Care Home: Carleen Nursing & Residential Care Home

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What the care home does well People who use the service who took part in our survey all gave positive responses to questions about the quality of care, food and activities, the environment, staffing and management. This was also reflected in the comments from people we spoke with during our visit. Additional comments about the home from people who use the service or their relatives included: "Administration of my medicines, personal and nursing care is excellent". "(They) always help me with my needs. Lovely meals and organised activities to keep me occupied and my mind stimulated". "The all round care is excellent. We have no complaints, only praise. The home is always clean and fresh, carpets are cleaned very regularly and the decoration is kept very well. If dad is unwell they always phone me. Nothing is too much for them". "They do everything possible". Carleen has a track record of providing good quality care and continues to do so. Record keeping is detailed and accurate and this helps to ensure that staff provide the right amount of support and care to individuals who use the service. Routines and activities reflect the wishes and interests of individuals and ensure that people can continue to make choices in their lives. There is a good atmosphere in the home and staff were observed to have a friendly and respectful relationship with people who use the service. The home is well managed and the manager is supported by a knowledgeable and committed staff team. A particular strength of the home is the high level of quality assurance that is undertaken. This means that staff are continuously reviewing and evaluating the practices and policies that inform the care that is given and this helps to ensure that people`s different and changing needs and wishes are at the heart of the service. What has improved since the last inspection? Care plans now contain more information about peoples abilities as well as their needs. The following statements are examples from the homes own quality assurance assessment. Evidence gathered during this inspection finds them to be accurate: The home has introduced a new pre-admission assessment document to help gather a comprehensive background and history of prospective residents to ensure we are able to meet their wishes and needs. The home has introduced regular residents meetings where individuals are free to bring any issue or topic to the agenda. A new kitchen has been fitted and new laundry equipment has been installed. What the care home could do better: The homes own quality assurance programme has identified areas which the management team feel could be further improved, for example, more staff to receive training in palliative care, more opportunities for visits into the community in the warmer weather, continuing to consult people who use the service about menus and improving the laundry service. Key inspection report Care homes for older people Name: Address: Carleen Nursing & Residential Care Home 38 Portchester Road Fareham Hampshire PO16 8PT     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: Laurie Stride     Date: 1 5 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 27 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 27 Information about the care home Name of care home: Address: Carleen Nursing & Residential Care Home 38 Portchester Road Fareham Hampshire PO16 8PT (01329)232418 01329230310 info.carleen@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Serincourt Ltd Name of registered manager (if applicable) Joyce Ann Dawson Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 36 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Carleen Nursing and Residential Care Home is registered to provide nursing and personal care for 36 people, some of whom may have physical disabilities. People may be admitted over or under 65 years of age. Carleen is a large house that is in a residential area of Fareham and is close to local amenities. The home has a ground floor extension and provides accommodation over two floors, which are connected by a Care Homes for Older People Page 4 of 27 Over 65 36 0 0 36 Brief description of the care home passenger lift. There are two sitting rooms and a dining room on the ground floor. The home has large, well-tended, front and rear gardens which are accessible to people who use the service and there is ample parking space for staff and visitors at the front of the building. Care Homes for Older People Page 5 of 27 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: We (the commission), visited the service on 15/04/10. This visit was part of a key inspection, which takes into account all the information we have received about the service since it was last inspected on 16/05/07. The information included the homes Annual Quality Assurance Assessment (AQAA), which the registered manager sent to us prior to the visit. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Before our visit, we had sent survey questionnaires to the manager to distribute to people who use the service and staff members. At the time of writing this report we had received completed questionnaires from seven people who live in the home and three staff members. During this key inspection visit we spoke with some of the people who live in the home, members of staff, the registered manager and the owner. We also looked at samples of the records held in the home. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 7 of 27 The homes own quality assurance programme has identified areas which the management team feel could be further improved, for example, more staff to receive training in palliative care, more opportunities for visits into the community in the warmer weather, continuing to consult people who use the service about menus and improving the laundry service. 