, that residents can choose from. Regularly and properly follows the organisations recruitment and selection procedures so that only people who are able work with vulnerable adults do so. Promotes a high level of support for people who have problems with their skin or are receiving end of life care. One relative told us that she thought the staff in the home were `fantastic`. The whole staff team has worked hard to achieve changes in the home in a very short period of time, they are commended for their commitment, the sensitivity we saw being offered to residents, and for the co-operation and support given to the inspectors. What has improved since the last inspection? A new manager is in post and she has worked with the staff team to meet all the requirements that were outstanding at the last inspection and those new ones made at the same time. A new deputy manager is in post and an activities co-ordinator is due to start shortly. The organisation has also employed their own training manager. Person centred care and service user plans are being introduced that properly reflect individual needs, wishes and choices. These are supported by a range of other forms that will evidence staff have read the care plans and know how to care for residents in the way they have chosen. Six month, in-house reviews, of residents needs have been re-started. These include the resident and their relative as appropriate. A new medication system is being introduced at the end of the month and this will promote the safe administration and management of medication in the home. Twelve members of the staff team have achieved a National Vocational Qualification since the last inspection. Activites, events, outings and social opportunities for residents have improved and increased giving people the chance to join in and live a more interesting and stimulating life. Environmental changes have taken place that promote more choice and interest for the residents. Staff, relatives and residents meetings have started and the manager is trying to establish an Activities Committee involving relatives for the benefit of residents. Staff are now receiving regular supervision, training and support to help them do their job. What the care home could do better: No requirements were made as part of this inspection. Key inspection report Care homes for older people Name: Address: Briardene Care Home Newbiggin Lane Westerhope Newcastle upon Tyne NE5 1NA     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: Elaine Charlton     Date: 2 7 1 0 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 31 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 31 Information about the care home Name of care home: Address: Briardene Care Home Newbiggin Lane Westerhope Newcastle upon Tyne NE5 1NA 01912863212 01912866820 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Windmill Hills Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 59 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Briardene is a care home with nursing providing care for older people with physical and mental health needs. The home is owned and managed by Windmill Hills Limited that is part of a larger group, which provides care services for a variety of client groups. The home is staffed by registered general nurses supported by care staff. The philosophy of care is to support the residents in their activities of daily living and to provide for their physical and mental health needs. The home is situated in Newbiggin Lane in the west of the city of Newcastle upon Tyne fairly close to local shops and public transport links. The building is comprised of three floors, the top floor being staff accommodation. The lower two floors are resident Care Homes for Older People Page 4 of 31 Over 65 31 28 0 0 3 0 0 6 2 0 0 9 Brief description of the care home accommodation with 59 single bedrooms all with en-suite facilities. On each of these floors there are a number of bathrooms, toilets, lounge and dining rooms. The home has a visitor coffee room and hairdressing room. There is also a kitchen and laundry room. To the rear of the home there is a very nice garden and patio area. Fees in the home vary and are available on request from the organisation. Care Homes for Older People Page 5 of 31 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 quality rating for this service is two star, this means that the people who use this service experience good quality outcomes. An unannounced visit was made on the 27 October 2009. Two inspectors spent a total of five hours in the service. The manager and responsible person were present throughout the inspection. Before the visit we looked at Information we have received since the last visit on the 30 June 2009. The Annual Quality Assurance Assessment (AQAA) that gives CQC evidence to support what the service says it does well, and gives them an opportunity to say what they feel they could do better and what their future plans are. How the service has dealt with any complaints and concerns since our last visit. The providers view of how well they care Care Homes for Older People Page 6 of 31 for people, and the views of people who use the service, their relatives, staff and other professionals who visit the service. We have also reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the visit we Talked with people who use the service, staff and the manager. Looked at information about the people who use the service and how well their needs are met. Other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around the building/parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since our last visit. We told the manager and responsible person what we found. