Care Home: Caldy Manor Residential Home

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What the care home does well The manager is experienced in managing a care home and this was reflected in how policies, procedures and training had been introduced since the home was purchased by Barchester Healthcare. Before people that use services decide if they want to live in the home their needs are discussed with them, their families and people involved in their care by a representative of the home so important information is gathered about their needs. The home demonstrated a positive commitment to staff training with a varied staff training programme taking place so staff were provided with training and support to do their jobs. The home provides information to people that may choose to live there and people that use services so they are aware of the facilities, services and costs of their care. The home treats people with dignity and respect and people that lived at Caldy Manor said they enjoyed living there. A person that used services said,"I have lived at this home for over eight years. It`s lovely, peaceful and quiet and you couldn`t wish to be in a nicer setting" another person said,"You couldn`t wish to live in a nicer place, we are all friends together and usually get on well. I enjoy a laugh and a joke with the staff" People that use services are offered a variety of recreational activities so they have a variety of lifestyle options to choose from. People that use services are confident they can raise concerns so they will be acted upon. The home provides a clean and comfortable place to live so people that use services live in a homelike environment with access to the local village amenities. Appropriate staffing levels are provided so people that use services are supported. What has improved since the last inspection? The care plans of people that use services had improved so where they made choices about managing their medicines plans called risk assessments were in place that showed staff had made sure they understood how to keep their medicines safe so could take them without help. The care plans of people that use services contained guidance for staff on how to help and support people with their personal care and maintaining their safety so they could receive the right help and support when needed. Medication administration had improved and receipt, storage, administration and returns were looked at and found to be safe so that people that used services received or had support to administer medicines safely.The building had been refurbished so radiators were fitted with guards so people that use services were protected from hot surfaces. Windows had window restrictors fitted so the windows opened to a safe distance. The maintenence checks of the building had been completed so people that use services lived in a safe home. What the care home could do better: The home needs to improve how the personalisation of the care of people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples` routines and decisions are to them and how these are transferred into how they receive care. Information in records needs to be recorded accurately and transferred between records so staff are aware of where they need to take action and contact health care professionals. The recording of daily records and reviews of care plans needs to include more information on the daily lives and routines of people that use services and if the care plans in place support them to remain healthy and independent. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Caldy Manor Residential Home Caldy Road Caldy Wirral CH48 2HY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anthony Cliffe     Date: 2 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Caldy Manor Residential Home Caldy Road Caldy Wirral CH48 2HY 01516252311 01516250984 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Barchester Healthcare Homes Ltd care home 38 Number of places (if applicable): Under 65 Over 65 6 38 dementia old age, not falling within any other category Additional conditions: 6 0 One named adult PD (Physical Disability) within the overall number of 38. One unnamed adult over the age of 50 years with a physical disability (PD) within the overall number of 38. Six unnamed service users with dementia (DE(E)) within the overall number of 38. Date of last inspection Brief description of the care home Caldy Manor offers personal care to 38 older people including six people with dementia. Accomodation is provided on two floors with access to the first floor by stairs and a passenger lift. There is separate accomodation for people that use services that have dementia and this area is all on one level. The majority of bedrooms have ensuite facilities with a bath or walk in shower. There are spacious and comfortable communal areas including a large lounge and dining room. Outside there are large well tended garden areas and a large patio area with seating. There is ample space for parking. The home is situated in a residential area and access Care Homes for Older People Page 4 of 29 Brief description of the care home to local amenities can be restricted without transport. Fees range between three hundred and eight hundred and fifty pounds per week. Additional charges are made for hairdressing, chiropody and other services. Information about the home can be obtained directly from the home including a copy of out last visit report. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: References to we, our or us represent the Commission for Social Care Inspection This unannounced visit took place on the 26th February 2009 and lasted eight and a half hours. One inspector carried out the visit This was the first visit to this service since it was registered by Barchester Healthcare in June 2008. This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since the last visit, to provide us with up to date information about the services Care Homes for Older People Page 6 of 29 provided. This helps us to determine if the management of the home see the service they provide in the same way we do and if our judgements are consistent with homeowners or managers. We provided questionnaires for people that use services, relatives, staff employed at the home and social and health care professionals involved in their care so they can tell us about their views about the service the home provides During the visit various records and the premises were looked at. People that use services were