Care Home: Broadacres

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What the care home does well People live in a home that is exceptionally well maintained and decorated, with access to pleasant communal areas and landscaped gardens. There are en-suite facilities (including baths with aids for access if needed) for all the bedrooms in the home. This is well above expected minimum standards. Staff show a high degree of respect for people`s privacy and dignity, checking out what personal information they could share with us, and ensuring they always use people`s preferred mode of address. People tell us the staff are "very good" and a relative says that `they all do an excellent job` feeling it is great that the person they visit has `such excellent care.` Someone living at the home also told us that they felt the home was very good "at all the finessing", and the little touches that make Broadacres a pleasant place to live and this is why "no one wants to move". Staff are offered regular opportunities to undertake training that will help them understand and meet people`s needs more effectively or more safely. One person told us that the management team look at any training that is suggested might be useful or necessary and try to make sure this is delivered. Everyone living or working at the home who was asked, says that the manager is approachable and that they can go to her with issues or problems. This shows that she is willing to listen to any suggestions for improvements and to address complaints at an early stage. One visiting professional sums up their views of the service in their hopes that `all care home aspire to the level this home has - good nursing care, good communications, very good family support, good food and cleanliness within the home - excellent management`. What has improved since the last inspection? There was nothing that the manager needed to do by law as a result of our last inspection. However, she has continued to make improvements in the service that people are offered, monitoring and reviewing it regularly. This includes acting upon recommendations for good practice that the previous inspector made, as well as identifying things for herself that she would like to see done better or have been suggested by people living at Broadacres. What the care home could do better: The is one requirement made as a result of this inspection and discussed with the manager. This is because records of medicines that staff have given people are not always clear and complete. There are also concerns that medicines prescribed for use on a short term basis, such as antibiotics for infection, are not always given as intended by the G.P. It would be good practice to increase medication audits for people who are prescribed such medication which is not part of their normal drug regime. This is so the management team can satisfy themselves that staff are making proper checks on prescriptions and giving these medicines as intended. Key inspection report Care homes for older people Name: Address: Broadacres Hall Road Barton Turf Norwich Norfolk NR12 8AR     The quality rating for this care home is:   three star excellent 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: Judith Last     Date: 0 6 0 4 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 30 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 30 Information about the care home Name of care home: Address: Broadacres Hall Road Barton Turf Norwich Norfolk NR12 8AR 01692630939 F/P01692630939 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.broadacres.co.uk Mr Michael John Muir-Smith,Mrs Daphne Gillian Muir-Smith Name of registered manager (if applicable) Shirley Ann Ellis Type of registration: Number of places registered: care home 28 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 who can be accommodated is 28 The registered person may provide the following categories of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Broadacres is a care home for older people situated 6 miles from Wroxham in the broads village of Barton Turf. At the front of the property is a car park and to the rear is a large well-maintained and Care Homes for Older People Page 4 of 30 Over 65 28 0 Brief description of the care home accessible garden, which backs onto Barton broad and has its own lake. The home is an adapted building to which a purpose built extension has been added. Communal space is on the ground floor and peoples bedrooms are on the ground and first floor. There is a lift to the first floor for ease of access. All residents rooms have en suite toilets and baths (with bath seats for those who need aids to get into the bath). The current range of weekly fees is £525 to £825 (for a shared room), and is individually assessed according to peoples needs for support. Care Homes for Older People Page 5 of 30 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: three star excellent 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: Before we visited the home we reviewed all the information we had about it. This includes the information the manager sent us about the quality of the service and the results of our previous inspections and annual service reviews. (The home was last visited for an inspection in April 2007 when it was rated as excellent. There have been two annual service reviews since then.) We also looked at things the manager has needed to tell us about by law. These are called notifications. We also had surveys from four people living in the home and seven of their relatives. Seven staff and two visiting professionals also wrote to us with their views. We visited the home unannounced and spent about 9 hours there. During our visit, the main method of inspection we used is called case tracking. This means we look at records to see what they say about peoples needs and what is going Care Homes for Older People Page 6 of 30 on in the home, and then try to find out from observation and discussion how well people are being supported. We used all the information we have and our rules to see what outcomes there are for people in their daily lives. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The is one requirement made as a result of this inspection and discussed with the manager. This is because records of medicines that staff have given people are not always clear and complete. There are also concerns that medicines prescribed for use on a short term basis, such as antibiotics for infection, are not always given as intended by the G.P. It would be good practice to increase medication audits for people who are prescribed such medication which is not part of their normal drug regime. This is so the management team can satisfy themselves that staff are making proper checks on prescriptions and giving these medicines as intended. Care Homes for Older People Page 8 of 30 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 30 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 30 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 thinking about moving into the home will have their needs assessed so that staff could be clear how to meet them. Evidence: There are assessments of peoples needs on their files. Two staff told us that they know what peoples needs are and one added that no-one is admitted without an assessment so that staff would know what to do to be able to meet them. This confirms what the manager says in information she sent. Six out of seven of the staff who completed surveys for us feel they always have up to date information about the needs of the people they support, and one feels this is usually the case. We were present at handover when someones needs were discussed who had been admitted two days previously in an emergency. Information passed to staff coming in Care Homes for Older People Page 11 of 30 Evidence: who had not met the person was clear about what they needed support with and what they could manage themselves, showing information had been gathered promptly. (However, one staff member had to enquire about the persons name and how they prefer to be addressed as this information was not given straight away.) Staff took some paperwork to the person for them to complete at their leisure to increase the full picture of their needs and wishes with respect to their care and how they want this to be delivered. Care Homes for Older People Page 12 of 30 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. Peoples personal care needs are met as they require and prefer. Health concerns are followed up promptly but medication is not always effectively managed. Evidence: We looked at the individual care plans for four of the people living at the home. Care plans show that there are regular updates and that service users are involved in the process. They have signed their records where they are able to do so, showing their involvement in making decisions about their care. People told us they felt the staff were good and offered them help when they needed it. One person told us about having had a fall and how the staff had reassured them they told me not to worry and got the contraption to lift me. It was comfortable and they got me back to bed. There are risk assessments setting out how peoples safety is promoted and these are updated if the audit of accidents indicates there are concerns showing that someones Care Homes for Older People Page 13 of 30 Evidence: needs or dependency has changed. We know from discussions with staff that they are aware of the risks posed to people in their day to day lives, for example from choking, and during any assistance with moving and handling. We were told about one person who is at risk of choking, how their food and drink needs to be prepared and the supervision staff need to offer to keep them safe. However, relevant parts of care plans are are not always crossreferenced with risk assessments. For example, care plan guidance about supporting someone with eating and drinking is not clearly cross referenced to the risk assessment for choking. Despite this, staff showed in discussion that they were aware of the issues and how they needed to reduce risks. Peoples files show where they may be at risk of developing pressure sores or from poor nutrition and hydration. We could see that people were encouraged with mobility and that a physiotherapist attends the home regularly to support people with this. One staff member told us how they seen care staff following up and acting upon the therapists instructions and how people themselves listened to and acted on the advice they had been given. The manager told us she had arranged for those people who were not able to attend the surgery, to have some screening by a practice nurse. She says this has been helpful in identifying developing problems and ensuring that they could act promptly to ensure the right treatment was obtained. We were able to see records of such appointments in peoples files. The manager is qualified to deliver Excel exercise programmes for older people. The activities programme also shows that carpet bowls is popular showing that people are encouraged with some physical activity in addition to any physiotherapy that is needed. We were able to see from records that people are consulted about their health care. In one case where a relative had expressed concerns, the person themselves had been consulted about their wish to see their doctor before arrangements were made for an appointment. This shows that peoples autonomy and ability to make their own decisions is respected. One person wrote to us that they feel the home has excellent staff who look after residents very well within their medical training. Everyone we spoke to