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? A new manager is in post and she has worked with the staff team to meet all the requirements that were outstanding at the last inspection and those new ones made at the same time. A new deputy manager is in post and an activities co-ordinator is due to start shortly. The organisation has also employed their own training manager. Person centred care and service user plans are being introduced that properly reflect individual needs, wishes and choices. These are supported by a range of other forms that will evidence staff have read the care plans and know how to care for residents in the way they have chosen. Six month, in-house reviews, of residents needs have been re-started. These include the resident and their relative as appropriate. A new medication system is being introduced at the end of the month and this will Care Homes for Older People Page 8 of 31 promote the safe administration and management of medication in the home. Twelve members of the staff team have achieved a National Vocational Qualification since the last inspection. Activites, events, outings and social opportunities for residents have improved and increased giving people the chance to join in and live a more interesting and stimulating life. Environmental changes have taken place that promote more choice and interest for the residents. Staff, relatives and residents meetings have started and the manager is trying to establish an Activities Committee involving relatives for the benefit of residents. Staff are now receiving regular supervision, training and support to help them do their job. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may want to move into the home have their differing and diverse care and support needs and wishes fully assessed so that everyone is sure they can be met. Evidence: We looked at the admission assessments for the two people most recently admitted to the home. Both admissions had been within the previous 48 hours. Each file included a copy of the homes initial assessment and that of the healthcare professional involved in the persons admission to the home. We saw a range of professionally recognised assessment tools being used to record the type of help, and how much, a person needed with nutrition, mobility, pressure area care, and mobility. The home is also making use of a Deprivation of Liberty screening checklist to Care Homes for Older People Page 11 of 31 Evidence: establish a persons capacity to make decisions or whether they need additional input from outside the home. In the older files we saw evidence of a 72 hour care plan being used to support a persons admission and to give staff quick access to important information. This has been withdrawn. Consideration is being given to re-introducing a short term care place to give staff advice about what care and support should be given, and how the individual should be helped to settle in. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 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 receive care and support that is person centred, reflects their choices and wishes and takes account of their different and diverse abilities. Staff support people with their care and medication needs in a sensitive, caring and professional way. Evidence: We looked at the records for four other people who live in the home and spoke to residents and relatives as we walked around the home. The feedback we got from residents and relatives about the changes in the home were all extremely positive. One relative said I cannot find the words to describe the staff, they are fantastic. Two of the service user plans have been updated and were presented in a more person centred way. These had been written in a way that reflected each persons choices and preferences, included information gained through observation and discussion with residents and their relatives, where appropriate. Care plans were signed by the person writing them and the resident or their next of kin. This is good Care Homes for Older People Page 13 of 31 Evidence: practice. The manager has introduced a new form in each persons care file that all staff members involved with that resident have to sign when they have read the whole care file. The mananger monitors progress with this task. The home also uses a Service Limitations care plan. This is written to support Mental Health Capacity 2005 and Deprivation of Liberty safeguarding legislation. It sets out what people can expect and some of the limitations they may experience living in a care home. For example, standard meal times. We saw that risk assessments and screening tools are regularly evaluated. Some of the more outcome based evaluations nicely reflected the benefit not only to the resident but what staff had achieved as well. This is a good initiative. Peoples individual choices and preferences were well recorded throughout the extensive range of care plans we saw. Examples of this were prefers trousers and does not like bare arms, sometimes if staff ask me simple questions I can answer. Sleep and rest care plans cover areas of whether the person likes their bedroom door opened/closed, whether they want a drink before they go to bed, what time they like to get up and how many pillows they like. We saw minutes of staff meetings where the manager had told staff that the night staff team will get a maximum of four people up in the morning, that these will only be people who want to get up and set out the amount of time that should be spent helping someone with their morning care. Records showed that people are able to see a range of healthcare professionals as and when they need. Several GPs and other professionals visited the home during the inspection. We saw excellent tissue viability records for one person who had been admitted to the home from hospital with severe damage to their legs. Pressure