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 8 of 27 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 9 of 27 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. Admissions are not made to the home until a full assessment of the needs of the person has been completed. This helps to ensure that the service can provide the appropriate level of care and support. Evidence: The previous inspection report identified that admissions are not made to the home until a full assessment of the person has been completed. The AQAA told us that the service has introduced a new pre-admission document to help gather comprehensive background information and histories of prospective residents. During this visit we looked at the assessment and admission records for a person recently admitted to the home. The new assessment format had been used and included details of the persons medical history, family structure and social network, likes and dislikes, abilities and needs. Information about the individual was continually being added to and reviewed as staff observed and recorded the persons progress during the trial period following admission. We noted that the assessment had identified a particular training need for Care Homes for Older People Page 10 of 27 Evidence: the staff who would be working with the individual and that admission had been delayed in order to provide the training first. We spoke with the individual whose assessment records we had seen. They told us they are very happy to be at Carleen and to have a base where I can call home. The person said that the staff know and understand her condition and support needs, including those staff members who she had since met for the first time following her admission. This indicates that accurate information is available and that there is good communication among the staff team. Prior to our visit we received completed survey questionnaires from seven of the people who use the service, four of whom had received assistance from a relative in filling in the form. All said they received enough information to help them decide if this home was the right place for them, before they moved in. Six indicated that they have been given written information about the homes terms and conditions of residence. One said they did not know about this. Three staff members also took part in our survey. The staff said that the ways that information about people is shared with other carers and the manager always or usually work well. Care Homes for Older People Page 11 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust quality monitoring systems ensure that peoples health and personal care plans are regularly reviewed and updated. This helps staff to respond effectively to each individuals need. Peoples rights to privacy and dignity are always observed. Evidence: The previous inspection report identified excellent quality outcomes in this section, which was due to the service having robust monitoring systems in place. One suggestion that we made at the previous inspection was for care plans to contain more information about peoples abilities as those seen tended to focus more on needs. The AQAA told us that care plans are now more person centred and we saw evidence of this during our visit. We looked at the care plans for two people who use the service. These were comprehensive documents showing how each persons health and social care needs are to be met. The records included, for example, communication, vision and hearing, oral hygiene, risk assessments for skin care and the prevention of falls, nutrition, hydration and current medication. The plans also described each persons likes, Care Homes for Older People Page 12 of 27 Evidence: dislikes and preferences when receiving personal care and support, including those areas where the individual is able to be more independent. We saw that the plans had been reviewed on a monthly basis and are kept in the persons bedroom, so that the individual has access to their records and staff are able to record immediately the care that is given. We saw other records showing that the registered manager carries out visits to the home at night four times a year. As a result of this and team discussions night care plans had been reviewed, which now included the desired outcomes of each plan, the times when individuals like to go to bed and when they like to get up, the level of lighting they require and their preferences in relation to receiving support from male or female staff. We saw a sample of the induction training that staff receive. The induction workbook shows that staff are given guidance on the principles of giving personal care, involving the individual receiving support and promoting privacy and dignity. This includes a senior staff member observing the new carer providing support and ensuring the correct use of the care plan before and after care is given. We spoke with the relative of one person who uses the service and they told us that they were very happy with the care provided and that staff were meeting the persons needs. Another person we spoke to who lives in the home said that the staff are very good, that her health needs are seen to and her privacy, dignity and independence is respected. Another resident told us that the staff work well as a team and are very good and understanding. The matron is excellent and the staff are all very helpful and cheerful. Survey questionnaires from seven of the people who use the service indicated that they receive the care and support they need. Staff who took part in the survey