Care Home: Cornford House

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What the care home does well The home provides excellent information for enquirers and new residents, including a detailed website. The providers have been innovative in regards to care planning, as care plans can be accessed on line by residents and relatives with the authorised permission of the resident concerned. This enables close relatives to be more involved with the day to day life of their loved ones, and to raise any issues of concern promptly. The home has also installed a computer programme with a large fingertouch screen, which enables relatives and residents from the dementia unit to communicate with each other, by sending e-mails and photographs. There are good processes in place for accessing health care professionals for additional advice and support. Residents said that the food is very well cooked and presented, and provides a varied diet. What has improved since the last inspection? The home has linked up with a hospice in order to register for the "Liverpool Care Pathway" which is a system of procedures for effective care of the dying. The staff are currently working with medical staff from the Hospice on a research project to identify and improve palliative care for residents with terminal dementia. The home now has a full time activities organiser for the dementia unit, as well as two other activities staff in the home. This is the first key inspection since the new premises were opened in 2008, and the building provides excellent accommodation for the residents. Even though the building is only two years old, a rolling programme of redecoration has been commenced; and the dementia lounge has been redecorated to make it more homely. The home is kept very clean in all areas. A new programme of e-learning has been installed for all staff to access, so that they can carry out training at times to suit them. A senior administrator has been appointed to assist the manager with all aspects of the admissions procedure. What the care home could do better: The home is operating well in all areas, and no requirements have been given. However, several comments in staff and residents` surveys indicate that communication between different units could sometimes be improved; and some staff feel that the dementia unit would provide more effective care if there were more care staff available for the residents. Key inspection report Care homes for older people Name: Address: Cornford House Cornford Lane Pembury Tunbridge Wells Kent TN2 4QS     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: Susan Hall     Date: 0 8 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 28 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 28 Information about the care home Name of care home: Address: Cornford House Cornford Lane Pembury Tunbridge Wells Kent TN2 4QS 01892822079 01892822796 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.cornfordhouse.co.uk Cornford House Ltd Name of registered manager (if applicable) Mrs Linda Margaret Wenham Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 50. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) 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) - maximum number 32 Dementia maximum number 18. Date of last inspection Brief description of the care home Cornford House Nursing Home is a new build, large detached property, standing in ten acres of gardens on the outskirts of Pembury. The home can easily be accessed by car, and there is on-site car parking available.There is a bus stop nearby, with buses to Care Homes for Older People Page 4 of 28 Over 65 0 50 50 0 Brief description of the care home Tunbridge Wells and Tonbridge. The new premises were completed in April 2008, to replace an original older building. The home is owned by Ernie and Dr. Karen Graham, who own several other care and nursing homes. They take an active role in the development of the care homes, and Mr. Graham is in daily contact with the home and frequently on the premises. The home was formerly owned by the Overseas Missionary Fellowship, and was opened to meet the nursing needs of retired missionaries. The home retains a strong Christian ethos. The home provides nursing care for fifty older people. There are nursing beds on the lower and ground floors; and a separate unit on the first floor for residents with dementia and nursing needs. All floors can be accessed via a large passenger lift. The premises adjoin a number of care suites, which are overseen by the same manager. The care suites are owned or leased by the people requiring care; and their care is delivered by an associated nurses agency and domiciliary care agency. These do not form part of the inspection for the care home as they are inspected separately. The new building is very well appointed and provides a very pleasant environment for the residents. Fee levels are currently set at £850.00 to £950.00 per week, and are arranged according to the individual needs of the residents. Additional payments include costs for newspapers, hairdressing and chiropody. 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: 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: The home is assessed as having a rating of Excellent, 3 stars. This was a key inspection, which includes assessing all of the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. The AQAA was well completed by the previous manager, and was returned to the Commission within the required timescale. We received sixteen completed CQC survey forms, which contained very helpful information about peoples views of the home. Eight of these had been completed by Care Homes for Older People Page 6 of 28 residents or relatives; and eight had been completed by staff. All of the surveys contained positive comments, particularly about the good atmosphere in the home, and the kindness of staff. The home has a new manager who has been in post for several weeks. She was present throughout the day and was very helpful in locating documentation, and in showing the Inspector round the home. During the day, we (i.e. CQC) talked with nine residents, two visitors, and nine staff, including nurses, laundry staff, activities staff, and the maintenance man. We viewed all areas of the home; inspected medication; and examined documentation including care plans, staff recruitment files, staff training records, policies and procedures, and some servicing records. The management are reliable at keeping CQC informed of any adverse events in the home and other formal notifications. We have not been informed of any safeguarding alerts, or information in regards to any serious complaints during the last year. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The home is operating well in all areas, and no requirements have been given. However, several comments in staff and residents surveys indicate that communication between different units could sometimes be improved; and some staff feel that the dementia unit would provide more effective care if there were more care staff available for the residents. Care Homes for Older People Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Enquirers and prospective residents are provided with comprehensive information, enabling them to make an informed choice about moving into the home. Evidence: The home has produced very clear documentation for enquirers and prospective residents. This includes the Statement of Purpose, which clearly states the homes ethos of care to provide Christian-based whole person care, providing residents with physical, emotional and spiritual support. The home provides nursing care for older people on the lower ground and ground floors; and nursing care for older people with dementia on the first floor. The floors can be accessed via passenger lifts, which have a keypad system to protect the security of residents with dementia. The Service Users Guide includes a sample contract, which provides a clear breakdown of the fee structure, as well as explaining day to day management of the home; including arrangements for dietary needs, visiting etc. All rooms are for single Care Homes for Older People Page 11 of 28 Evidence: use with en-suite facilities, and are provided with their own telephone. A specific guide for residents with dementia has been very sensitively produced, with large photographs of different areas of the home; and simple pictures to talk through the different aspects of the home. The home runs a very comprehensive website, and people are encouraged to view this for specific details. Enquirers can view a sample care plan and a daily record in addition to other documentation. An admissions co-ordinator is available to show people round the home, and to answer their questions if the manager is not available. Each resident or representative is provided with the Terms and Conditions of residency, which explains details such as insurance, and retaining the bed if the resident is admitted to hospital. We viewed four pre-admission assessments, which are carried out by the manager or a senior nurse. These enable the assessor to discuss all aspects of the persons individual needs, and to determine if the home will be able to meet these needs. The pre-admission assessments viewed, had been well completed. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a competent and caring staff team, who provide personalised care for the residents. Evidence: The home has an innovative computer system for writing and updating all residents care plans; and these are accessible to residents and their relatives with agreed permissions. The system is backed up each day, and hard copies are printed out for visiting healthcare professionals as necessary. We viewed five care plans, three from the nursing unit, and two from the unit for residents with dementia and nursing care; and we found these to be very detailed records. Each resident is assessed for all aspects of daily living, such as communication, personal hygiene, mobility, continence, mental well being and nutrition. Care plans have suitable details, such as (for personal hygiene) if the resident prefers a bath or shower; how much assistance is needed; and if they require the services of the hairdresser and chiropodist. Mobility care plans show if a hoist is needed, and specify the type of hoist, the size of sling, and that two staff are needed for each change of position. Care plans are accompanied by relevant risk assessments, such as if bed rails are needed; and risk assessing if residents are safe Care Homes for Older People Page 13 of 28 Evidence: to walk with a walking frame unsupervised. Nutritional risk assessments show if the person needs assistance with eating and drinking, if fortified foods or supplements have been recommended by the dietitian; and have records for monthly weights and BMI index. We viewed the management of wound care for two residents, and these records are excellent. They show an assessment of each separate wound at each dressing change; and have clear instructions from the tissue viability nurse for wound management. Daily records are written directly on to the computers, and once these have been completed, they cannot be altered. This ensures that records cannot be altered at a later date. We noted that there are at least two entries per day from nursing and care staff, and often three or four; and they have extensive details about how the person has spent their day; about hygiene care; the persons mood; and how well they have taken their diet. As many relatives (as authorised by the resident) have access to these daily records, it enables them to see how the person is progressing, and provides them with understanding of how the persons needs are being met. Computer terminals are password protected. The home is currently working with an external research project in regards to effective commmunication between staff, residents and relatives. The home has a GP who is a visiting medical officer, but residents can stay with their own GP if they wish to do so. There are excellent links with other health professionals such as Hospice Nurses for palliative care; speech and language therapist; dietitian; physiotherapist and psychiatry services. The home employs an occupational therapist, who works alongside the activities staff. There is currently a programme in place to develop the homes palliative care for residents with terminal dementia. Care plans and care plan reviews (which are at least monthly), are discussed with the resident and/or relatives as appropriate. Medication is stored in a well maintained clinical room. The room and drug fridge temperatures are recorded daily. Most medication is currently administered via a monitored dosage system, but we were informed that the home is currently changing to a different supplier. This is to ensure that medication is always available as soon as possible, as there have been some delays with obtaining some specific supplies. The cupboards were clean and tidy, but there was not evidence of good stock rotation, and the manager said that she would address this. Medication Administration Records (MAR charts) are accompanied by a photograph of the resident, and highlight if there are any allergies. There are separate records to show when as necesary medication Care Homes for Older People Page 14 of 28 Evidence: has been given, and the reaon why. The MAR charts were seen to be good records, clearly and properly completed. We observed staff caring for residents, showing them concern and kindness. During the inspection residents said that they are very well looked after and that the care is very good. Another resident in a survey stated that I am happy here. The carers are very kind. 