areas were documented, photographed and treatment routines identified. There was a copy of the Tissue Viability Nurses report. People were seen wearing protective dressings and foot ware and one resident told us that he was waiting for a caliper to be fitted to give him some extra strength and support to one of his legs. Care Homes for Older People Page 14 of 31 Evidence: For a person who had recently been diagnosed as epileptic we saw a care plan had immediately been put in place so that staff had the relevant advice and guidance to hand. The manager has re-commenced a programme of six monthly in-house reviews. We saw copies of minutes from these reviews, they had been dated and signed by staff and relatives who had attended. We also saw that additional reviews had taken place, particularly for one resident whose family had expressed some concern about a letter from the persons GP. Throughout the inspection all levels of staff were seen talking to and treating residents in a respectful way. They included people in conversations, helped them move around where necessary or just walked alongside them. One lady told us she was supervising the staff setting out a dining room after breakfast. We carried out a random check of controlled drugs kept in the home. These were secure, properly recorded and all entries had been double signed by staff. There was also evidence of audit checks being carried out and recorded in the controlled drugs register. This is good practice. Medication Administration Records (MARs) were reviewed. These were in the main fully completed, but there were still one or two recording ommissions. We were told about a new medication system that is starting at the end of October. This includes MARs with a digital photograph of the resident and measured dose medication packs that also include a photograph of the resident. This is being introduced to minimise the risk to people who need support with their medication and sounds a very positive and proactive initiative. Weekly medication audit sheets had not been completed since the end of September. People can choose the time of day they have their bath and also how often they would like to have a bath or shower. This can be daily if the person would like. The manager has made contact with the hospital based Dental Hygiene team and is shortly to attend training with them. Care Homes for Older People Page 15 of 31 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 who live in the home can join in events, outings and activities as they wish. Visitors are welcomed into the home and community contact is increasing. A varied and nutritious menu is offered and includes lots of home cooked and fresh produce. Evidence: A new activities co-ordinator has been appointed and is due to take up her post in the near future. Since the last inspection more activities and social events have started to take place. These include outings to the Scottish Borders and the coast, entertainers coming into the home, tea dances, line dancing, baking sessions, and games. A Halloween party is advertised and planned for the weekend, staff are going to dress up and relatives are invited to join in the fun. Chef told us that she had bought a magazine with Halloween recipies so that she could make the buffet more interesting. She was going out to buy decorations for the food. Other planned events include more entertainers, a Christmas party, carols by a local school and Christmas Fair. Care Homes for Older People Page 16 of 31 Evidence: One gentleman told us he was going on an outing the day after the inspection to the Durham Light Infantry Museum and he was really looking foward to this, checking out information about his family and other records. The manager held an initial meeting with families to try and establish an Activities Committee, we saw the minutes and another meeting is planned for next month. People are being encouraged to get involved and let the home know about events and activities/social opportunities that they think their relative, and others, may enjoy or what to take part in. A photograph album has been started and shows what outings and events people have taken part in. This is a nice initiative and gives relatives the chance to see what people have been involved in and talk to them about it. The organisations booklet is being introduced to residents and their families to help staff collect information about each person, lifetime events, memories, and about activities/events they may enjoy. Staff are also encouraged to find out one new thing about a resident they are key worker for that they can share at handover so everyone gets to know people as individuals, their likes and dislikes. Chef has almost completed her NVQ. She showed us her portfolio that included test results all of which have been around 100 . Choice of lunch on day of inspection was beef stew and dumplings/home made chicken pie, mashed potatoes, carrots and cauliflower. Followed by pineapple upside down pudding and custard. We sampled both choices and pudding. Both meals were tasty, well presented, the meat was tender and pudding delightful. For teatime there was jacket potatoes with a choice of fillings or egg salad, followed by strawberry mouse. We were told that regular food deliveries are received and additional supplies can be purchased when needed. A good store cupboard is mainatined and there are lots of alternative choices should a resident want something different. Daily choice record sheets are returned to the kitchen. They record the type of diet/the need for pureed food/alternatives. One entry we saw recorded that someone was reqeusting a sandwich with no butter at lunch time. Care Homes for Older People Page 17 of 31 Evidence: Care Homes for Older People Page 18 of 31 