Care Home: Dale Park

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What the care home does well We saw some assessments carried out on a person recently admitted and these were thorough. They were supported by further information and assessments from professionals such as social workers and health care professionals so that a full picture of the person could be built up. We looked at the care records for people in the home. These were fairly comprehensive and we were able to follow the care of the people concerned. The care records include a `care plan` which details the care needed for each person so that staff can carry out the care with some consistency. We saw that relatives were involved in care plan reviews so that they felt involved in the care of people in the home. One relative commented: `The staff are very good and always keep us up to date. They invite us to reviews to discuss the care`. other comments were: `Staff are wonderful. There is good care. My relative is more relaxed and content. He can wander at will. Ideal for him. He has improved since he`s been here and is actually clearer in himself`. `They are good at providing social events. These are quite regular. Lots going on in lounges most days. Personal care is good. He`s [resident] always clean and tidy`. The care records contained very good references to peoples health care needs. We saw that the monitoring of one person who had a pressure sore was very thorough and included good liaison with external health care professionals. A relative spoken with told us that the home had been very proactive in arranging medical appointments and ensuring that these were kept. During our observations we saw staff assisting people to walk and also encouraging people with their diet. Staff also used moving and handling skills to assist some residents. We observed varying levels of staff interaction but none of these were negative or adverse. Staff supported people well on these occasions and clearly recognized people as individuals. The relative reported that staff were always respectful when dealing with peoples personal care needs. This shows that staff are careful to maintain peoples dignity. We observed that the managers and staff are developing the environment in line with many good practice principals such as orientation aids and bright decor. The home has an excellent range of aids and adaptations to help people with disability. These include specialised baths, chairs and beds. This shows that the home are considering a wide range of care needs. We observed a lunchtime social event organised in the garden this was well paced and relaxed so that people were observed to be enjoying this time. The food was well presented and appetizing.The home continues to be staffed appropriately. Staff are well trained with over 50% having completed an NVQ [National Vocational Qualification]. This shows that staff are well equipped to care for peoples care needs. The management systems in place remain consistent and have helped to maintain continued improvement in care standards. There are good feedback systems so that relatives can have some say in the running of the home. The manager was also able to show an understanding of the needs of individuals and is keen to develop further good practice in the home. What has improved since the last inspection? We have made previous recommendations around activities in the home being more consistent and wide ranging. We spoke to the activities coordinator who explained that her time is now more devoted to this role and the feedback from relatives was that activities are much more consistent and `theres always something going on`. There has been further developments to the environment such as new bathing facilities and more aids and adaptations for people with disability and dementia so that they can experience a better quality of life and live comfortably. What the care home could do better: We did observe that day areas were not always staffed at all times. Given the amount of day space it is difficult to ensure staffing at all times but managers and staff should be aware of the need to ensure good observation to maintain residents safety. Three people were reviewed who had needs around encouraging extra fluid intake recorded in the care records. All three records indicated that people were getting `adequate` fluid intake but we were a little concerned that given the care plan instructions the monitoring was not more rigorous. For example one care plan said `encourage fluids at least 1500 - 2000 mls daily`. The person had been monitored on a fluid intake chart for three days which recorded 1000mls daily. There was a lack of reference in the evaluations to this fact and there was no `extra` fluids encouraged outside of the routine drinks given to all of the residents. We spoke to nursing staff and the manager in some depth as to how the home might review their routine procedures to ensure increased attention and rigour in this respect. We looked at the way medicines are managed and administered on one of the units. We made two recommendations at the time of the inspection. The first was the need to ensure that any PRN [give when required] medicine has the reason for administration clearly recorded. This would be best recorded on a care plan so that all staff are consistent in the reasons for any administration. Also we observed some handwritten entries by staff for medicines. These were not signed. We would recommend that handwritten entries are signed by two staff as this reduces the risk of errors in recording. Key inspection report Care homes for older people Name: Address: Dale Park 221 Meols Cop Road Southport Merseyside PR8 6JU     The quality rating for this care home is:   two star good 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: Michael Perry     Date: 2 3 0 7 2 0 0 9 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 29 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) 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Dale Park 221 Meols Cop Road Southport Merseyside PR8 6JU 01704501780 01704501782 dalepark@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Alan Mee Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 54 Date of last inspection Brief description of the care home Dale Park is a purpose built home providing nursing care for 46 older residents with mental health needs related to dementia [the home is registered for 54 but shared rooms are used for single use]. The home is owned privately by Southern Cross Health Care and the Responsible Person is Mr Phillip Scott. The Registered manager is Mr Alan Mee. The home is situated in Southport close to a retail park and with access to a bus route Care Homes for Older People Page 4 of 29 Over 65 0 54 Brief description of the care home for the town centre. There are shops close by and a pub. Dale Park is divided over 2 floors and 4 units. Each floor has 2 lounges and 2 dining rooms. The first floor is accessible by a passenger lift and stairs. Two bedrooms have ensuite facilities. The home is equipped with manual handling aids and grab rails to promote independence. There is a car park to the rear of the home and there is an enclosed garden. The current Fees for the service are 537 - 642 pounds weekly. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the home the manager filled out a form (Annual Quality Self Assessment, or AQAA) we sent and returned this. It had a lot of information about the home and how the people are supported to live their lives. We also sent for and received some feedback from surveys we sent to relatives and staff who work in the home. We visited the home without telling the staff we were coming so that we could see how things work normally. We spoke with many of the people who live there and watched how they spend their day and how the staff support them. We also spoke with visitors including health care professionals. We spent time observing people in the day areas to see how they spent their time over this period and how staff interacted with them. We have used used some of the Care Homes for Older People Page 6 of 29 observations made to support findings in the report. We looked at the records kept on people who live in the home and other records to do with how the home is run. We looked around the home to see if it was clean and a nice place to live and we were also able to view some of the bedrooms. Care Homes for Older People Page 7 of 29 What the care home does well: We saw some assessments carried out on a person recently admitted and these were thorough. They were supported by further information and assessments from professionals such as social workers and health care professionals so that a full picture of the person could be built up. We looked at the care records for people in the home. These were fairly comprehensive and we were able to follow the care of the people concerned. The care records include a care plan which details the care needed for each person so that staff can carry out the care with some consistency. We saw that relatives were involved in care plan reviews so that they felt involved in the care of people in the home. One relative commented: The staff are very good and always keep us up to date. They invite us to reviews to discuss the care. other comments were: Staff are wonderful. There is good care. My relative is more relaxed and content. He can wander at will. Ideal for him. He has improved since hes been here and is actually clearer in himself. They are good at providing social events. These are quite regular. Lots going on in lounges most days. Personal care is good. Hes [resident] always clean and tidy. The care records contained very good references to peoples health care needs. We saw that the monitoring of one person who had a pressure sore was very thorough and included good liaison with external health care professionals. A relative spoken with told us that the home had been very proactive in arranging medical appointments and ensuring that these were kept. During our observations we saw staff assisting people to walk and also encouraging people with their diet. Staff also used moving and handling skills to assist some residents. We observed varying levels of staff interaction but none of these were negative or adverse. Staff supported people well on these occasions and clearly recognized people as individuals. The relative reported that staff were always respectful when dealing with peoples personal care needs. This shows that staff are careful to maintain peoples dignity. We observed that the managers and staff are developing the environment in line with many good practice principals such as orientation aids and bright decor. The home has an excellent range of aids and adaptations to help people with disability. These include specialised baths, chairs and beds. This shows that the home are considering a wide range of care needs. We observed a lunchtime social event organised in the garden this was well paced and relaxed so that people were observed to be enjoying this time. The food was well presented and appetizing. Care Homes for Older People Page 8 of 29 The home continues to be staffed appropriately. Staff are well trained with over 50 having completed an NVQ [National Vocational Qualification]. This shows that staff are well equipped to care for peoples care needs. The management systems in place remain consistent and have helped to maintain continued improvement in care standards. There are good feedback systems so that relatives can have some say in the running of the home. The manager was also able to show an understanding of the needs of individuals and is keen to develop further good practice in the home. 