spoken with and gave their views about the service. We also received questionnaires from people that use services and staff. What the care home does well: What has improved since the last inspection? The care plans of people that use services had improved so where they made choices about managing their medicines plans called risk assessments were in place that showed staff had made sure they understood how to keep their medicines safe so could take them without help. The care plans of people that use services contained guidance for staff on how to help and support people with their personal care and maintaining their safety so they could receive the right help and support when needed. Medication administration had improved and receipt, storage, administration and returns were looked at and found to be safe so that people that used services received or had support to administer medicines safely. Care Homes for Older People Page 8 of 29 The building had been refurbished so radiators were fitted with guards so people that use services were protected from hot surfaces. Windows had window restrictors fitted so the windows opened to a safe distance. The maintenence checks of the building had been completed so people that use services lived in a safe home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services have their needs assessed before they move into Caldy Manor so they know their needs can be met. Evidence: The home was registered in June 2008 as a new service following it being purchased by the Barchester Healthcare group. The information provided to people that use services was called a statement of purpose and service user guide with a brochure telling them about the facilities and services available. This is called a welcome pack. People that may wish to choose to live at the home can visit to look around the home, share a meal and spend time at the home. On arrival people that use services are given a welcome pack. People that choose to live at the home are given all the relevant information inclusive of our report so they can decide if the home can meet their needs. Ten questionnaires were returned by people that use services. All said Care Homes for Older People Page 11 of 29 Evidence: they received a contract and information that helped them to choose Caldy Manor as their home. Barchester Healthcare provides training on equality and diversity to staff so when they gather information on people before they move in important information is gathered about their needs such as disability, religion and sexual orientation. Information gathered about people that use services involved gathering information from families and other professionals involved in their care so staff at the home had useful information to help them provide the right support and care. The home use a person centred approach to care so the care of people that use services was based on their daily routines and preferences. The information we saw gathered about people before they moved into the home included details about their needs so staff had information about them before they moved into the home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live their preferred lifestyles, however information held about them does not support that they are directly included in the decision making process. Management and administration of medicines was safe so people that use services received their medicines correctly. Evidence: We examined the care plans of three people that use services. We could see that the home were using Barchester Healthcare documents in which to records information about people that use services, what their needs were and how staff would provide care and support to them. The home does not use person centred planing. Person centred planning is a really good way for people that use services to take control of their lives. Person centred thinking helps staff that care and support people that use services to listen to them and then to get what they want. A person centred plan contains information on what is positive about people that use services for example what people like and admire about them and their gifts and talents. Information should be included about what and who is important to people that use services from their Care Homes for Older People Page 13 of 29 Evidence: viewpoint, as well as what people want for their future. A person centred plan should have information about how people that use services want to be supported, so stay healthy, safe and well. This is called a support plan but may be called a care plan. This should be detailed enough to provide a living description of how people that use services want to be supported, how they make decisions and says who will do what by when. We could see from the care plans and conversations we had with people that use services and staff that the needs of people living at the home where met and their privacy and dignity respected. We could see that a lot of information had been gathered abut people that use services. The information included copies of information gathered from social workers and health professionals from the NHS and local Primary care Trust so important information was shared and gathered about their needs. The information the home had about people that use services was about their needs, routines and lifestyle but this information was not always reflected in the care plans the home had written to support and provide care for them so staff did not always have information to provide individual care. Care plans reflected a person centred approach and contained some information on how people could care for themselves or be involved in their personal care so provided staff with information on how to offer individual care but could be improved further. We could see many examples of how people that lived at the home chose their daily routines and followed their own lifestyles but this was not always reflected in the care plans written about them and we could not see how they were involved in making decisions about their lives or how staff made decisions for them if they lacked the capacity to do so, so care plans did not say how important choices and decisions were to people that use services. Reviews of care and daily records also needed to include information on how people chose their daily routines and what they enjoyed doing so care and support could be planned around them. Care plans included details of the health and social care professionals involved in their care. Care plans