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 who live in the home are protected through policies, procedures and staff training on the acceptance, recording, investigation of concerns, complaints and safeguarding. They know they will be listened to and that any worries they have will be taken seriously. Evidence: The organisation has policies and procedures in place that promote the acceptance, recording, investigation and proper feedback of concerns, complaints and allegations. Three complaints had been received by the home since the last inspection. These were well recorded, had been investigated and resolved to the satisfaction of each complainant. CQC has been kept up to date and notified about any events and incidents that affect the well being of people living in the home. All staff are required to have a Criminal Records Bureau (CRB) checked carried out at an enhanced level before they are able to work in the home. They are also required to notify the manager if they receive any cautions or convictions following their employment. Care workers are employed in accordance with the General Social Care Council Care Homes for Older People Page 19 of 31 Evidence: (GSCC) code of conduct. Nurses are required to provide evidence that their registration with the Nursing and Midwifery Council is up to date. We checked the homes records of nurses PIN numbers and these were all up to date and current. The manager is establishing links with the Newcastle Safeguarding Team and attending their training so that she is up to date with the local authoritys expectations and procedures. Some staff still need refresher training in safeguarding adults and this is being organised. The new training matrix also records when refresher training is due. This is a good system to adopt. The organisation has a whistle blowing policy that encourages people to report incidents or practice that they know or believe to be unacceptable. Care Homes for Older People Page 20 of 31 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 home that is warm, comfortable and safe and where they can spend time privately, or in a range of communal areas of their choice. The home is clean, tidy and odour free and staff promote good infection control. Evidence: We walked around the home and saw a range of environmental changes that have taken place since our last inspection. Everywhere was clean, tidy and odour free. Staff promote good infection control practices. Sensory equipment was seen in various parts of the building including books and CDs in the lounges. Lots of new black and white photographs have been donated by the relative of a late resident and tactile wall art has been provided in the corridors that prompts people to stop, look and touch. Another area displayed photographs of movie stars and advertising posters that people may remember. Everyone has access to a private bedroom. Many of these have been very personalised by residents and their families with the inclusion of photographs, Care Homes for Older People Page 21 of 31 Evidence: pictures, and small items of furniture that the resident is familiar with. Lots of flowers and plants both real and artificial were seen around the home. Changes have taken place on the first floor to provide a choice of dining areas. One room provides a private space where a family or couple could enjoy a meal together. The smoking room on the first floor has moved to the top floor and in its place a hairdressing salon has been created. This means that hair appointments can be a very social event with people being able to sit and chat, look out over the garden or just watch what other people are having done. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected through recruitment and selection procedures that are regularly and properly followed, staff training and support that helps them to do their job and a management team that promotes the well being and inclusion of residents. Evidence: The organisation has recruitment and selection policies in place, together with interview sheets and a scoring matrix. The evidence at this inspection is that these are now being regularly and properly followed. We looked at the records for three new people recruited to work in the home. The files were tidy, easy to use and contained all the information to show that the person had been properly recruited. This included an application form, health clearance, evidence of identification, rehabilitation of offenders statement, references, interview checklist and scoring matrix. These new staf files have much improved on those we saw earlier in the year. The manager told us that she will be updating all staff files so they are presented in the same way. Seven staff have just achieved a National Vocational Qualfication (NVQ) at level 2, one Care Homes for Older People Page 23 of 31 Evidence: person has achieved an NVQ at level 3, three have completed a Support Services NVQ and the manager has done the Leadership and Management course. This is an excellent achievement by all. There is a training file for each floor that includes a copy of the new training matrix, a record sheet for each member of staff and copies of their certificates of achievement. The training matrix shows when people completed their training and when refresher training should be provided. Staff told us that they had taken part in recent training that included the safe handling of medication, moving and handling and infection control. A Training Officer has been employed by the organisation and this means that more frequent programmes of training can be delivered and that training can also be delivered to meet individual staff and residents needs. A programme of training is in place to make sure that the small number of staff who need their mandatory training will receive this. We were told that additional staff were registering to start further NVQ training in November. Two courses on Challenging Behaviour have recently been delivered. One at Briardene and one at its sister home close by. The latter had been over-subscribed by staff so will be repeated. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being run in an open and inclusive way that promotes and encourages the people who live there and their relatives to be involved. Their choices, wishes and preferences are valued and welcomed. Evidence: The new manager is qualified and experienced, and has come from one of the organisations homes that achieved an excellent quality rating with CQC. Both she and the responsible person for the organisation have co-operated and communicated with CQC to achieve improvements since the last inspection. It is evident that people have worked hard to ensure that all requirements outstanding at the last inspection, and the new requirements made, are met. The atmopshere in the home is warm, welcoming and promotes the inclusion of both residents and their relatives. Care Homes for Older People Page 25 of 31 Evidence: We were provided with a copy of the homes Annual Quality Assurance Assessment (AQAA) when we asked for it. Regular audits are carried out by staff inside the home and those with responsiblity for reviewing quality in the organisations homes. We saw evidence that these are being completed. A recent catering audit scored the home at 89 and an unannounced medication audit in September achieved 78 . A new programme of supervision and appraisals has started. A schedule is in place so that the planned and actual dates meetings take place can be seen. Appraisal dates are being recorded in red and supervision in black to it is easy to see the difference. The manager plans to hold staff meetings on a six weekly cycle. We saw minutes of meetings that she has already held for night staff, nurses and carers. Each group has their own meeting to promote staff raising issues that may affect them or the residents. The minutes we saw were clear and promoted the standards of care and support expected of staff as well as the importance of including and valuing the residents. It was stressed that routines must be established to meet the needs and wishes of the residents and not the staff supporting them. Incidents and events that may have affected the well being of people living in the home have been reported to CQC as required by Regulation 37 of the Care Homes Regulations 2001. These have been well detailed and have told us if there has been a need to alert other professionals and family members. The manager held an initial meeting for families it is planned that these will take place on a six weekly basis. Servicing and maintenance contracts for the home are in place and up to date. The certificate of registration is properly displayed a well as evidence of the homes insurance. Policies and procedures are in place that promote safe working practices. Fire and accident records were reviewed and we discussed with the manager and RI the value of staff being able to practice evacuation procedures on each other. Care Homes for Older People Page 26 of 31 Evidence: There is a monthly health and safety checklist in place covering general, fire, accidents, first aid, COSHH (Control of Substances Hazardous to Health), the environment, and waste management. A monthly accident audit is carried out and remedial actions are noted and taken where and as appropriate. The weekly maintenance checks include water temperature testing, showers, and extractor fans. Within a month of the new manager starting an interim quality assurance survey was carried out. Seven surveys were returned by residents or their relatives, all of which were mainly positive. One healthcare professional was very positive. A further survey is planned for six months time. Care Homes for Older People Page 27 of 31 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Consider the re-introduction of the 72 hour care plan so that staff have access to all the information they need to look after the new resident and know how much care and support they need to help them settle in. Weekly audit sheets for medication should be regularly completed and should include follow up actions needed when problems or issues are identified. This will help to ensure that people living in the home receive their medication correctly. Staff should follow the organisations policies and procedures and good practice guidance for the proper completion of MARs charts so that it is clear whether a person has received their medication as prescribed. This will support the health and well being of people living in the home. Ensure that staff training in safegaurding adults is completed. This will promote the safety and well being of people who live in the home as well as the understanding of staff. Ensure that the planned programme of mandatory training Page 29 of 31 2 9 3 9 4 18 5 30 Care Homes for Older People 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 is completed so that all staff training is up to date. This will promote the health and well being of people who live in the home. 6 36 The programme of supervision and appraisal should continue to achieve the National Minimum Standard of six meetings a year. This will mean that staff get the support they need to do their job. Consider introducing practice fire drills that staff can take part in so they are sure what to do in the event of an incident taking place. This will promote the health, safety and well being of both staff and residents. 7 38 Care Homes for Older People Page 30 of 31 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. 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