Care Home: Caroline House

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What the care home does well The Statement of Purpose and the Service User Guide have been reviewed and updated and accurately reflect the services provided and the current situation within the home. The atmosphere within the home was comfortable and relaxed. All parts of the home were clean and comfortable. Comments received included `All the staff very friendly, address us by christian name, always ask us first thing how we are`. ` They make me feel happy safe and content`. `Home very well run`. The residents benefit from a comfortable, well furnished home that has level access to all communal areas. The care staff spoken with have a good understanding of the residents needs and preferences and respond in a considerate manner to these. A survey received stated ` I am very happy living here`. The quality and choice of meals remain good and all residents spoken with confirmed this, comments `The food is very good`, `I really enjoy the food` `Home cooked food, biscuits and cakes!`. There is an open-house policy which welcomes visitors at all reasonable times. Two visitors confirmed that they were welcomed in to the home at all times. Satisfactory arrangements are in place to safeguard service users finances. The home works closely with specialist health care professionals to ensure that residents health care needs are being addressed. Flexible routines are an important part of daily life at the home with residents choosing their preferred routine. Complaints are taken seriously by the home and policies and procedures are followed. Recruitment practice was seen to be robust and the necessary information was included in the staff files. What has improved since the last inspection? Resident`s and where appropriate their relatives have the opportunity to partake in individual assessments and be directly involved in care planning and reviewing processes This was evidenced in the care plans and from talking to residents. Formal staff supervision has been introduced which ensures staff have the appropriate skills, knowledge and understanding of residents individual care and support needs. Residents individual care plans are now more accessible to care staff. Pre admission assessment form were seen to be completed in full. What the care home could do better: This was a positive inspection where although there are areas that still need to be developed further, it is a reflection on the strong management structure that these will be attended to and therefore no requirements have been made. The daily records are still written by the senior care worker on each shift and it was discussed that the key workers who performed the care should take on the responsibility of writing the daily record. Staff supervision is in place , but is running behind and this is an area that the manager is progressing at this time. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Caroline House 7-9 Ersham Road Hailsham East Sussex BN27 3LG     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: Deborah Calveley     Date: 1 4 0 5 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 28 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 28 Information about the care home Name of care home: Address: Caroline House 7-9 Ersham Road Hailsham East Sussex BN27 3LG 01323841073 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) : Mr Thuraisamy Ravichandran and Mrs Radha Ravichandran care home 24 Number of places (if applicable): Under 65 Over 65 24 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is twenty-four (24) The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Date of last inspection Brief description of the care home Caroline House is a large, detached three storey Victorian house situated in a quiet residential area of Hailsham, close to the town centre. It is registered to provide care and accommodation for 24 older people, not falling within any other category. Menus are varied, well balanced and nutritious. Meals are served either in the dining area or in the residents room. Service users rooms are equipped with a TV point, telephone and alarm call system. Rooms that do not have en-suite facilities are fitted with washbasins. Care Homes for Older People Page 4 of 28 Brief description of the care home There are two lounges and a dining area on the ground floor. A passenger lift provides access to all floors. At the rear of the house there is easy access to a large, landscaped garden, which is both safe and secure. There are ample car parking facilities at the front of the home. Information about the service, including the Statement of Purpose, Resident?s Handbook (Service Users Guide) and CSCI reports is made available to prospective service users or their relatives on request as part of the admission process. The range of weekly fees are available on request. Additional charges not included in the fees include hairdressing, chiropody, toiletries and transport. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Caroline House will be referred to as residents. This was a key inspection that included an unannounced visit to the home and contact with residents representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6 hours on the 14 May 2009. There were twenty residents living in the home on the day, of which four were case tracked and spoken with. During the tour of the premises five other residents both male and female were also spoken with. The purpose of the inspection was to check that the Care Homes for Older People Page 6 of 28 requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Three members of care staff and the cook were spoken with in addition to discussion with the manager and area manager. Two visitors and two health care professionals were spoken with during the inspection visit and their comments have been incorporated into the report The information received from ten surveys has also been incorporated into this report What the care home does well: What has improved since the last inspection? Residents and where appropriate their relatives have the opportunity to partake in individual assessments and be directly involved in care planning and reviewing processes This was evidenced in the care plans and from talking to residents. Formal staff supervision has been introduced which ensures staff have the appropriate skills, knowledge and understanding of residents individual care and support needs. Residents individual care plans are now more accessible to care staff. Pre admission assessment form were seen to be completed in full. Care Homes for Older People Page 8 of 28 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home its facilities services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission and they are assured in writing that their