and daily records showed that staff acted on recommendations from professionals such as doctors and district nurses. A good example of this was before a person living at the home moved in the manager had already made arrangements with the local district nursing service to visit the home to look at a leg ulcer. We found some inconsistencies in care plans, for example a risk assessment to prevent a person who had a history of falling did not have a this information recorded in a care plan for mobility which indicated the persons mobility was good so records were not always accurate. In another plan we could see that staff had recognised where a person using the service had lost weight but had not included information on nutrition that said staff only needed to contact health care professionals when the person reached a certain Care Homes for Older People Page 14 of 29 Evidence: score on the weight chart used. Care plans were reviewed monthly and daily records completed. However these did not say if people using services benefited from the care plans in place and if their health or welfare was improving and mainly recorded no change so we could not see if the care plans were working or not. People that use services were all registered with a General Practitioner practise and were supported to see their own doctor and attend hospital visits. Records showed that Doctors, dentists, opticians, chiropodists and other professionals visited people that use services so they had access to health care support when needed. The home completed nutritional screening on everyone admitted to the home and repeated this so people that were at risk of malnutrition were regularly monitored and the necessary action taken where people were at risk. A good example of this was when a person using the service had lost weight and staff had noticed this through doing regular checks of weight and body mass and contacted the dietitian about this. People that use services returned questionnaires before the visit and said there health needs were always met. Medication policies and procedures were comprehensive so staff understood their responsibilities and accountability for their actions when administering medicines to people that use services. Both areas of the home had medicine storage facilities and procedures in place and the manager agreed the need to replace the controlled drugs storage cupboard in one area following changes to the law. A medicine fridge and controlled drugs storage was available with the operational temperatures of the drugs fridges regularly recorded so staff knew they were operating safely. Each storage area contained the policies and procedures for medicine administration with specimen signatures of staff responsible for administering medicines. We looked at the arrangements for the ordering, receipt, administration and disposal of medicines and found no errors so people that use services were receiving their medicines safely. We talked to the manager and senior care staff who were responsible for administering medicines about the arrangements for giving out medicines during meal times which seemed to add to this busy time of the day. They agreed to look at the arrangements for the administration of medicines to fall into line with good practise so medicines were given at times chosen around the routines of people that use services. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services are supported to maintain relationships and make choices about lifestyle and leisure activities so have control over their lives and a lifestyle based on their personal choices. Evidence: The routines of the day were flexible and based around the needs of people that use services so they chose their lifestyle were possible. We spoke with people that use services in both the dementia care area and elderly frail area. A person living in the dementia care unit said they enjoyed watching the television and relaxing in the peace and quiet of my own company. I have lived here a long time and enjoy sewing and baking. Another person said they liked to spending their day in the larger lounge area where there was more people to talk to and enjoyed the lively atmosphere at meal times. The home employed an activity organiser for 20 hours a week and also the services of a Chaplin. There was lots of examples of people that use services being involved in activities such as playing dominoes, talking to one another or the activities organiser reading books and new papers to people that use services so they could keep up to Care Homes for Older People Page 16 of 29 Evidence: date with events. People that use services sat reading and listening to music. Activities took place between 10am and 5pm and included quizzes, painting, chair based exercise, flower arranging, baking and reminiscence sessions. Monthly church services with communion were held. At the time of the visit a service took place to celebrate ash Wednesday. The home has its own Chaplin who works at the home most days. Themed social events take place with visiting artists and musicians and a hairdresser visited weekly. There was a varied choice of activities available to people that use services so they had recreational activities from which to choose. The garden was also used and people sat in it. A person using the service talked about how people helped the Gardner by looking after potted plants and hanging baskets and had won a competition held each year run by the provider for the best garden. Mealtimes were seen to be both relaxed during breakfast when many of the people using service had chosen not to get up and at lunchtime when lunch was a social gathering. At breakfast the menu included the option of a cooked breakfast. Lunch included soup to start with a main course and sweet. Families and friends are invited to share meals with people that use services free of charge so they can maintain family routines they had at home. People that use services were generally complimentary about the meals provided. One person said they felt the standards of food varied since Barchester had taken over the ownership of the home with some things on the menu not being on due to cost. The manager explained that Barchester had introduced a more healthier menu and was using more locally produced foods so fresh foods were being offered. In discussion with people that use services the menu was discussed and the menu options talked about. This had led to to people thinking they could not have things they enjoyed due to expense such as oven chips. The manager said that people that enjoyed more traditional meal choices could do so and the chef would buy what they wanted so they had a diet of their choosing. The manager said she had done a survey of the meals provided and people that use services had given glowing compliments about the menu. At mealtimes tables were set with table clothes and condiments and menus displayed on them so people that sue services were able to choose from a varied menu. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services are protected by the safeguarding adults procedure in place so people that use services will be confident they are protected at all times. Evidence: The complaints procedure was contained in the information pack given to people that use services when they moved in and displayed throughout the home but not in the dementia care unit. The dementia care had an electronic lock on this so people that use services could not gain access to areas of the home displaying the complaints procedure so could not use it. The home did not make the complaints procedure available in a way that people with memory problems could read and understand easily. The manager agreed to consult the Barchester dementia care specialist about how the home could support people with memory problems to have access to a complaints procedure they could use. Before the visit people that use services sent us surveys and said they knew who to speak to if they were unhappy or had concerns and knew how to use the complaints procedure. One comment we received was, I have never had to use this. I have been totally satisfied so far, moving here was the right choice. The information returned to us by the manager before the visit said the home had received two complaints which had been resolved. Staff surveys returned to us prior to the visit said that staff knew what to do if people that use services, relatives, advocates or friends raised concerns Care Homes for Older People Page 18 of 29 Evidence: about the home. Comments received from staff were that they had access to the complaints procedure and knew where it was kept. They would report complaints to senior staff and or ask their advice on what to do and if concerns or complaints were reported and also seek confirmation that the complaint had been acted upon and not left. Staff commented that the manager had an open door policy and they could talk to her about concerns. Policies and procedures were in place to protect vulnerable adults called the safeguarding adults procedures. The safeguarding adults procedure is how we, the local council, police and other agencies respond to and manage allegations or suspicions of abuse against vulnerable adults. Staff at Caldy Manor had received safeguarding training which helped them to respond to suspicions or allegations of abuse or neglect to make sure vulnerable adults were protected. Staff spoken with said they received safeguarding adults training during their induction. Staff spoken with during the visit were knowledgeable about the safeguarding adults procedure and how to report their concerns so could protect vulnerable people. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services live in a comfortable well maintained home which is suitably equipped so their needs can be met. Evidence: The building was well maintained and decorated. Since Barchester Healthcare took over ownership of the home over one hundred thousand pounds had been spent on the refurbishment of the home and purchase of equipment. The personal areas of people that use services were personalised to their taste and the home is safe, comfortable and homelike. The home had been fully decorated and bedroom furniture replaced though people that use services could have their own furniture if they wished so their bedrooms were more like when they lived at home. The dementia care unit had a double bedroom for married couples or couples in long term relationships. At the time of the visit this was being used for single occupancy as chosen by the occupant. The dining room has been fully refurbished with new dining furniture containing memory foam to prevent skin breakdown. People that use services had access to the gardens especially for people that use wheelchairs. The home manager had support from a interior design, estates team and company business plans. The kitchen is planned for a full refurbishment and following a visit from the local council environmental health officer have to fit new external screens to Care Homes for Older People Page 20 of 29 Evidence: the building to prevent insects getting into the kitchen. All bedrooms were planned to be redecorated in the future. In some communal areas the carpets were beginning to rise up causing ridges in them which were a trip hazard to people using services so were unsafe. The manager confirmed the carpets were to be replaced. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good employment policies, procedures and training is in place so staff understand the needs of people that use services and they receive appropriate care. Evidence: Staff surveys returned before the site visit all said that recruitment was thorough, induction was very well done or mostly covered what staff needed to know. Training was described by staff as excellent and training was described as varied and provided staff with the knowledge, skills and experience they needed to do their jobs so they were kept up to date with working practise. Supervision and appraisal were referred to and staff said the manager regularly or often met with them to offer support and guidance so they had opportunities to discuss how they did their jobs and how they could develop. Staff said they were confident that they had the right skills to provide care for people that use services. Staff described the team as one that worked together and senior experienced staff supervised the younger less experienced staff and this worked well. Staff said they had the opportunity to complete and NVQ level 2 and several questionnaires said staff had completed NVQ level 3 which is a nationally recognised qualification in social care. The information returned to us before the visit by the manager said 23 care staff were employed and two bank staff. Fourteen of these had an NVQ level 2 or above qualification and 5 staff were working award an NVQ level 2 qualification. Care Homes for Older People Page 22 of 29 Evidence: We examined the recruitment records of four staff employed at the