said they are always given up to date information about the needs of the people they support or care for (for example, in the care plan). We observed one of the nurses doing the medication administration round after lunch. The nurse wore a red tabard while carrying out the round so that other staff knew not to interrupt her. The medication trolley had been prepared for the lunch time round and there were clear written procedures and guidance notes with the medication administration records (MAR). Where particular medications are not to be given on a daily basis, there were crosses marked in the records to prevent these being given by mistake. All of the contents of the trolley were individually labelled and had been checked that day to make sure they were in date order. Liquid medications had labels Care Homes for Older People Page 13 of 27 Evidence: showing the dates when opened. We saw the nurse take medications to people in their rooms and then sign the records immediately after each person had taken them. The nurse then returned the trolley to a locked clinical room, where she checked the MAR against the labels on individual medication boxes in the cabinet as she prepared the trolley for the next round. There are a number of checks in place, for example monthly checks for medications that are not frequently needed to ensure these have not passed the expiry date. We saw that procedures and records were in place for controlled drugs, new medication requests and returns and fridge temperature checks. A file is kept of individual medication reviews by a doctor that are held at least every six months, which lists the names of people being reviewed, the dates the review was requested and completed and the outcomes. This ensures that peoples changing medication needs are monitored and appropriate action is taken. The nurse, who was new to the home and had experience of working in other services, told us she thought the medication system at Carleen is excellent. The AQAA told us that the service has updated the policies and procedures for care of the dying. A number of nurses have had training from the local hospice in the use of the Liverpool Care Pathway guidance and staff can get advice from the palliative nurses as required. The manager regularly attends palliative care updates and study days at the local hospice. Care Homes for Older People Page 14 of 27 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 are encouraged to pursue their interests and preferences in their daily routines and are able to maintain contact with their families and the local community. Meals are good and how they are received is closely monitored. Evidence: The AQAA informed us that activities are provided twice a week from an outside agency in addition to those arranged by the homes activities co-ordinator who is employed for fifteen hours a week. The AQAA states there are plans to continue to improve the catering service and to offer people more opportunities for outings. During our visit we saw that records are kept of the activities offered and provided for each person who uses the service. Activities are offered to groups of people or to individuals depending on their personal preferences. Each person has a social care plan that contains information about their interests, likes and dislikes and the sort of activities they prefer. Some of the activities we saw recorded included church services, art and crafts, nail painting, foot spa, flower arranging and quizzes. Peoples craft work was on display in the dining room and one person showed us the rosette they had won for first prize at skittles. This person told us that the activities are very good and he attends most of them, including some light physical exercise. Care Homes for Older People Page 15 of 27 Evidence: Another resident we spoke to told us their relative had visited the home before the person was admitted and had been impressed by the activities taking place. This resident told us there are activities several times a week and there are monthly residents meetings. The relative of another person who uses the service told us during our visit that she is treated like family by the staff. She told us that her relative in care chooses not to join in with activities, has a nice room and likes to be there. In our survey, five of the people who use the service told us that the home always arranges activities that they can take part in if they want. Two people said the home usually does. People we spoke with during our visit told us that visitors are made welcome. We observed that a visitor approached the manager and arranged through the chef to have a meal with their relative in care on a given date. The AQAA told us that people who use the service have full choice about where they wish to dine. The service uses the latest nutritional guidance and an assessment tool which flags up any problems. Menus are rotated on a four week basis and changed seasonally. People who live in the home have a choice of menu for all meals each day and the times that meals are taken can be flexible. During our visit we saw that individual dietary needs are documented. In our survey, four of the people who use the service indicated that they usually like the meals at the home and three people said they always do. People we spoke with also gave positive comments about the meals in the home. One person told us that food is ample and you can have alternatives to the main meal, for example an omelette. Another person said there is a choice of three things at mealtimes and told us they had a catering questionnaire they were completing. During our visit we saw further evidence of people being consulted about the food being provided. A visitor said that her relative in care enjoys the food and has ice cream every day. Another person who uses the service told us that staff are aware of and responsive to her requirements at mealtimes, so that she can continue to use the dining room as she wishes. We observed the lunch time meal in the dining room. Care staff assisted the kitchen staff in bringing meals on warm covered plates from the nearby kitchen. Some took these to individuals who preferred to eat in their rooms. We saw that support with cutting up food was given to people who required it. The meal took place in well lit surroundings and there was a relaxed atmosphere. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an effective complaints procedure in place and staff understand how to protect people who use the service from abuse. Evidence: The AQAA told us that there is a robust complaints procedure and an open door policy in relation to anybody wishing to express a concern. All staff have training in the Safeguarding of Adults procedure during their induction and as annual updates. The manager has undertaken training and trains the staff in the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DOLS). During our visit we looked at records showing how the service had dealt with four complaints it had received in the last twelve months. One of these had initially come to light as comments given by relatives in the homes quality assurance survey and had been identified by the manager as requiring action. The records included the details of each complaint, the managers response letters to the complainants and the outcomes and dates when each matter had been resolved. There is also a log kept of any concerns raised not as part of the formal complaints procedure. This gives clear details of the issue, action taken and is signed and dated by the manager or a senior staff member when resolved. Seven people who use the service took part in our survey questionnaire. Six said there Care Homes for Older People Page 17 of 27 Evidence: is someone they can speak to informally if they are not happy. The other persons relative told us we have never had to do this. All told us they know how to make a formal complaint. A person we spoke with during our visit said there is not much to complain about. Everything runs smoothly. Another person told us I have no complaints at all. We get good treatment here. The three staff members who completed our questionnaire indicated that they know what to do if someone has concerns about the home. We spoke with a new staff member who confirmed they were scheduled to attend the safeguarding training and who demonstrated a clear understanding of reporting any safeguarding concerns. We saw a sample of records that showed that thorough checks are carried out on new staff before they commence employment and that the relevant training is provided. Care Homes for Older People Page 18 of 27 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 who use the service benefit from a clean, well maintained, comfortable and homely environment. Evidence: The AQAA told us that the environment is audited every six months for maintenance and decoration and an action plan is developed. For example, there is a programme in place to provide profiling beds in each bedroom. The company employs a full time maintenance team and a gardener who visits the home once a week. All staff are trained in infection control, there is an infection control representative and procedures are in place. During our visit we saw evidence that the action plan was being carried out. A new kitchen had been fitted and a number of profiling beds had been provided. The manager told us that a new specialist bath was on order. There are three bathrooms in the home and one has a spa facility. The laundry room had been refurbished with new worktops, cupboards and flooring as well as new washing and drying machines. Laundry facilities are sited away from areas where food is stored or prepared. We observed that staff follow infection control procedures, for example, wearing protective gloves and aprons to carry out care tasks. Care Homes for Older People Page 19 of 27 Evidence: The seven people who use the service who took part in our survey indicated that the home is kept fresh and clean. The views of people we spoke with were also positive. One person we spoke with said staff keep the home very clean and hygienic. I have a lovely room. I can see the birds and the squirrels. Its a happy room. Another person also told us she is happy with her room, which has a small patio area outside where she plans to hold parties for her relatives. A visitor remarked that the home is always lovely and clean. The number of shared rooms had been reduced to six at the time of the last inspection. A person who shares a room told us that their privacy and dignity is always respected by staff. Care Homes for Older People Page 20 of 27 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 who use the service are protected by robust recruitment practices. Staff are deployed effectively, are well trained and have the skills to meet peoples needs. Evidence: The AQAA told us that the home has a staff team that is adequate in numbers with a good skill mix to care for our residents. The home employs nineteen full-time and thirteen part-time care and nursing staff, as well as kitchen, laundry, cleaning and maintenance staff. The three staff members who took part in our survey indicated that there are always or usually enough staff to meet the individual needs of all the people who use the service. During our visit we observed people receiving appropriate support from staff and that call bells were answered promptly. We spoke with the companys training and development manager who showed