Care Home: Derby House Nursing Home

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What the care home does well People are well informed about the home to assist them in choosing to live there. And their needs are suitably accounted for. Peoples health and personal care needs are well accounted for and met in accordance with their given capacities, choices and risk assessed needs. From staff that promote their rights and welfare. Peoples daily living expectations and preferences are well promoted in consultation with them and they are provided with nutritious food in accordance with their choices and assessed needs. The home takes concerns and complaints seriously. Listens and acts on them and works in peoples best interests to protect them from harm and abuse and to promote their best interests. The home is overall,safe, clean, comfortable, well furnished and decorated and for the most part equipped and suits peoples needs. People can be assured that they will receive care and support from staff that is effectively recruited, inducted, trained and deployed. The home is well managed and run in peoples best interests and their health, safety and welfare is overall effectively promoted and protected. What has improved since the last inspection? The service is proactive in continually seeking to develop and improve the standards of care and services provided there. And they ensure that they keep up to date with changes in legislation and any new initiatives for the benefit of people accommodated there. We were able to postively verify the improvements that they told us about in the AQAA at this inspection, including the following. Service information is further developed to provide details as to the range of needs the home caters for and advice of its availability in alternative formats. Approaches to determining and recording peoples individual needs and care plans have developed considerably, including by way of information technology support systems. These provide a person centred framework accounting for peoples lifestyle preferences, personal choices and decisions about their care and their given mental capacities. Staffing arrangements at mealtimes have been reviewed to ensure that people are provided with the time they need to enjoy their meals and for unhurried assistance with these where necessary. People are consulted about the provision of locks to their bedroom doors. And there is an operational improvement plan for the ongoing upgrading, repair and renewal of theenvironment there, with focus on ensuring peoples comfort and provision of equipment necessary for their care. And with a recently added infection control auditing and improvement programme. There has been a review of management arrangements, with a registered manager approval granted for the new manager there. What the care home could do better: Ensure that oxygen cylinders are always correctly stored. Ensure that the responsible individual, who is now no longer in day to day charge of the home as the manager. Provides written reports of his monthly visits to the home to the registered manager, each of the directors and the Commission so as to account for the conduct of the home and to form an opinion as to the standards of care provided there. Undertake a risk assessment and consult with the local Fire Authority about the use of the specified lock type that is fixed to a service users bedroom door at their request. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Derby House Nursing Home 12 Broad Walk Buxton Derbyshire SK17 6JS     The quality rating for this care home is:   three star excellent 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: Susan Richards     Date: 1 8 0 6 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 31 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 31 Information about the care home Name of care home: Address: Derby House Nursing Home 12 Broad Walk Buxton Derbyshire SK17 6JS 0129823414 0129823334 info@derby-house.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Derby House Nursing Home Limited Name of registered manager (if applicable) Mrs Jane Worthington Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Derby House Nursing Home can accommodate the two named variations for the category of PD approved on the 1/4/2002 and 6/10/2005. Derby House Nursing Home is registered to provide personal care with nursing to male and female service users who fall within the following categories: Old age, not falling within any other category (OP) 31. Physical disability (PD) 1. No persons can be accommodated under the category PD at Derby House nursing home when one person is already accommodated under this category. The maximum number of persons to be accommodated at Derby House Nursing Home is 31. Date of last inspection 0 1 Over 65 31 0 care home 31 Care Homes for Older People Page 4 of 31 Brief description of the care home Derby House is located in the heart of Buxton, overlooking a park within a pleasant residential area. The home is an old Victorian building, initially registered under the Registered Homes Act 1984, transferring under the Care Standards Act in 2002. Accommodation is over three floors and is suitably adapted to meet the needs of people with mobility problems, with a range of mobility aids provided. There is a shaft lift and emergency call system provided throughout. There is one communal lounge and dining room available on the first floor. And although floor space and facilities here are limited in terms of the number of residents that may use this room at any one time. Due to the large size of many individual bedrooms, most residents prefer to use these as bed sits. There is a choice of bathrooms and toilet facilities and some rooms have an en suite facility. There are central kitchen and laundry facilities and with dedicated staff facilities also provided. Residents receive care and support from a team of registered nurses, care and hotel services staff, together with the newly registered manager who is a Registered General Nurse. Ownership of the home is a family concern and limited company. And directors are on site daily giving high profile business and administration and buildings maintenance support. Fees charged range from 524.37 to 634.37 pounds per week, dependant on individuals assessed needs. 106.30 pounds is reduced from the above for the free nursing care element of the fee funded via the local primary care trust for those who may be eligible. There are additional charges for hair dressing, escorts to outside appointments, newspapers and additional personal toiletries. However, basic toiletries and chiropody are included in the weekly fee. Care Homes for Older People Page 5 of 31 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 quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. Our last key inspection of this service was conducted on 23 May 2007 and the previous quality rating then was good. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire (AQAA), which we ask the home to complete on an annual basis in order to provide us with key information about the service. We also received some survey returns from people who use the service, their advocates and from staff that work Care Homes for Older People Page 6 of 31 there. At this inspection there were twenty seven people accommodated, all in receiving nursing care. We used case tracking in our methodology, where we looked more closely at the care and services that three people receive. Due to some peoples given mental capacities, it was difficult to obtain meaningful verbal feedback. And where this was the case, where possible we spoke with their advocates. We also observed staff interactions with people, looked at their written care plans and associated health and personal care records and also their private and communal accommodation. We received many positive comments from people about the service, which included, Its warm and welcoming here with a lovely caring atmosphere. I am very well involved in the plan of care. Its lovely, clean, good food and kind and thoughtful staff. I am looked after very well. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We spoke with the nurse manager, together with one of the directors, who is also the administration and business manager, about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian religion, with one person falling under the category of PD, physically disabled. What the care home does well: What has improved since the last inspection? The service is proactive in continually seeking to develop and improve the standards of care and services provided there. And they ensure that they keep up to date with changes in legislation and any new initiatives for the benefit of people accommodated there. We were able to postively verify the improvements that they told us about in the AQAA at this inspection, including the following. Service information is further developed to provide details as to the range of needs the home caters for and advice of its availability in alternative formats. Approaches to determining and recording peoples individual needs and care plans have developed considerably, including by way of information technology support systems. These provide a person centred framework accounting for peoples lifestyle preferences, personal choices and decisions about their care and their given mental capacities. Staffing arrangements at mealtimes have been reviewed to ensure that people are provided with the time they need to enjoy their meals and for unhurried assistance with these where necessary. People are consulted about the provision of locks to their bedroom doors. And there is an operational improvement plan for the ongoing upgrading, repair and renewal of the Care Homes for Older People Page 8 of 31 environment there, with focus on ensuring peoples comfort and provision of equipment necessary for their care. And with a recently added infection control auditing and improvement programme. There has been a review of management arrangements, with a registered manager approval granted for the new manager there. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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 well informed about the home to assist them in choosing to live there. And their needs are suitably accounted for. Evidence: At our last key inspection here we found that people were mostly well informed about the home and its services. And that the homes approach to individual needs assessment was consistent and structured. Although we made a requirement that clear information be provided for people about the range of needs that are catered for. And for key service information be provided in alternative formats as may be necessary. Both are met at this inspection. We also made a recommendation that the home record peoples personal choices and abilities in respect of their medicines arrangements. This was also found to be met at Care Homes for Older People Page 11 of 31 Evidence: this inspection. In our annual quality assurance questionnaire, or AQAA, the home described a comprehensive individual admission and needs assessment process for people. They told us about improvements they are making to develop their approach to individual needs assessment and care planning. In order to ensure that peoples individual mental capacity to make key decisions and to consent to their care and treatment is effectively accounted for. At this inspection we saw how measures were being introduced to effect this, by way of staff training and instruction and individuals needs assessment and care planning records. People told us that they received the information they needed to assist them in choosing the home, including a written contract and that their needs, including their medical needs are being met. The recorded needs assessment records that we examined for people case tracked, were comprehensive and person centred. Accounting for potential risks identified to peoples safety and included placement assessment information from the placing authority. Care Homes for Older People Page 12 of 31 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. Peoples health and personal care needs are well accounted for and met in accordance with their given capacities, choices and risk assessed needs. From staff that promote their rights and welfare. Evidence: At our last key inspection we found that peoples health, personal and social care needs were well accounted for and met. We made two recommendations about promoting care planning agreements with people and ensuring confidentiality of information as to peoples personal bathing routines. Both are met at this inspection. In our annual quality assurance questionnaire that the home completed, they told us that they continue to ensure peoples health, personal, social and medical needs are met. And that they operate effective medicines systems and practises and have good established relationships with outside health and social care professionals. They also told us that they promote peoples privacy and dignity at all times. Care Homes for Older People Page 13 of 31 Evidence: They told us about some of the improvements they are making. Including to ensure that the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Act 