home. Recruitment procedures were robust and included staff having to complete an application form, full employment history and two references sought about their suitability for employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. Staff were also issued with the General Social Care Council code of practise a guide for social care staff on the standards expected of them so they were aware of their responsibilities and practise when providing care to people that use social care services. Staff had access to a personal advice line so they could get advice on work related matters if needed. Staff had access to NVQ training and modern apprenticeships through Barchester learning and development academy. Staff surveys said that Barchester had introduced E learning into the home and that staff could complete training via a computer during their shift for which they were paid if they did this following or before commencing their usual shift so could complete training around their availability and personal circumstances. The staff team has been enhanced by a nigh time coordinator and continence coordinator. Staff had attended training in induction, moving and handling, safeguarding adults, fire, food hygiene, customer care, medicine administration and first aid. The manager had completed Yesterday, Today and Tomorrow training from the Alzheimers Society to increase her knowledge and awareness of dementia so were able to provide appropriate care. In February 2009 eleven staff started a twelve week dementia care course. Once this was completed then staff would commence a twelve week training course on infection control. Staff also completed training in moving and handling in February 2009 with further training planned for March 2009. The home has its own trainer who was qualified to provide training in fire safety and had completed the Barchester Healthcare training course. The trainer is also the deputy manager and said she wanted to do further qualifications so she could provide training in safer moving. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance identifies areas for improvement so the welfare of people that use services is promoted. Evidence: Surveys returned to us before the visit said that the manager has an open door policy. The manager had been the manager of the home for nearly five years and had made improvements since out last visit. The manager was not working as part of the staff rota and worked in addition to this so was able to provide supervision and support to the staff team. Monthly visit were carried out by by the regional director and monthly audits by the manager to maintain quality assurance within the home. As part of quality monitoring of the home the manager held monthly meetings with the chef, activities staff and senior care staff. One of the senior care staff is the health and safety representative Care Homes for Older People Page 24 of 29 Evidence: for the home and meetings included health and safety matters so the health and safety of people that use services and staff is seen as a priority. Staff meetings were held every three months and senior carer meetings every two to three months so the manager has an opportunity to discuss management of the home with all the staff team. Matters discussed were about how staff speak to people that use services, answering the telephone and medicine administration. The reviews of care plans were discussed as as part of the managers audit she found that monthly reviews of care plans were not being completed on time so they did not meet the needs of people that use services. As part of the quality assurance system the manager completed checks on information gathered about people that use services. The checks done by the manager are then checked by the regional director who visits every month so the information is correct. For example if staff were not weighing people as needed or nutritional information was not being checked so poor practise is identified and actions taken. The manager had introduced a meeting for people that use services that started in February 2009 to create a committee that would raise issues and seek the views of people that live at the home so they could have a say in how the home was managed. Barchester Healthcare uses an annual survey to seek the views of people that use services on the quality of service offered at the home. The survey for 2008 was completed and displayed for people that use services so they had information on their views about how the home was managed. A total of seventeen surveys were received from people that used services, relatives, and friends. None were returned by professionals involved in the care of people living at the home. The survey showed an improvement in the overall opinion of the home and an increase in people choosing or recommending Caldy Manor as a pace to live. Barchester Healthcare do not manage or keep personal monies of people living at the home. These were managed by people using the service or their families. The home kept some monies for people that wished to deposit monies for personal use. The home kept records for any monies received and withdrawn and the amounts of these audited by the manager and regional director. The information sent to us by the manager before the visit said all the required maintenence has been completed and checked as part of the monthly audits. Policies and procedures were all reviewed in September 2007. All accidents in the home were electronically recorded centrally and were required risk assessments put in place so the safety of people that used services was maintained. Barchester Healthcare has a web site in place to record pressure ulcers and safeguarding issues. Care Homes for Older People Page 25 of 29 Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Daily records and reviews of care plans should include more information on the daily lives and routines of people that use services and if the care plans in place support them to remain healthy and independent. The home should improve on how the personalisation of the care of people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples routines and decisions are to them and how these are transferred into how they receive care. Information in records should be recorded accurately and transferred between records so staff are aware of where they need to take action and contact health care professionals. 2 7 3 7 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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