us the staff induction programme, which had been developed in line with the Skills for Care induction standards. The induction is in two parts, with the first part covering mandatory training subjects such as fire safety, health and safety, food hygiene, moving and handling and infection control. Safeguarding Adults training is also completed as mandatory. There is a comprehensive training matrix showing ongoing training updates and courses in further specialised areas to meet the needs of people who use the service. Recent additions to the programme include stroke awareness and epilepsy awareness. The company also employs an NVQ (National Vocational Care Homes for Older People Page 21 of 27 Evidence: Qualification) assessor and the training manager confirmed that fourteen out of twenty-one of the care staff have NVQ in health and social care. Care staff are registered on the NVQ programme following their three month probation period. We saw the training records for a new member of the care team, which showed a completed induction and further training scheduled in Safeguarding, Diabetes, the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DOLS). We also saw a record of one of the trained nurses induction. The nurse told us how she had shadowed another nurse during her introduction to the home and the people who live there. We looked at the recruitment records of the two staff members who had recently commenced employment. The records included the dates when references were received and when Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks had been cleared. All of these dates preceded the time when the new staff members had started work. The three staff members who took part in our survey confirmed that their employer carried out checks and references before they started work in the home. Asked if their induction covered everything they needed to know to do the job when they started, one told us it did very well and two said it mostly did. All indicated that they are being given training which is relevant to their role, helps them understand and meet the needs of people who use the service, keeps them up to date with new ways of working and gives them enough knowledge about health care and medication. People we spoke with who use the service had very positive views about the managers and staff who work there. Their comments indicated that staff showed good teamwork and effective communication, were polite, helpful, sensitive and responsive to individuals needs and wishes. The people we spoke to and those who completed our questionnaire all felt their health and social care needs are being met. One person said to us I have nothing but praise for the staff. Care Homes for Older People Page 22 of 27 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. The home is well managed and the quality of the service is monitored very effectively to ensure that peoples health, safety and wellbeing are protected and promoted. Evidence: The registered manager has been in post since March 2006. She has been a registered nurse since 1974 and has worked for the company since the year 2000. She was the deputy manager at Carleen prior to taking over as manager and has also been the deputy manager in one of the companys other homes. Since the last inspection, the registered manager has completed an NVQ level 4 in health and social care and recently passed her NVQ 4 in Leadership and Management for Care Services. The manager stated in the AQAA that she encourages an open door policy for residents, visitors and staff. We observed this during our visit and people we spoke with confirmed that the manager is approachable. One person said The matron (manager) is excellent. The staff who completed our questionnaire indicated that their manager gives them enough support and meets with them regularly or often to Care Homes for Older People Page 23 of 27 Evidence: discuss how they are working. As identified throughout this report the service has continued to develop and implement effective quality assurance processes to ensure that it is run in the best interests of people who live there. These include the regular review and update of policies and procedures, questionnaires for people who use the service, relatives, staff and visiting professionals and regular staff supervisions and meetings. There is evidence that the service responds to feedback given, for example, following requests the manager now has a monthly meeting with residents. There is an annual development plan, which is regularly reviewed to ensure it is meeting the aims and objectives of the home. The management team have a clear vision of how they wish to continue to develop and have made a number of improvements, for example they have carried out a catering audit using the expertise of a catering consultant. They consult with external agencies where necessary and follow recommendations, such as implementing changes following an external health and safety audit, to help them to further develop the service. Secure facilities are provided for the safekeeping of money and valuables. The manager showed us that there is a record of regular checks and audits and that receipts are kept. As identified in previous sections of this report, staff are provided with appropriate health and safety training to ensure safe working practices. Night staff receive fire safety training four times a year and individual fire risk assessments for people who use the service are being introduced. The AQAA states that electrical, gas and fire safety equipment are regularly checked and serviced. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 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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