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 on page 4. Care Homes for Older People Page 9 of 29 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 10 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed and admitted to the home appropriately so that care needs can be effectively planned. Evidence: The pre inspection self assessment completed by the manager [AQAA] tells us that the home complete detailed assessments prior to people being admitted to the home so that the home are sure that any care needs can be met. We saw some assessments carried out on a person admitted and these were thorough. They were supported by further information and assessments from professionals such as social workers and health care professionals so that a full picture of the person could be built up. From this information a care plan can be drawn up. We spoke with relatives of people in the home. They felt that staff gave good information as they were being admitted and that the written information [Service user Guide] was available [freely available in the foyer]. This helps people to orientate Care Homes for Older People Page 12 of 29 Evidence: and settle into the home. Care Homes for Older People Page 13 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health care needs are well monitored by the home and staff ensure peoples personal care so that privacy and dignity are maintained. Evidence: We looked at the care records for three of the people in the home. These were fairly comprehensive and we were able to follow the care of the people concerned. The care records include a care plan which details the care needed for each person so that staff can carry out the care with some consistency. These were completed well and included reference to a diverse range of peoples individual needs. For example one person had a pressure sore which was being well monitored and treated using a range of good practice. There were clear records of care staff interventions including dressings and routine pressure relief. There was also good notes showing that the tissue viability nurse had been involved at various times. This shows that the home are liaising with health external health care professionals. The care plans are evaluated monthly and these were written so that we could get an understanding of the persons progress. There was also very good evidence in the care Care Homes for Older People Page 14 of 29 Evidence: plan reviews that relatives are being involved and kept up to date. This did vary as one care file did not display the same evidence as others as the care reviews did not have any dates or names of participants. Generally however the relatives spoken with felt included in the care. One said: The staff are very good and always keep us up to date. They invite us to reviews to discuss the care. The care records contained very good references to peoples health care needs. We spoke to a visiting professional who said that staff were knowledgeable regarding peoples health and well being and that the reviews of the care were generally very positive. Another relative spoken with told us that the home had been very proactive in arranging medical appointments and ensuring that these were kept. We saw staff assisting people to walk and also encouraging people with their diet. Staff also used moving and handling skills to assist some residents. We observed varying levels of staff interaction but none of these were negative or adverse. Staff supported people well on these occasions and clearly recognized people as individuals. The relatives reported that staff were always respectful when dealing with peoples personal care needs.We observed two staff assisting a person to the bathroom and a notice was placed on the door to ensure privacy for the person. This shows that staff are careful to maintain peoples dignity. We did observe that day areas were not always staffed at all times. This has been raised as a concern by one relative recently. Given the amount of day space it is difficult to ensure staffing at all times but managers and staff should be aware of the need to ensure good observation to maintain residents safety. It was noted for example that the majority of the accidents in the home are unobserved. We looked in depth at the way the home ensures people have enough the drink and are properly hydrated. This has been raised as an issue in a recent complaint investigated under local safeguarding procedures. Three people were reviewed who had needs around encouraging extra fluid intake recorded in the care records. All three records indicated that people where getting adequate fluid intake but we were a little concerned that given the care plan instructions the monitoring was not more rigorous. For example one care plan said encourage fluids at least 1500 - 2000 mls daily. The person had been monitored on a fluid intake chart for three days which recorded 1000mls daily. There was a lack of reference in the evaluations to this fact and there was no extra fluids encouraged outside of the routine drinks given to all of the residents. Staff reported that other fluids including milk on cereals and soups and Care Homes for Older People Page 15 of 29 Evidence: prescribed supplements probably ensure enough intake. We spoke to nursing staff and the manager in some depth as to how the home might review their routine procedures [fluid chart records and supply of drinks] to ensure increased attention and rigour in this respect. We looked at the way medicines are managed and administered on one of the units. We found good auditing carried out by management to ensure that safe standards are maintained. We found it very easy to track how various medicines had been administered and the stock count was also easily checked. We made two recommendations at the time of the inspection. The first was the need to ensure that any PRN [give when required] medicine has the reason for administration clearly recorded. This would be best recorded on a care plan [possibly kept in the medication record] so that all staff are consistent in the reasons for any administration. Also we observed some handwritten entries by staff for medicines. These were not signed. We would recommend that handwritten entries are signed by two staff as this reduces the risk of errors in recording. Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social life of people living in the home continues to be developed so that they feel relaxed and engaged in the daily life. Evidence: There are activities organised for residents. We observed that the managers and staff are developing the environment in line with many good practice principals such as orientation aids and bright decor and this is being further developed. We spoke to the activities organiser who is employed full time. A social event was organised on the day of the inspection [Chinese buffet] hand this was well attended by residents and relatives who enjoyed being out in the garden. Staff reported that there had been at least 4/5 for these events and that there are also regular outings as the home has access to a mini bus. There are also indoor activities planned and some residents benefit from one to one activities. Relatives reported that they can visit at any time and that staff are always welcoming and friendly. There is a regular friends and family meeting organised so that relatives and visitors can feel involved in the life of the home. One relative said: Care Homes for Older People Page 17 of 29 Evidence: Staff are wonderful. There is good care. My relative is more relaxed and content. He can wander at will. Ideal for him. He has improved since hes been here and is actually clearer in himself. Another commented: They are good at providing social events. These are quite regular. Lots going on in lounges most days. Personal care is good. Hes [resident] always clean and tidy. We saw that each person had activities recorded and there are also very good pen portraits of the people in the home so that staff can become aware of peoples history and preferences regarding social activities. People responded positively to staff attention and interventions during the day. This shows that the people in the home respond positively to staff being present. We observed the lunchtime meal [buffet in the garden] and this was a well organised and social event that was well paced and relaxed so that people were observed to be enjoying this time. The food was well presented and appetizing. We saw that dining tables on the units are well presented and that tables are laid appropriately so that people with dementia can be clearly orientated. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures and staff are trained so that peoples concerns are listened to and reported and they are protected Evidence: We found the complaints procedure to be readily available in the home and displayed in both the information supplied by the home [service user guide] and also displayed prominently in the entrance to the home. Relatives spoken with said that they felt able to speak with staff and raise concerns. The manager advertises a weekly surgery so that any issues can be raised and dealt with. We looked at the complaints log for the home and found one complaint listed which had been dealt with appropriately by the manager. Since the last inspection there has been one concern raised through social service safeguarding team and investigated by them. This concerned some care issues raised by the family of a resident in the home and a concern that when admitted to hospital they had been dehydrated. The investigation concluded that there had been no neglect. We felt that as a result of the issues raised we would look at fluid intake for people in the home as one focus of the inspection and there are comments and recommendations around this under Health and Personal care. We spoke with staff and the manager who have a good understanding of the principals Care Homes for Older People Page 19 of 29 Evidence: involved in both recognizing and reporting any alleged abuse. Staff reported training in this area and staff records showed that this is ongoing. The AQAA also tells us that Dale Park Care Center as part of Southern Cross Health care also participates in the new confidential helpline launched by Southern Cross which is staffed by Action on Elder Abuse. This shows good practice in this area. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and clean so that people living there enjoy comfortable surroundings. Evidence: We found that the home continues to be upgraded and maintained with respect to the quality of the decor and furnishings / facilities. Improvements since the last inspection include the provision of a new bath facility, new furnishings, upgrading of the garden area to make it more accessible and safe and general improvements to the environment with respect to orientation aids so that people can find it easier to get around the home. There is a good range of aids and adaptations around the home including specialised chairs, beds and bathrooms and toilets. The day areas are bright and there is plenty of visual stimulus with art projects and pictures / photos displayed. The bedrooms seen were highly personalized and displayed evidence of peoples individual lifestyles. The home was found to clean and there are policies and procedures in place for the control of infection. There are regular audits of the environment and the manager was able to show that there is continual upgrading which reflects good practice principals Care Homes for Older People Page 21 of 29 Evidence: in dementia care. