Care Home: Crouched Friars Residential Home

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What the care home does well Residents are happy living at Crouched Friars and they speak positively about the staff and the care provided. Comments included `Its nice here, I have my freedom`, `the care staff are kind and decent` and `the staff are very helpful and come quickly if you call them`. Residents have a good level of choice in their day to day lives and staff are resident led with the daily routines in the home. Residents and relatives feel happy about the management of the home and are confident to raise any concerns that they may have with the team. Residents and relatives are consulted regularly by the management team for their feedback on how well they are doing and residents meetings are also held . The home is clean, tidy, had no noticeable odours and is generally well maintained. It has a nice secluded garden to the rear. Staff are generally well trained and supported well by the management team through supervision and staff meetings. What has improved since the last inspection? Since the last inspection the care planning systems at the home have improved giving a better and more up to date picture of the care planned and provided. The proprietor continues to steadily reinvest back into the fabric of the building and buy new furniture and curtains etc. What the care home could do better: The manager and her team need to review how activities are provided and the hours assigned to this, to help ensure that residents individual and group social needs are assessed and met as far as possible. A review of the lunchtime routine is also needed to ensure that this is a positive experience for residents and continue to consult with them over the food, as comments are variable in this area. Whilst work has been completed on the care planning system there are some areas that still need work and these relate to reviews, some aspects of care planning and monitoring tools for fluids and weight management. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Crouched Friars Residential Home 103-107 Crouch Street Colchester Essex CO3 3HA     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: Diane Roberts     Date: 0 3 0 7 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 30 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 30 Information about the care home Name of care home: Address: Crouched Friars Residential Home 103-107 Crouch Street Colchester Essex CO3 3HA 01206572647 01206763622 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) : Weldglobe Ltd care home 56 Number of places (if applicable): Under 65 Over 65 1 56 dementia old age, not falling within any other category Additional conditions: 0 0 One person, who name was made known to the Commission in December 2006, who requires care by reason of dementia Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 56 persons) The total number of service users accommodated in the home must not exceed 56 persons Date of last inspection Brief description of the care home Crouched Friars is a period property that has been extended to offer care to 56 older people on three floors. The upper floors are accessed via a passenger lift. Most of the bedrooms are single occupancy and all have en-suite facilities. There are several communal areas offering a choice for people to use, and a large pleasant garden at the rear of the property. The property is situated close to Colchester town centre and has access to local amenities, including libraries, shops, post office and public transport. Care Homes for Older People Page 4 of 30 Brief description of the care home The fees charged by the home range from £390.09 to £490.00 per week. In addition to the weekly fee, service users pay for hairdressing and for the chiropodist where those services are used. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We visited the home for a day and a half and met with the manager and her team. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. As discussed in section seven of this report, the manager needs to complete her AQAA more comprehensively in order to give us more information about the home and the work in progress etc. The managers current AQAA was of limited value in compiling this report. On the day of the inspection we spoke to 6 residents and 3 staff at the home and prior to that we sent out surveys to relatives, asking for feedback on the home. Care Homes for Older People Page 6 of 30 The response was quite good and these comments are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. What the care home does well: What has improved since the last inspection? 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 8 of 30 Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can expect to be properly assessed before coming into the home and that they would have sufficient information about the home on which to base a decision. Evidence: The service user guide for the home is comprehensive with extensive information regarding the day to day running of the home. However, it should contain a copy of the complaints procedure and, for example, the views of residents living in the home. This is a document that is, amongst other things, meant to help people making a decision about coming into the home. A review, linked to standard one or the national minimum standards is recommended. The format is good with regard to font size and layout. Consideration could be given to making it more pictorial if the home has or would take residents with communication difficulties. Care Homes for Older People Page 11 of 30 Evidence: Residents spoken to said that the staff team had been very good at helping them to settle in and that they had been shown around the home and introduced to people. They also said that they had settled in quickly to the home but had not seen the service users guide. Overall, residents and relatives responding to our surveys said that they always had enough information about the home. The manager has a system in place for the pre-admission assessment of prospective new residents. The manager usually assesses new residents and takes one other person with her. The assessment tool is a tick box system and whist this gives a picture of the persons needs, it lack detailed in some areas and any person centred information, such as preferences and social background/interests. A review of the tool used may would help to promote a more person centred approach to the information gathered, leading into person centred care planning. The assessments were completed fully, appropriately timed and they were supported, where required, by information from the referring local authority. The information gained, although limited in places, was sufficient on which to base a decsion regarding suitability for admission to the home. In the AQAA the manager said that they had recently introduced a new document into the pre-admission assessment process to assess mental capacity. Completed mental capacity assessments were seen as part of the overall process. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a good standard of care provided in an individual way in order to meet their needs. Evidence: The manager has a care planning system in place. Two care plans were reviewed fully and two further care plans were used to cross reference. Overall the care plans in place were good, generally up to date, quite person centred and contained a good level of detail in order to guide staff as to the individual needs of the residents. For example, daily routines detailed residents choices, how their mood may be, what may affect them, what order they like to do things etc. Where staff have assessed residents as needing support, in some cases they need to detail what the support is. For example, one resident required support with feeding due to a medical condition but the actual support needed was not identified. Daily notes showed that staff had a caring approach to residents and their needs or concerns and they also showed that they offered residents choice. For example, staff Care Homes for Older People Page 13 of 30 Evidence: were ensuring that one resident had a person sit with them until they went off to sleep. On discussion with staff they knew the residents well, including their social circumstances. It would be of value to document more of the social and person centred information that staff know, that was not in the care plans, in order to ensure that the whole care team are aware of specific issues affecting residents. Some of the care plans contained more person centred information than others. Relatives actively asked to see daily records books and these were given freely for review. The daily records also showed a good level of communication with relatives. Care plans relating to mobility need to take account of residents needs in relation to pain relief to ensure that staff have an understanding of how this may affect a persons abilities. Residents were noted to be on regular pain relief but this was not mentioned in the care plan as significant. Some care plans were noted not to be a true reflection of residents current needs. For example, one residents care plan said that they were confined to bed but they were observed to be up and sitting in a chair for significant periods during the day, another said that a resident could feed themselves but on observation was being fed. Staff need to ensure that the reviews are undertaken in a meaningful way. Residents spoken to at the home said that they were happy with the home and the care provided. Comments included, I am happy here, its much better than where I was living before, I came to this home because of a recommendation and I am quite happy here. Residents had a range of risk assessments in place, including nutrition, manual handling and specific assessments relating to the individual. Overall these were seen to be up to date, with sufficient detail to outline the risk and any associated management. Consideration should be given to introducing a falls risk assessment to see if anything can be done to reduce risks of residents falling, by means of proactive management. Overall residents are being weighed regularly and only the occasional omission was noted. Residents are weighed on admission and care plans detailed, for example, if they needed more calories to put on weight and how this would be achieved. Some, but not all residents with weight loss, for example, low weight on admission, were on the nutritional risk guidance charts that were seen around the home. These were seen to be helpful as with the care plans, they gave accessible information to staff on what to give residents to help them with their diet. A more consistent approach to the use of these forms may be of value to some residents. Some residents were also seen to be on fluid intake monitoring charts. Staff constantly record sips of fluids but the records do not give a picture of how much the resident has actually drunk during the day. This was discussed with the manager and consideration should be give to reviewing the recording of fluid intake. Care Homes for Older People Page 14 of 30 Evidence: Records showed that residents health care needs were being met and there was evidence, for example, of timely GP intervention, chiropody, practice nurse visits, physiotherapy input and medication reviews. The medication system at the home was reviewed and found to be in good order. Records showed that there were several auditing systems in place that allowed the senior staff and management to check that the medications were being safely administered and properly recorded. Controlled medications were seen to be properly stored and administered and these are checked at every shift. It is clear from the administration charts that residents are being offered their as and when medication and when it is administered, staff record how much has been given. For residents on anticoagulants there was a very good monitoring system in place that helps to ensure that the changing prescription used is correct. Un-prescribed medicated creams were seen to be left in bathrooms. Any medicated items should be prescribed and stored appropriately, to reduce the risk of communal use and infection control risks. Residents spoken to said that they always got their medication on time. Comments included I worry about getting my medication on time, but they have never let me down. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents experience variable outcomes in relation to mealtimes and activities but have positive choices in how they live their day to day lives. Evidence: From records and discussion with the residents and the staff, it is clear that the routines of the home are resident led. Residents have their daily routines outlined within their care plan and these were individual, detailed and evidenced residents choices and promoted their independence. Residents spoken to said Its nice here, you can get about the home, see people and I have the freedom to do what I want, Its my choice when I have a bath, what time of day etc, I often have a lie in and there are no restrictions in this home. Within the care plans, residents had a social profile completed giving good information on residents family/social histories and preferences. These give staff a good picture of the resident as an individual. Residents also had social care assessments in place. Whilst these contained some good information regarding, for example, mental health, mood, how residents may feel, there was often limited information on what their actual needs were, goals if any and how these could be met by providing social care. Care Homes for Older People Page 16 of 30 Evidence: The home has an activities lady who works every afternoon, five days a week. 15 hours in total. Activities records are maintained and show that residents choose whether to take part or not. Records showed that they participate in such activities as games, dominoes, crosswords, quizzes, baking, chatting, keep fit, music, darts, knitting and photography. The records are quite good and do also give, for example, the topics of conversations that were held. They primarily relate to group activities and do not always give a picture that residents individual needs are being assessed or met in a way that would promote their independence, the retention of skills and their self worth. On discussion with the activities officer, she is primarily group orientated in order to entertain as many residents as possible in the time allowed. Whilst it is clear that residents have some input with regard to the activities taking place the activities officer says that she has an idea of what they would like and arranges the programme. Her one to one time with residents is limited and these needs may not always be fully assessed or met by her input, relying on care staff to also take an active role. In saying that the activities officer clearly has an understanding of peoples individual interests and was able to show items that she had sourced for residents so they were able to keep their interests going. Residents who commented said there are a couple of activities that I enjoy, I dont like much else, the activities officer is a nice lady but the activities offered are not for me, I dont want to throw balls and the activities lady works hard, I join in most things, she keeps you active and sometimes she finds things for me that she knows that I would like. Staff report that by late morning they are able to spend more social time with residents and often go out to the local shops with those who are able and wish to go out. The dining tables were nicely laid with condiments etc available. At breakfast, most residents choose to eat in their rooms with only a minimal number choosing to eat in the dining room. Residents spoken to confirmed this choice. Drinks were seen to be available in the lounges and in residents rooms other than just at drinks rounds. Lunches are staggered in the home. Lunches are served in two dining rooms and to those who choose to eat in their rooms. The lunchtime routine was observed. It was noted that the system for serving lunches was very slow and staff organised it in such a way that residents, who may be sitting on a table of four, were all served at different times. For example, one resident was eating their lunch whilst the other three waited for some time, watching them, before they were served their lunch. The manager said that they knew this was an issue and had tried other ways to address this to no avail. There was no evidence that they had consulted with residents about how they feel on this matter and it should be reviewed again. Residents we spoke to found it unacceptable, uncomfortable if they got their dinner Care Homes for Older People Page 17 of 30 Evidence: first and somewhat frustrating. One dining room seats residents who have a higher level of dependency. It was noted that staff helping in this dining room did not interact with the residents, the atmosphere was uninviting and staff where observed to stir residents meals up, without notice, whilst standing next to them. This is poor practice and shows little understanding of peoples needs and dignity. Residents spoken to regarding the food did not know what was for lunch that day until it was served. The menu is available but not prominently displayed where it would remind residents. The comments regarding the food were variable and included the food is good, there is plenty of it and its hot, we do get a choice the food has declined recently, the menu variety is now more limited, too much potato with cheese and jacket potatoes, there is plenty for elderly people its fine, strawberry jam sandwiches with brown bread is not good and there is less choice with regard to sandwich fillings recently, the food is not dreadfully wonderful, there is always choice and always fresh fruit available, big bowls of it and the menu is repetitive and the sausages quite hard and they use instant mash, not real potatos. Relatives also made comments on the food provided in our surveys and these included there could be more hot meals at supper time instead of sandwiches, lunches could be better, they use instant mash which is never very good, so they dont have boiled or roast potatos and the soup is not very good. When we discussed the food at the home with the staff they said the food is ok, but I dont like the potatos they use instant potato, if the manager cooks she uses proper potatoes. Residents who responded in the managers own quality assurance questionnaire said that they were happy with the food provided at the home. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their concerns would be listened to and that, as far as possible, they would be protected from abuse. Evidence: The manager has a complaints logging system in place. No complaints have been logged since out last visit. Whilst all the residents and relatives who responded in our surveys said that they all knew how to make a complaint, relatives gave variable responses as to whether any matters raised had been dealt with satisfactorily. For example, some relatives said that usually or sometimes the matter had been dealt with to their satisfaction. The manager may wish to consider this and also consider whether staff are recording all verbal concerns/complaints so she can ensure they are dealt with fully. In her AQAA the manager said that they had improved by encouraging staff to document and concerns, issues and complaints. There was no evidence that this had happened. Residents who commented said that I would raise any concerns I had with the staff and I dont have any complaints but I would feel comfortable raising any issues with the manager. Relatives who commented also said that they would be happy to raise any issues with the manager. The complaints procedure, which is displayed, needs a review so that it is clear who Care Homes for Older People Page 19 of 30 Evidence: would take the lead in investigating a complaint. Consideration should also be given to the font size to make it easy read. It was also possible to see recent compliments the team at the home had received and comments included thank you for looking after me so well during my recent stay at your home, thank you for taking such good care of my relative and excellent care was given to my relative. Staff spoken to showed a good understanding of adult protection matters. Since the last inspection there has been one safeguarding referral at the home which at the time of the inspection had yet to be concluded. The manager has in-house adult safeguarding policies but staff also need to have access to the local authority guidance which is also relevant. Training records show that there was a good compliance level with staff training on adult protection matters. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, safe and generally well maintained home. Evidence: A partial tour of the home was undertaken with the manager. All communal areas, bathrooms and a number of bedrooms on each floor were viewed. Overall the home was seen to be clean and tidy. No odours were noted. Bedrooms were personalised by the residents and from observation, it is clear that they have some choice over this. All the bedrooms are en suite. Decor in the bedrooms was variable but acceptable overall. The manager said that they were steadily refurbishing bedrooms and was able to show us recently redecorated rooms with new furniture and soft furnishings. Records show that the manager has consulted with residents regarding the choice of decor in the home and with regard to the colour of furniture as well. Decor in the older part of the home looks tired in places, with regard to woodwork etc. The manager reports that the maintenance man has an ongoing redecoration programme to address this. The manager also showed us bathrooms where they were planning to make changes to allow more room to work in and the use of new lifting hoists. Since the last inspection there has also been some replacement of dining room furniture, curtains and a small kitchen upstairs has recently been refurbished. The home benefits from a very pleasant garden which has a path with railings. There is a summerhouse and garden furniture available. Care Homes for Older People Page 21 of 30 Evidence: Residents who commented said that the home is always nice and tidy, my bedroom is lovely and the home is clean and the cleaners are helpful. The full time laundry assistant only has to deal with small items and personal clothing as all the bedding laundry is contracted out. Residents were generally happy with the laundry service but some said it could be collected more often and relatives concurred with this. The home has a full time maintenance man and records show that he records when any items for attention have been completed. Records show that staff are good at recording requests and are keen to ensure things are done so that residents concerns would be addressed promptly. Records show that the maintenance man regularly checks the hot water temperatures and other equipment in the home. Records in relation to fire safety were checked. Staff fire drills and the maintenance of equipment was in good order but more attention is needed to consistently checking the fire alarms system and the fire safety risk assessment was out of date, last being reviewed in 2007. This needs attention to ensure that it is up to date. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living at the home can expect to be cared for by a staff team that is supported and trained to meet their needs. Evidence: At the current time for 49 residents, the staffing levels at the home are 6 in the morning including one senior, 5/6 in the afternoon and 4 at night. On discussion the manager says that the levels are flexible and relate to the needs of the residents. She said that they do go up to seven staff during the morning, if needed, and also bring in twilight staff should the need arise. Residents who commented said that the care staff, day and night, are alright, they are caring and polite, when I use the buzzer the staff come quickly, the care staff are kind and decent, sometimes a bit brusque if they are stressed, very kind and thoughtful staff who mean well and the staff are a nice bunch of people, mostly polite. Staff spoken to confirmed that they had undertaken NVQ courses and the managers AQAA confirmed that 22 out of the 25 care staff had achieved this qualification. Staff also confirmed that they were being trained in the home to undertake the role of senior carers and this included observations of medication rounds and being in charge Care Homes