expressed their satisfaction with the staff and say they are given help when they need it. Care Homes for Older People Page 14 of 30 Evidence: Medication administration records were checked for the period of time from 8th March, because current sheets had only been in use for two days. These showed omissions from records when it was not possible to determine whether medicines had been given as prescribed, refused or withheld for some reason. One antibiotic prescription had not been administered regularly four times daily as prescribed, presenting concerns that the treatment might not be as effective as it should and that bacterial resistance could develop. There was also an anomaly for another antibiotic where 15 had been supplied, one dropped and destroyed (but without clear indication of when), and only 13 signed for, making anomaly of one tablet. One steriodal inhaler designed for regular use was not recorded as being offered or refused at prescribed times indicating that staff (and possibly the person concerned) had not appreciated the importance of regular use in preventing rather than treating symptoms. The manager has audit systems in place to help identify errors each month, but these may have occurred some weeks previously and so be difficult for staff to recollect what has happened. There is separate storage and recording of controlled drugs - those requiring additional precautions in their storage, recording and management. None were present when we visited and the pharmacy had signed records showing that they were received back for disposal when no longer needed. However, although the records in the register show that they were returned and that this corresponds with the pharmacists notes, the balances have not been reduced to zero to present an accurate record. We asked a staff member about the needs of one person. The staff member was unsure until it was explained, what right of access we as inspectors have to information and checked this before disclosing personal information. This shows that staff are aware of the principles of confidentiality and privacy and put these into practice. Care Homes for Older People Page 15 of 30 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. Peoples recreational and social needs are met as they prefer and with opportunities to express how things could develop further. Evidence: There is a member of staff who is allocated to develop the programme of activities for people living in the home. The manager, activities coordinator and activities programme confirm that staff are involved and volunteer for those activities they would like to help deliver. The manager says that sometimes rosters are changed but these are monitored to ensure that responsibilities are shared between the staff to help ensure peoples recreational and social needs are met. We saw photos of events that have taken place in the home and this has recently included a 1940s day, with reminiscence, appropriate menus and staff dressed up in costume. We asked three people about this who said how much they had enjoyed it. It was lovely. The person having responsibility for coordinating activities is new to post and says they do not yet know whether people are engaging in activities that they wish to do and did in their own homes, for example cooking, tidying their rooms or doing their Care Homes for Older People Page 16 of 30 Evidence: own personal laundry. She plans to look at this but the manager confirms some people do dust and tidy their rooms and do their washing if they wish to do so for themselves. People living in the home are also supported to organise any activities they might wish to do and one person told us about a fund raising event they were organising for a charity they had supported for a long while. Staff were involved in assisting with this. One visiting professional commented to us that there are some well planned activities but they felt this could be improved to suit all residents tastes. One staff member wrote in a survey that they also felt this area could be improved. However, our discussion with staff shows that they recognise the importance of activities in encouraging relationships and interaction between people living in the home. A relative commented to us that the person they visit prefers not to mix and enjoys their own company. They feel that staff can do no more. We were told by two staff and by the manager in information she sent, that alternative methods of communication using symbols, are in place if this is needed for people to make their views known. People are free to receive visitors in their own rooms or in communal areas. They told us about people who come to visit them and take them out regularly. The manager says she does not manage finances on behalf of service users. These are managed either by individuals or by relatives where appropriate. We saw that people are able to bring in possessions from home where they wish, and information from the manager confirmed that one person had furnished most of their own room with things they wished to bring in, while they were living there. One person described to us that the home is very good at the finessing. Everyone had received small Easter card on a little dish with an Easter chick and some eggs. The person added that everyone is made a fuss of on their Birthday, with a cake and everything. While we were present, we saw that people are served afternoon tea on an individual tray with their own teapot, milk and sugar. We saw that one person was offered assistance to pour it out when it was presented and staff took care to make sure that the table alongside their chair was positioned so that they could reach it. Care Homes for Older People Page 17 of 30 Evidence: There are menus for people to choose from. Although one person expressed some concern about the presentation and