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited and trained appropriately so that the care needs of residents can be met. Evidence: At the time of the inspection visit the home had one nurse on each of the two floors and these were supported by four care staff on each floor. Care staff are supported by housekeeping staff, kitchen staff and an activities organiser. The manager works supernumerary to these figures and also has the assistance of an administrator. A maintenance person is also employed. This is sufficient staff for the number of residents in the home. We looked at the duty rotas and spoke to staff and both confirmed that the numbers were consistent and that there has been a reduction in the turnover of staff overall since the last inspection. Staff spoken with and who returned survey forms felt that they were supported by the management and that there was enough staff to carry out the care needs of the residents. Staff spoken with clearly understood the care needs of the people in the home and could explain their role in providing support. We observed the staff to be warm and supportive in their interactions with the residents and this was confirmed as consistent by speaking to residents who could express an opinion and also relatives. During our observations we also observed that staff interactions with residents were positive and recognized residents individuality. Care Homes for Older People Page 23 of 29 Evidence: Most staff are involved with some training. The pre inspection information states that over 50 percent of staff have achieved a National vocational Qualification [NVQ], and most other staff are on these courses. Staff files seen and staff spoken with evidenced ongoing support around training. This shows that the staff have the basic skills to care for people in the home. We looked at some staff files and found that the checks required for each staff prior to employment had been made and that staff were recruited thoroughly. This ensures that staff who work in the home are fit to do so. The home have developed a residential unit within the home and currently are in the process of giving further training to care staff who are running this unit so that they are clear about their role and responsibilities. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are management systems in place to ensure standards are monitored and the home is run in the best interests of the residents. Evidence: The manager is Alan Mee and he has been newly registered by The Care Quality Commission over the past year. He is a registered nurse and has achieved NVQ 4 and RMA [Registered managers Award] and has been in post since August 2008 and has been with Southern Cross since 2000. We spoke at length and he was able to give a clear outline of the current needs of the service in supporting residents with elderly care needs and also outline how future developments would fit in with best practice with particular reference to dementia care. An example of this was an awareness around the current law around deprivation of liberty safeguards following a recent training course. This shows that the manager is continuing to update himself. The home are also keen to develop an auditing tool which can be used to monitor the progression of dementia care in the home. Care Homes for Older People Page 25 of 29 Evidence: We asked how the service promotes peoples views and suggestions and was told about the canvasing of opinions of residents and relatives through surveys so that people can provide feedback about the service and feel more involved in the running of the home. We saw some of these and the feedback was generally positive. Results are displayed. There is also a freinds and family group and the manager has a surgery once a week so that people can have direct access if they have any issues to discuss. The manager discussed the various internal audits that are carried out including regular environmental checks and also visits by senior managers in the company who also complete a regular inspection and report [Regulation 26 report] which provides further feedback for the manager. We found that the management of health and safety in the home was good. The pre inspection information completed states that all safety certificates are up to date and some of these were spot checked on the inspection. This ensures that the environment for people is safe and maintained. The Health and Safety policy is available. The manager and staff have worked well further improve the home since the previous inspection visit which displays an ability to plan effectively and ensure continued improvement. The home has an external quality audit yearly which helps to monitor and reflect care practice so that further improvements can be made. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 We would recomend that the manager and staff condider the comments in the report arnd the monitoring of fluid intake for people in the home and review some of the standard care pracices to ensure that all residents are ensured enough fluid intake. We recomend that any PRN [give when required] medicine has the reason for administration clearly recorded on a care plan so that all staff are consistent in the reasons for any administration. Handwritten entries by staff for medicines were not signed. We would recommend that handwritten entries are signed by two staff as this reduces the risk of errors in recording. 2 9 3 10 We would recommend that day areas are staffed consistently so that people can be monitored effectively and safety maintained. Care Homes for Older People Page 28 of 29 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. 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