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. The home provides a varied programme of activities and events for residents enjoyment. The food is well prepared and provides a nutritious menu with plenty of choice. Evidence: The home has three activities co-ordinators, who work together to provide sufficient stimulation and a variety of activities for the residents. We observed lots of photographs of recent events on one of the noticeboards, and a resident expressed her enjoyment of a recent visit to a farm to feed the lambs. There are lots of large print books easily available, and jigsaws and games. We talked with six residents in the activities room, who were busy carrying out craft activities with an activities organiser, and who were clearly enjoying themselves, with lots of laughter and general chatter. One of the residents stated that there are always lots of things going on. Other activities include reminiscence, quizzes and cooking; and cooking is usually carried out in one of the three dining-rooms which provides plenty of space for this. The home frequently arranges visits from outside entertainers, such as singers and Music for Health; and had recently had a visit from a trainer with Birds of Prey. Some of the group entertainments include residents from all units; whereas outings are Care Homes for Older People Page 16 of 28 Evidence: usually arranged for small groups of residents from the individual units. The dementia unit has specific pictures on each bedroom door to help residents to identify their own rooms. There were limited activities items on view on the day of the inspection, but the co-ordinators are building up resources for more reminiscence etc. One to one activities are also carried out, which might just be sitting reading or chatting with someone, according to what they prefer. The home was originally provided by the Overseas Missionary Fellowship, and has a strong Christian heritage. Church services are held each Sunday for those who wish to attend, but the home ensures that residents are free to follow the religion of their choice. Residents stated that there are very good activities and outings arranged; and that the home has a very good atmosphere, and visitors are made to feel welcome. One commented in a survey that the gardens are well looked after and give lots of pleasure as well. Residents were also complimentary about the food, stating that the food is extremely good, with all home-cooked food, including the cakes for afternoon tea. The head chef has been employed in the home for the past seventeen years, and is familiar with the different likes and dislikes of the residents, as well as their individual dietary needs. The chef is assisted each day by catering and kitchen assistants; and one of the kitchen staff, or a carer, speaks to each resident in the morning to check their menu choices for the day. The menus are written separately for each week, which allows for seasonal changes and for including suggestions from the residents. Menus are also discussed with activities staff, so as to coincide with specific functions; for example, there is a forthcoming British Food Week which will incorporate traditional food items such as roast beef. And the home sometimes holds cream teas for residents and relatives in the Summer. The kitchens were seen to be clean and well equipped. An Environmental Health Officer visited two weeks prior to our inspection visit, and stated that there are excellent standards throughout. 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. Residents are confident that their concerns and complaints will be listened to sensitively, and will be dealt with effectively. Residents are protected from abuse. Evidence: The homes complaints procedure is included in the service users guide, and all residents are provided with a copy of this. The procedure directs people to apply to the manager or the nurse in charge in the first instance, and states that an initial response will be made within forty-eight hours. A final response will be given within twenty-eight days. The procedure includes clear contact details for the providers, for Social Services and for the Care Quality Commission. The home keeps a record of compliments and complaints, and this showed that people feel confident to share their views about how the home is running. There had been several complaints over the previous few months which related mostly to communication between staff and relatives. It is therefore very appropriate that the home is currently engaged in a research programme for this. All staff are trained at induction and with ongoing training, for recognition and prevention of different types of adult abuse. The manager stated that she had recently discussed this subject with some of the staff, and they showed a good understanding of the pathways to follow and the action to take if they have suspicions of any form of Care Homes for Older People Page 18 of 28 Evidence: abuse. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises provide a very attractive, pleasant and well-equipped home for the residents. Evidence: The premises were opened in April 2008, replacing the original older building. They are well designed to meet the needs of older residents, and provide a pleasant and comfortable home. The website includes a virtual tour of the home, and this enables people to have a good idea of the facilities provided before they visit the home. There are three lounge/dining rooms, which are spacious and attractive, as well as a reception area which includes a hot drinks machine for visitors to use. Communal areas also include an activities room on the lower ground floor; a hairdressing salon; and attractively presented and well maintained gardens. The new build incorporates all of the required fire alarm and fire prevention regulations; a call bell system; and individual room thermostats. Bedrooms are all for single use, and have en-suite toilet and shower facilities. There are also large assisted bathrooms on each floor with integral hoisting facilities. The home provides up to date equipment such as hospital and profiling beds, pressurerelieving mattreses, three mobile hoists, slide sheets and grab rails. There are shared toilet facilities near to communal areas. All of the bedrooms meet the latest size Care Homes for Older People Page 20 of 28 Evidence: requirements, and most are much bigger than the specified sizes. Bedroom doors are painted in individual colours which assists residents in finding their rooms, and also provides a sense of the privacy provided by having their own front door. The home is fitted with a well-equipped laundry on the lower ground floor, which has three washing machines and three tumble dryers. This is run by dedicated laundry staff. 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. The home benefits from having a team of competent and well trained staff. Evidence: The home has good numbers of nursing and care staff available each day. The numbers are determined according to the dependency levels of the residents, and will therefore be altered by the manager according to need. The usual levels are for one nurse on the nursing unit, and one nurse on the dementia unit each day and night. Care staff numbers are usually (for the nursing unit) five in the morning, four in the afternoons and two at night; and (for the dementia unit) three carers in the mornings, three in the afternoons and evenings and one at night. Staff surveys returned to us showed that most staff consider that these numbers are sufficient for effective staffing, but two felt that higher numbers of care staff in the dementia unit would provide more time to spend with the residents. There are also three activities co-ordinators, a deputy manager and an admissions manager; and ancillary staff such as housekeeping, kitchen, laundry, and maintenance staff. The home is above the expected level of carers with NVQ qualifications for NVQ 2 or 3 in health and social care, with approximately sixty per cent having completed this training at the time of the inspection visit. Care Homes for Older People Page 22 of 28 Evidence: Recruitment procedures were assessed by viewing three staff recruitment files, and these contained good evidence of robust recruitment procedures. Staff files included a recent photograph and proof of identity; a full employment history, two written references, POVA first and Criminal Record Bureau (CRB) checks; medical history, and work permits where applicable. Nursing staff have checks on their Nursing and Midwifery Council (NMC) PIN numbers. All staff complete an induction and foundation training programme during the first six weeks of employment. A training matrix confirmed that all staff complete training for the protection of vulnerable adults, and mandatory training for subjects such as infection control, moving and handling, and health and safety. A high priority is placed on staff training, and there is computer-based training which can be completed during working hours or at home. Staff who complete training in their own time are remunerated for this. The manager stated that she is expecting to develop more training on a face to face basis to back up the e-learning completed by staff. Nursing staff are enabled to develop their skills and competencies e.g. for palliative care, medication, and wound care. There are designated nurses delegated to concentrate on specific areas of nursing within the home, e.g. tissue viability and infection control. 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. There are good management systems in place, ensuring the security, comfort and well being of the residents. Evidence: The manager had only been in post for a few weeks prior to the inspection visit, but was already well acquainted with the management of the home. She is a trained nurse and has completed the Registered Managers Award. She is suitably experienced in the care of older people with nursing needs, and is in the process of applying to the Commission for formal registration. She is assisted by a deputy manager who has been employed in the home for six years. Regular staff meetings are held at all levels, e.g. for heads of departments, nurses, kitchen staff etc. There are handovers for nursing and care staff at each shift change. Some of the staff surveys returned to us indicated that staff would value more frequent staff meetings. Care Homes for Older People Page 24 of 28 Evidence: There are regular meetings for residents and relatives, and these are advertised well in advance. The home has two surveys each year carried out by an external company, and the results from these are made available. There is a monthly visit carried out by an external consultant, and monthly auditing processes to ensure ongoing effective management. The company achieved an Investors in People award (ISO 9001:2008) during 2009. This ensures that all aspects of the running of the home are maintained to given standards. Residents personal monies are not looked after in the home. All financial management is carried out by the residents designated relative or representative. Staff receive ongoing one to one supervision every two to three months, and this is recorded. They also have yearly appraisals. The manager is committed to ensuring that staff feel valued and are supported in carrying out their allocated tasks. Policies and procedures are reviewed each year, and are updated in between as necessary. We viewed some of the policies and procedures, and found them to be written clearly and concisely, so that staff are able to follow them. Maintenance records show that due consideration is given to the health and safety of the residents and the staff. We viewed some of the records for legionella checks, hot water temperature records, fire alarm tests, emergency lighting and PAT testing, and these records are all well maintained. The maintenance man stated that window restrictors are fitted in all areas of the home, but as this is a new build, these have not yet been added to ongoing check lists. However, he stated that he would raise this as a point of discussion with the management. 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 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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