needs will be met. Evidence: There is a comprehensive Statement of Purpose and Service Users Guide in place which contains clear information about the home, the range of fees charged and the services it provides. Copies of these are available on request. It was confirmed that the contract arrangements are clear and these are updated to encompass fee increases and changes in the accommodation. There is a copy of the terms and conditions of residency included in the Service Users Guide. The Care Homes for Older People Page 11 of 28 Evidence: management team of the home need to ensure that any changes to the room occupied by a resident is updated in their original contract, this is due to building work and changes in the environment. The homes certificate of registration is prominently displayed in the home and was correct on the day of the inspection. Three pre admission assessments to the home were reviewed as part of the inspection process and confirmed that they are completed by the registered manager. The assessments contain all the information required to ensure that new admissions to the home are suitable and that the home have the staff knowledge and environment to meet the care needs identified. Prospective residents are seen either in their home or hospital before admission and the manager confirmed that wherever possible the family or representatives are involved; however the venue and the people involved needs to be clearly documented. It was evidenced that the home confirms in writing that having regard to the assessment that the home can meet the assessed needs of the prospective resident. The manager was able to verbally demonstrate her knowledge and awareness of the different specialties required in the home and ensures that the carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. The manager is pro active in ensuring that the physical needs of residents are monitored and seeks advice and support as required. There are also guidelines in place of when to arrange a move to specialist home if required. Trial visits to the home can be arranged, this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Intermediate or rehabilitative care is not provided at Caroline House Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system in place ensures that appropriate support and care is provided for residents and they are protected by competent staff following the homes policies and procedures for dealing with medication. Evidence: The care documentation pertaining to four residents was reviewed as part of the inspection process. The care documentation contained a good level of personal information in respect of individual residents activities of daily life and include guidelines for staff to follow so as to provide a consistent approach to the care given. The documentation included nutritional assessments, personal histories and risk assessments. On the whole the care documentation demonstrated that the care was reviewed and evaluated on a regular basis. As discussed during the inspection, there are areas that need further developing along with training for staff in using some of the assessment tools; in particular the mental health assessment. The staff are weighing residents Care Homes for Older People Page 13 of 28 Evidence: monthly but the records evidenced large weight loss and weight gain with no follow up within the care plan. On discussion with the manager it is thought that the weights are incorrect due to a new person taking over this role. It would therefore be beneficial if the documentation stated this and new guidelines put in to place. This was discussed in full during the inspection visit. Residents are registered with a GP from local surgeries. Residents are supported to attend the GP surgery or if appropriate home visits are conducted. Referrals to the Optician, Occupational Therapist, Physiotherapist, Dietitian and Audiologist are made via the GP or the hospital. The district nurse was visiting two residents and was able to confirm that the staff at Caroline House are pro active in consulting with the surgery for dressings and advice. Residents access private dental surgeries where able and a domiciliary dentist will visit on request. A visiting Chiropodist attends residents six weekly with additional appointments being arranged if necessary. The chiropodist was visiting on the day of site visit and was happy to give her opinion of the home Residents feet are always very clean and soft, The home is clean and welcoming The staff are friendly. The records in the home evidence that the health needs of the residents are met. Staff spoken with confirmed that they received a report on each resident daily and read the daily care documentation that is kept in the office. They also felt that their views were taken into account when planning residents care. Each shift has a senior carer who takes the lead, administers medication and will accompany the district nurse or G.P when they visit, care staff assist the residents with their personal care. Talking to staff it was identified that that the senior carer writes up the daily notes and gives the hand overs, from talking to the junior staff they would like to be more involved and write the daily notes for the people they have assisted that day. This would be beneficial as they are the ones who notice residents moods, their skin condition and will pick up when a resident is not themselves. This was identified at the last key inspection and was discussed with the registered manager who will review current practice at the next staff meeting and be introduced. There are policies and procedures in place for the ordering, safe administration and recording of medication, these evidence regular review. The medication administration charts were viewed and were seen to be in the main competently completed. Recommendations of good practice were made and these include: Staff to ensure that all handwritten entries are signed and dated, that all medication brought in to the home are counted and entered in to the charts, all medication not administered or refused to be recorded on the rear of the administration charts and returned medications are to be kept in a locked cupboard until returned to the pharmacy. Care Homes for Older People Page 14 of 28 Evidence: From talking to staff it was confirmed that senior care staff administer medication and receive appropriate training. This was evidenced by the training matrix supplied. The home operates a key worker system that seems to be working satisfactorily and the manager has introduced individual roles and responsibilities for senior staff which are working well in the home. The interaction observed between staff and residents was seen to be positive and all residents and visitors spoken with felt that the staff were respectful and that the dignity was promoted and respected. The staff on duty were seen to be respectful and considerate to all residents and whilst attending to their needs and the interaction observed was open and friendly There is a Privacy and Dignity policy in place and this is reviewed regularly.The protection of residents privacy and dignity is highlighted as one of the main aims of the home in its Statement of Purpose and Service User Guide. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are enabled and supported to make choices about all aspects of their day to day lives and the meals at the home are good, offering choices and meeting residents specific dietary needs. Evidence: The home staff co ordinate activities for the people who live in the home and these are provided both in the morning and afternoon if there is time on a daily basis. The activities include armchair exercises, board games, trips out, gardening and games. There are plans to recruit an activities co ordinator in the near future who will take over the responsibility of activities and be involved in residents meetings to develop a programme that meets their expectations and interests. Residents independence is promoted and encouraged within the home and it was confirmed that wherever possible residents are enabled and supported to make choices and take decisions affecting their life and daily routine. The majority of residents spoken with stated that they felt they had choice regarding their daily lives including times for bathing, bed and rising. This was confirmed when reviewing residents care plans. Care Homes for Older People Page 16 of 28 Evidence: The manager confirmed that there is open visiting hours as long as consideration is shown to all the people living in the home. The meals at the home are wholesome, nutritious and devised with the residents likes and preferences in mind. Choices are available at all meal times and some residents enjoy a different cooked breakfast daily. The home caters for specials diets such as diabetic and vegetarian and the cook makes special cakes and biscuits specifically for them. The home now provide a wide range of fruit dishes to supplement their diet as fresh fruit was not being eaten regularly despite being available. The dining area is fairly small but the planned extension will provide extra living space which residents spoke positively about. The inspector joined the residents for their midday meal and observed the residents being offered support and assistance discretely if required. The residents had a choice of two different main meat dishes, Sheppards pie or chicken with fresh vegetables and a vegetarian option of cheese flan and salad followed by a choice of pudding. Fresh water was available with their meal and tea or coffee served after. The cook has worked in the home for some years and is knowledgeable about the residents dietary needs and of the methods needed to fortify the residents food if required. Residents spoken with said that the food is very good, they can have something to eat any time they like and their relatives and friends can join them. The menus were seen and demonstrated a varied and nutritious diet which is changed seasonally. Staff are not formally recording the amount consumed by residents at meal times unless there is a problem. The introduction of a formal system of recording dietary intake will enable staff to track appetite trends, identify a potential risk and provide information for the GP or Specialist when a problem arises. The communication between the kitchen and staff is said to be good and the cook completes the safer cooking better business book as recommended by the environmental health agency. The kitchen is cleaned everyday and there are rotas for deep cleaning in place and records are kept of freezers and fridges. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear and accessible complaint procedure which enables residents, staff and visitors to express any concerns confident that they will be listened to and acted upon Residents are safeguarded from abuse through staff training and robust policies and procedures. Evidence: There are appropriate procedures in place for dealing with complaints. The manager explained that complaints are recorded and investigated within a twenty eight day timescale and acted upon if necessary. Residents spoken with said they are able to talk to about anything with the staff and feel that their concerns are acted upon. The AQAA stated that there have been no complaints received since the last key inspection. There are opportunities for residents and relatives to discuss any aspect of the services and care provided at the home during the residents and relatives meetings and the home operates an open door policy. Staff spoken with said they have attended training in safeguarding of vulnerable adults and were able to demonstrate an understanding of abuse and were quite clear that they would discuss any concerns with the manager. There have been no safeguarding referrals received. Care Homes for Older People Page 18 of 28 Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Caroline House provides residents with a homely and comfortable environment with communal rooms and a shaft lift that enables them to have access to all parts of the home. Training in the control of infection is provided for staff to protect residents. Evidence: The home is in the process of adding a large extension to the rear of the property which will provide five further bedrooms with ensuite facilities and a large communal living area. This will improve the facilities currently available. Whilst this work is being undertaken, residents whose bedroom is affected have been moved to a different room after discussion with the resident and family. The kitchen area will also be affected but this does not impact the service at this time. All the residents are aware of the building work and their safety has been protected and appropriate risk assessments put in place. The outside facilities have been altered, but there are plans for a landscaped garden once the building is completed. As discussed the front garden of the home appears neglected and this has been identified by the manager and a gardener contacted. The tour of the premises evidenced that the home is well maintained and there is a range of satisfactory furniture and furnishings that provide a comfortable pleasant and homely environment for the people who live in the home. The communal areas include Care Homes for Older People Page 20 of 28 Evidence: a good sized lounge with a small dining area to one end and a separate quiet lounge which leads in to the garden (not in use at this time due to the building work) These areas are pleasantly decorated with domestic lighting. The home continues to follow their plan of redecoration