2009 are understood and applied to promote best practise. Their introduction of a revised computer based care planning package. Consulting with outside health and social care professionals to deliver best practise and by providing of a variety of additional equipment to further assist in promoting peoples health, safety and independence. At this inspection people told us that their needs are met, including their medical needs. And that staff treat them with respect and ensure their dignity and privacy. And we observed staff to be sensitive in their approaches with people. We saw that people are regularly consulted as to their views of the care they received and that many positive comments were received from recent satisfaction surveys undertaken by the home with residents and their relatives and representatives. And during our visit we also received a number of positive comments. Comments included, The staff look after me very well. Staff are thoughtful, friendly and caring. I am very wel involved in the plan of care. We saw that people case tracked had recorded care plans formulated in accordance with their risk assessed needs, which accounted for peoples individual mental capacity and also consultation and inputs from outside health and social care professionals. And we found that staff were conversant with peoples required care interventions and their individual needs and choices. We saw that peoples care plans were reflective of nationally recognised practise and guidance concerned with the care of older people. And where possible people had signed their agreement for these, or their advocactes had signed for consultation with them. Staff also told us that they are well supported to access training to assist them in caring for people including relating to their medical conditions. And staff training records that we looked at reflected this. When we looked at the arrangements for the ordering, receipt, storage, administration and disposal of peoples medicines, we found these to be in accordance with recognised guidance. Although we reminded the home of the need to ensure that the medicines refrigerator is regularly defrosted and to to always record the date of opening of eye drops to be administered to any person. However, we saw that there are internal Care Homes for Older People Page 14 of 31 Evidence: management systems in place for the monitoring of medicines arrangements and practises. We saw that there are suitable arrangements in place via the local primary care trust for the regular monitoring of and advice about medicines supplied to the home via their local pharmacy supplier. A written report of their most recent visit told us that there are satisfactory arrangements in place for the management and administration of peoples medicines. Care Homes for Older People Page 15 of 31 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. Peoples daily living expectations and preferences are well promoted in consultation with them. and their advocates. And they are provided with nutritious food in accordance with their choices and assessed needs. Evidence: At our last key inspection we found there was some flexibility of daily living routine for people, with activities routinely organised for them to enage in. And with balanced and nutritious meals provided. Although that each of the above may not always be in accordance with peoples lifestyle preferences. We made recommendations to consult with people about their daily living and lifestyle preferences and choices and to ensure staff availability to assist people at meal times, giving people the time they need eat their meal. And we found at this inspection that these are met. In our annual quality assurance questionnaire completed by the home, they told us that people are provided with a variety of activities and entertainments they can join. That people are supported to maintain contacts with their families and friends. That Care Homes for Older People Page 16 of 31 Evidence: they provide meals from fresh local produce served in the location people prefer. And that they continue to cater for any special individual dietary requirements and undertake effective nutritional health screening for people. They told us they have improved their arrangements for serving meals and assisting people to ensure they are not hurried and are given time to enjoy their meal. That they more effectively account for peoples daily living choices and lifestyle preferences so as to promote flexible individual daily living routines. And that key staff have undertaken recognised training to enable them to provide suitable chair based exercises for people. They also told us they feel they could improve further by providing additional staff hours for more one to one activity time with people, but that financial constraints impact on their ability to do so. At this inspection people told us that activities are regularly organised that they can choose to join. And that they always like the meals provided. People said they are consulted about their daily living routines and lifestyle prefrerences and we saw that details of these are now included in peoples needs assessment and daily living plans. The home regularly reviews with people as to whether their personal expectations about their daily living arrangements at the home are being met. With records of those reviews maintained. A nominated staff member is responsible for co ordinating activities and for consulting with people about these. And records are kept about activities planning, meetings and consultation with people, including their participation and enjoyment in the activities they choose to join. Examples of activities regularly provided include, dexterity challenges via games, general knowledge quizzes, reminiscence, word association, chair based exercises, slide shows, memory lane bingo, singing, music, film days and board games. Outside entertainers come into the home on a regular basis and people told us they particularly enjoy the visiting accordionist. People also said they enjoy the poetry and prose sessions that a regularly held. Seasonal celebrations are undertaken and activities information is provided on the residents noticeboard. Details of forthcoming activities included a celebration tea party for the Queens birthday, music and entertainment from a local visiting school and a day trip. People told us they are well supported to maintain contacts with families and friends Care Homes for Older People Page 17 of 31 Evidence: who can visit at any time. And we saw that a number of people received visitors during our inspection visit. We saw that