cooking of food in their survey to us, the compliments record shows that others disagree about the same issues that were identified and named people express a high degree of satisfaction with the same meals. One persons daily records show that their diet has been discussed with them and that they were offered the opportunity to plan their own menus. Risks associated with eating and drinking, including the need for thickened drinks where appropriate, have been discussed with people and their decisions and views recorded. Our discussion with staff shows they are aware of the importance of encouraging people with drinks and we saw that where people needed assistance to eat, staff sat beside them at the table to help or prompt them, so helping promote dignity. One relative who says they visit regularly, wrote to us that the selection of food is very well cooked and varied and consistently so. The dining room is well maintained and lit, and people had cloths, napkins and condiments provided. There is a dedicated person to help serve meals and clear away so that peoples experience of eating at the home can be more pleasant. Care Homes for Older People Page 18 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their concerns, and they (and their representatives) have access to a robust complaints procedure. There are measures in place to help protect people from abuse. Evidence: We asked people what they would do if they had any concerns about their care. Everyone we spoke to expressed their satisfaction with the service and said the manager is someone they can go to. Shirley is very good and I could talk to her. Seven staff completed our survey and all of them say they know what to do if someone expresses any concerns about the home or their care. Likewise, all seven of the relatives who completed surveys say that they know how to make a complaint if they need to. One adds that at all times they have liaised with me and dealt promptly with any concerns that I have raised over the years. In addition to a proper record for recording complaints and their investigation and outcome, the manager introduced a record of compliments and grumbles after our last visit. She uses this to evaluate how well things are going, obtain a balanced view of what people think, and to address problems before they develop into complaints. Staff training records show that they have access to training to help safeguard vulnerable people. Recruitment records show they are properly checked before they start work at teh home, to make sure they are not unsuitable to work with those who Care Homes for Older People Page 19 of 30 Evidence: are vulnerable. Care Homes for Older People Page 20 of 30 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 excellent 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 homely, clean, safe and exceptionally well maintained environment. Aids and adaptations are available where they are needed. Evidence: There is level access across both floors of the home, with a lift to assist access to the first floor. There is a regular programme of maintenance, redecoration and cleaning. We looked at communal areas as well as five individual bedrooms where there were no concerns about maintenance or safety. People have access to a lounge, drawing room and dining room, as well as their own bedrooms, and make use of these for activities or receiving visitors if they wish. They also have access to landscaped gardens looking out over water, that are well maintained and were full of daffodils when we visited. (The home does not admit people who are confused and for whom this would be a risk.) Everyone has their own en-suite bathroom off their bedroom, with bath seats to assist with access to their bath if this is needed. There is also a whirlpool bath people can use if they prefer, and additional toilet facilities near communal areas. Facilities are therefore well above expected minimum standards. Areas of the home that we saw, were clean and free from odour. Domestic staff have Care Homes for Older People Page 21 of 30 Evidence: access to training to support them in their roles as do care staff so that everyone understands how to work in a way that minimises the risk of infection spreading. Antibacterial gels and protective gloves or aprons are available where these are needed. Care Homes for Older People Page 22 of 30 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 supported by an effective and competent staff team who are robustly recruited in order to make sure they are suitable for their jobs. Evidence: The manager says that staffing levels are adjusted from time to time to reflect occupancy and peoples needs. Four service users completed surveys for us. One says staff are always available when they are needed, and three say this is usually the case. We asked people about this and people say that staff are very good and help them as they require. One person said, They will come quickly if they are not sorting out someone else who needs it more. Staff are described as very good. Our observation of cleanliness and catering arrangements, as well as comments from service users, supports that there are sufficient catering and housekeeping staff to support care staff in the day to day operation of the home. Two visiting health professionals wrote to us about their satisfaction with the staff at the home. One commented that There is tremendous team work at Broadacres - the staff in whatever areas support each other and the relatives of their residents so well, from the care staff, kitchen, cleaners, hairdresser. Another says there is a good standard of care, knowledgeable staff about patients wellbeing and that they feel very happy with their care and the service they provided. Care Homes for Older People Page 23 of 30 Evidence: The manager provided us with information that over half