and refurbishment. The AQAA detailed the bedrooms re carpeted and the furniture replacement. Residents bedrooms were found to be clean comfortable and well maintained and evidenced that many of the rooms have been personalised with pictures, family photographs and other small items of furniture and personal belongings to reflect individual taste, choice and preferences. There are adequate communal bathrooms and a wet room in home with specialist equipment to ensure all residents, however physically frail can enjoy a bath or shower. A call bell facility is available in all areas of the home and the home has the necessary adaptations for the physically frail. The home was clean and free from offensive odours on the day of the visit. The laundry room was organised and has the necessary equipment to provide a good service, separate ancillary staff are employed for cleaning and laundry. There are policies and procedures in place for infection control and aprons and gloves are freely available, however the staff are to be reminded of the correct use of gloves and aprons whilst performing personal care. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment procedures are in place to protect residents and staff training ensures they are aware of their roles and are able to provide the support and care the residents need Evidence: At present there are 20 residents living in the home. The staffing levels were sufficient to meet the needs of the residents at this time. The manager confirmed that the staffing levels are flexible and if it is required extra staff will be brought in. Staff spoken with said they do have time to spend chatting with the residents and their relatives. Residents said they are well looked after and they do not have to wait long when they need assistance from the staff. Separate ancillary staff for the laundry, cleaning and kitchen duties are employed. The manager has introduced a training programme which tracks and identifies the staff training needs. All staff are required to attend mandatory training including moving and handling, fire training and infection control in addition to an induction training that is in line with Skills for Care. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the manager. This was confirmed through discussions with staff and supported by the training records examined. From talking to staff the initial induction to the home could have been Care Homes for Older People Page 22 of 28 Evidence: better and this was relayed to the manager who will investigate. The home has robust recruitment procedures and include: completed application forms, two references, identification, POVA first check and Criminal Registration Bureau (CRB) checks. Four staff files were examined during the inspection and all evidenced the necessary information in a format easy to examine. The home encourage their care staff to enroll and complete National Vocational Qualification (NVQ) training courses. At present the home employ 19 carers and of those 10 have an NVQ and 4 are working towards a qualification. Surveys received from residents and family were complimentary regarding the staff and comments included: I am very pleased with the excellent standard of care at Caroline House that my mother is receiving. The staff are both friendly and professional. I cant think of anything they could do better. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management approach at Caroline House is open and encourages residents, relatives and staff to be actively involved in decisions about the services provided at the home. The health and safety of residents is protected through an ongoing training programme for staff. Evidence: The manager has been in her current post at Caroline House since October 2006 and was registered by the CSCI in 2007. She has the necessary qualifications and experience to manage the home effectively and competently. She has completed the Registered Managers Award RMA and NVQ level 4 in Management and Care. The manager remains committed to improving the home and is proud of the staff team and their accomplishments. The staff spoken with were complimentary regarding her management approach and confirmed she is approachable and has successfully developed an open and inclusive atmosphere within the home. The manager has worked hard to meet the National Minimum Standards and has a clear leadership style Care Homes for Older People Page 24 of 28 Evidence: that is welcomed by the staff team. Residents relatives and staff are encouraged to participate in discussions about the services provided at the home. The manager confirmed that feedback is sought from all groups and individuals who have any contact with the home as part of the quality assurance system and monitoring of all aspects of the care and support provided is carried out on a regular basis. The formal quality assurance and quality monitoring systems enable the management to objectively evaluate the service and ensure it is run in residents best interests. Questionnaires are made freely available and the results are analysed. The registered providers visit the home regularly and the area manager is also a regular visitor. Regulation 26 visits are undertaken and a copy is available in the home. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible persons external to the home. The home run a resident deposit account and these were available for viewing along with safe systems of recording and all receipts are kept and a running total in place. Two staff signatures are required and these systems are followed robustly. Staff supervision has been commenced and whilst these are not totally up to date, there are plans to develop a system where another senior member of staff will take on the responsibility of a percentage of the supervision sessions. This is a work in progress and therefore a requirement has not been made at this time. Records were available to demonstrate that fire alarms, water temperatures and emergency lighting systems are regularly tested and fire drills undertaken. Testing of portable electrical appliances has been carried out. Certificates to demonstrate that bath hoists, gas appliances, electrical systems and appliances are safe were confirmed as being in place. Policies and procedures are available in relation to health and safety and good practice was evident in the management of records relating to accidents, servicing and repair of equipment and the building. There are first aid boxes in the building that are easily assessible for staff. Training required by legislation including moving and handling, fire training and infection control is being provided for all staff to protect the health and safety of residents. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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