for Older People Page 23 of 30 Evidence: of shifts for periods of time. There is a steady turnover of staff at the home. No agency staff are currently being used and the manager reports that recruitment is not a problem. Three staff files were reviewed in order to assess whether the manager has a robust recruitment process in place that protects residents. Overall the files were seen to be in good order with all the required checks and documentation in place. The manager also requests a full CV so that any gaps in employment can be checked as the application form does not allow for this. There was evidence that staff had been inducted to the home and had been undertaking the Skills for Care induction. Training records showed that there were good compliance levels with staff training in relation to fire safety, dementia, and health and safety. Many of the staff have up to date training in safe manual handling but nine staff were noted to have out of date training on this subject with some not attending training since 2007. This needs to be addressed. Some staff have been trained in infection control, the Mental Capacity Act and deaf and blind awareness. Consideration should be given to providing staff with training on medication conditions associated with old age, such as diabetes, Parkinsons disease etc. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well run home where they are consulted about issues that may affect them. Evidence: The manager has been working at the home nearly two years in her capacity as manager and before that she worked in the home as the deputy. The manager is suitably experienced to run the home and has completed the registered managers award. Staff speak positively about her and feel that communication between the team and the home in general has improved since she became manager. The manager completed her AQAA when required but, as noted at the last key inspection it was brief and possibly does not give a full picture of the work going on in the home. This could have an impact on inspection frequency in the future, if we do not have the information we need to properly assess the home. Residents spoke positively about the manager and comments included I see the manager about a lot, The manager is very nice, I like her and the other day we went out for a good walk together and the Care Homes for Older People Page 25 of 30 Evidence: manager is very good, she stops to chat. Minutes show that the manager meets with her staff and they discuss care practices, promote a person centred approach to care and cover feedback from residents meetings. The manager sends out quality assurance questionnaires to the residents, relatives and staff. Overall the results are positive with residents happy with the facilities, services, the staff and feeling safe and listened to. Relatives were also generally positive, highlighting a few more areas for action. The manager has developed and action plan to address any issues highlighted. Staff feedback was also positive. Regular meetings are held with residents and minutes are taken which show that there is consultation on the food and activities. Residents who commented said I think its quite a well run home and peoples needs are met. Overall relatives who commented felt that it was a well run home. The manager and administrator only hold small amount of personal money for a few residents who have no alternative help. The home has a system in place whereby relatives are invoiced for any outgoings. A double signatory system is in place for any cash transactions and a regular audit is undertaken. Records show that the manager has a good staff supervision system in place and staff spoken to confirmed that they received regular supervision. Supervision included one to one meetings and also observations of practice. Detailed records are maintained by the supervising staff and it is clear that any practice issues are discussed. The records show that the senior staff are promoting a good standard of personal care in the home. Accident records were reviewed and found to be completed well and no concerns were noted. There is no evidence that the manager monitors the incidence, type and times of accidents and this may be a valuable tool in a home with a complex layout with regard to the deployment of staff. The manager says that she has access to a local falls prevention team should the need arise. On touring the home no health and safety issues were noted. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 Review the arrangements 14/10/2009 for the provision of activities including the hours available. To help ensure that residents group and individual assessed needs are met in a person centred way. 2 15 16 Review the mealtimes arrangements and review the menu and the quality of the food being offered. To ensure that residents have a pleasant mealtime and that they are happy with the food being offered. 14/10/2009 3 19 23 Ensure that the fire safety risk assessment is kept under regular review and that alarm systems are tested regularly. To help ensure that residents and staff are kept safe from the risk of fire. 30/09/2009 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 3 Undertake a review of the service users guide and consider how to make it more available to residents. Undertake a review of the pre-admission assessment form in order to provide more detailed information and a person centred approach. Continue to develop a person centred approach to care planning. Check that there is sufficient detail in all care plasn to guide staff and that they are all up to date reflecting residents current needs. Consider the introduction of a falls risk assessment, to reduce the risk of falls in the home. Review the complaints procedure and check with care staff that they are recording all verbal concerns/complaints raised with them. As part of the quality assurance programme, give consideration to auditing the accident records to check for patterns, where risks could possibly be reduced. 3 4 7 7 5 6 8 16 7 38 Care Homes for Older People Page 29 of 30 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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