of the care staff have National Vocational Qualifications to at least the minimum standard. This supports that they are given opportunities to access training and qualifications to underpin their skills and abilities in supporting people effectively. In addition, housekeeping and catering staff also have access to training to enable them to achieve qualifications in relevant areas. We looked at training and recruitment files for three staff. These show that all required checks and references are taken up to make sure that suitable people are recruited and that staff are given appropriate induction training. All seven staff who wrote to us say their induction covered very well what they needed to know in order to work effectively with service users. One staff member told us there is good training - whatever is wanted and suggested is followed up. The manager confirms, and records support, that a probation period is used to make sure that staff understand and are able to apply this training and that they work in an acceptable manner with the people they support. Care Homes for Older People Page 24 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a service that is effectively and efficiently managed, where their views are taken into account and their safety and welfare is promoted. Evidence: There has been stable and consistent management at the home for ten years. The manager, based on discussion and information she sent, participates in relevant training to ensure her knowledge is kept up to date - particularly in relation to management and health and safety within the home. People living in the home speak highly of the manager and that she will listen to them if they have concerns. Staff we spoke to also say that the manager is approachable and they can raise any issues they need to. Three of the staff we spoke to say that morale is good. The manager surveys staff to find out what they think of the home and the support that they receive from more senior colleagues. The results are posted on the Care Homes for Older People Page 25 of 30 Evidence: noticeboard of the office used by staff for hand overs. where the results of one question had caused concern to the manager a notice indicated she had given the opportunity to the person concerned to come forward in confidence and explain their response in order for this to be addressed and to ensure that nothing had been overlooked. (The person has not availed themselves of this opportunity.) In addition to this survey of staff there is regular monitoring by the proprietors to find out what people living in the home think, as well as audits of concerns, complaints and incidents. There are also residents meetings where people can express their views and make suggestions about what they would like to see changed and these are recorded. People we spoke to confirm that one of the owners comes to see them regularly to make sure that they are happy with the way things are going. The manager completed the self assessment about service quality for us by the date we asked for it and included a range of information and evidence about what is done well. She also shows where she considers further improvements can be made so showing she continues to take responsiblity for developing the quality of the service people receive. People confirm they control their own money, or do so with the support or assistance of relatives who may act on their behalf. The manager says she does occasionally hold some spending money for safekeeping but that records are kept of monies received and signatures obtained when it is returned. We checked a sample of records to do with maintenance of the home, appliances and safety of equipment in use. These confirm arrangements for testing and servicing equipment such as emergency call systems, fire detection systems, lifting equipment and electrical appliances. Staff training records show that staff have training that contributes to and promotes peoples safety, such as in first aid, moving and handling and infection control. The manager also carries out audits to check what is going on, including reviewing incidents and accidents to ensure there are no developing patterns and that risk assessments can be reviewed and updated where appropriate to promote peoples safety and welfare in the home. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 9 13 The manager must ensure staff follow a safe procedure for administering and recording for all medicines managed on behalf of service users. This is so that people receive the medication they need as prescribed to improve their health or keep them well. This is so records support a proper procedure is followed and medication is accounted for. Regulation 13(2) of the Care Homes Regulations 2001 requires that the registered person shall make arrangements for recording, handling, safekeeping and safe administration of medicines received into the care home. 21/05/2010 Care Homes for Older People Page 28 of 30 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 7 Care plans could be cross-referenced with relevant risk assessments to increase the awareness of staff when supporting people with either care, or reviews of their care plans. The frequency of medication checks should be increased when medicines such as antibiotics for short term use and are not part of a routine prescription. This is to help ensure staff follow proper processes for checking medication charts when they are administering medicines. Access to training or supporting reference materials and information, should be considered for staff who have responsiblity for identifying and delivering activities that are suitable and appropriate and will enhance peoples quality of life still further. 2 9 3 12 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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