staff served meals to people in the location they chose and that they assisted people with senstivity and ensured they were given plenty of time to enjoy their meal. Lunch served was suitably presented in accordance with peoples assessed dietary needs. . Care Homes for Older People Page 18 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes concerns and complaints seriously. Listens and acts on them and works in peoples best interests to protect them from harm and abuse and to promote their best interests. Evidence: At our last key inspection we found that people knew how to complain and that complaints were taken seriously and acted on and that people were protected from harm and abuse. In our annual quality assurance questionnaire completed by the home, they told us that they continue to operate an effective complaints process and to protect people from harm and abuse. They also told us about some improvements they are making in their systems and arrangements to promote the best interests of people, including for those who may lack capacity to make key decisions about their lives or to consent to their care and treatment. At this inspection people told us that they know who to speak with if they have any concerns about the service they receive and how to complain and we saw that written information about this is also provided for people. Care Homes for Older People Page 19 of 31 Evidence: We found that staff were conversant with their role and responsibilities concerned with handling complaints and safeguarding people from harm and abuse. And complaints records that we looked at told us that the home has received two complaints since our last key inspection there, which were fully investigated and not upheld. We looked at work in progress and saw that that the home had obtained literature and information for staff and were in the process of developing their policy and procedures and arrangements for staff training concerned with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, which have recently come into full effect. And that all people had initial recorded mental capacity assessments in place in their care files and in consultation with their GP. In our annual quality assurance questionnaire, the home had given us some information about the use of restraint over the last twelve months, which we discussed with staff at this inspection. Its use concerned a named service user who has lived at the home for some time and who appeared to lack capacity to consent to the arrangements made for their care in this respect. The use and rationale for this was clearly documented in that persons care planning records. And we could see that the assessment and decision making process behind this met with the Mental Capacity Act Code of Practise. Care Homes for Older People Page 20 of 31 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. The home is overall,safe, clean, comfortable, well furnished and decorated and for the most part equipped and suits peoples needs. Evidence: At our last key inspection we found that people lived in a clean, safe and comfortable environment, which for the most part suited their needs. We recommended that people be provided with suitable locks to their bedroom doors and lockable storage space. And at this inspection found that suitable locks to doors are not routinely provided, although peoples care records accounted for individual consultation with them, or where necessary their representative, together with their choices made about this. People are also consulted about the provision for lockable storage space in their own rooms. In our annual quality assurance questionnaire completed by the home, they told us that they provide people with a safe, clean and comfortable home, employing an ongoing programme of continuous repair, renewal and upgrading and with priority on care, safety and the provision of necessary equipment. They gave us a lot of information about areas of upgrading and renewal that they have Care Homes for Older People Page 21 of 31 Evidence: achieved in respect of the above over the last twelve months and also further planned via their written programme. At this inspection people told us that the home is always fresh and clean. And when we looked at the private and communal accommodation of people case tracked we found these areas to be overall safe, clean, comfortable, suitably furnished and decorated and equipped to suit their needs. Although we saw in one persons room that there was a large oxygen cylinder which was not in use and was not correctly stored. We have made a requirement about this in the management section of this report. There was an internal door chain type lock in that persons bedroom, which they had requested. However there was no recorded risk assessment in place for this and no evidence of consultation with the Fire Officer about this. We also saw a commode there, which was rusting around the seat frame, which would not promote best infection control. And we saw that not all communal hand washing areas were provided with disposable paper towels or the correct type of waste bins. The manager advised that the infection control nurse from the local primary care trust was due to come into the home the following week to undertake a full infection control audit. And since has advised us of the outcome of this, with an overall scoring of seventy one percent indicated in the report from that visit. The manager has also told us about their intended action plan to address matters arising, including those indicated above, which is satisfactory in principle. And with further staff training updates arranged via the PCT. The separate laundry facility is suitably equipped, clean and tidy. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that they will receive care and support from staff that is effectively recruited, inducted, trained and deployed. Evidence: At our last key inspection here we found that people needs were generally well met from staff that were suitably recruited, inducted and trained. We made a recommendation for a review of staff availability at mealtimes, so as to ensure that people were provided with the time and assistance they needed there. We found at this to be satisfactorily achieved at this inspection. Information provided in our annual quality assurance questionnaire completed by the home tells us that they continue with the above and that over eighty five percent of their care staff have acheived at least NVQ level 2 or above. They also told gave us some statistical information that we asked for relating to staffing employed, arrangements for their deployment and staff recruitment and turnover. At this inspection people told us that staff are usually available when they need them and listen and act on what they say. Care Homes for Older People Page 23 of 31 Evidence: At this inspection staff described satisfactory arrangements for their recruitment, induction, training and deployment. Associated records that we examined were reflective of this. The provider advised us that for one carer who was more recently employed, and despite repeated attempts, that they had been unsuccessful in obtaining a reference from their most recent employer. We saw from looking at that persons recruitment file that records held there supported this. However, this meant that only one character reference was provided for that person and which was not at all work related. We discussed with the provider, the need to always ensure the provision of two suitable references for any prospective employee, so as to assist in determining their fitness to work at the care home. The provider advised they would pursue this matter further with the employee without delay. During discussions, staff were committed and enthusiastic about their role and demonstrated a genuine interest in caring for older people. They demonstrated a good understanding of the homes philosophy and its aims and objectives, including person centred thinking in respect of peoples care and support needs. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in peoples best interests and their health, safety and welfare is overall effectively promoted and protected. Evidence: At our last key inspection here we found the home to be well managed and run and peoples health, safety and welfare promoted and protected. In our annual quality assurance questionnaire that we asked the home to completed, they told us they continue to provide a family run home, that is well managed and run to create a happy and relaxed atmosphere. They also described effectively ways in which they provide staff with formal support to assist them in performing their roles responsibilities. They told us that they intend to keep pace with government initiatives concerned with standards in their service and to develop their quality assurance systems further to Care Homes for Older People Page 25 of 31 Evidence: assist in this, in consultation with people who use the service or who have an interest there. And to continue to develop their information technology systems to support their care planning and record keeping systems. They also gave us some additional information that we asked for concerned with the management of the home, including its policy and procedures and arrangements for the servicing and maintenance of systems and equipment there, which are satisfactory. We saw areas of policy development, including in respect of the Mental Capacity Act 2005, which are referred to under the Choice of Home, Healthcare and Complaints and Protection section of this report. And also in respect of infection control, which is also referred to under the Environment section of this report. At this inspection, the acting manager had submitted her application for manager registration with the Commission, which has since been approved. She has worked at the home as a registered nurse for a number of years, more recently moving into the acting manager role. Prior to this the responsibile individual for the company was also in day to day charge of the running of the home as the registered manager. We saw that the home continues to operate an internal quality monitoring system that has been in place for some years and which informs the homes annual development plan. We discussed the need to continue to develop quality monitoring systems, to include the provision of monthly reports, to record the findings from the providers visits there. So as to account for the ongoing conduct of the home and the standards of care there to the registered manager, other directors and the Commission. Staff described effective arrangements for their support and supervision and also to ensure safe working practises, including by way of training and provision of equipment. They were conversant with their role and responsibilities concerned with the reporting and recording of accidents and untoward incidents and we saw that there is an suitable system in place for this. We also looked at the arrangements for the management and handling of peoples monies and saw that these adhere with recognised best practise. During the course of our visit we observed the home to be mostly free from any observable hazards to peoples safety. Although we have referred to two areas of potential hazard, which are also referred to under the Environment section of this report, relating to the type of door lock used in one service users bedroom and also the storage of an oxygen cylinder there. Care Homes for Older People Page 26 of 31 Evidence: Care Homes for Older People Page 27 of 31 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 28 of 31 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 19 23 Consultation must take place 31/07/2009 with the local fire authority with regard to the internal door chain lock that is currently fitted to a service users bedroom door. So as to ensure adequate means of escape and evacuation in the event of a fire. 2 19 13 A recorded risk assessment 31/08/2009 must be undertaken for the internal door chain type lock fitted to an identified service users bedroom door and action taken as necessary . So as to ensure that any unnecessary risk that may arise as a result of this, to the health or safety of the service user accommodated there is identified and eliminated. 3 33 26 Where the registered provider is an organisaiton, the responsible individual 31/08/2009 Care Homes for Older People Page 29 of 31 must visit the home at monthly intervals unannounced and undertake that specified under paragraphs 4 and 5 of this regulation, including provision of a written report. So as to form an opinion of the standard of care provided at the home, its conduct and to account for these to the other directors, the registered manager and the Care Quality Commission. 4 38 13 The safe storage of oxygen 31/07/2009 cylinders must be ensured in accordance with recognised guidance such as that made from the Royal Pharmacists Society of Great Britain. So as to eliminate as far as possible any unnecessary risks to the health or safety of any service user that may arise from its incorrect storage. 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 30 of 31 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. 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