Care Home: Downs View Care Centre

What the care home does well Information made available about the home and the pre-admission assessment process ensures that placement is only offered to those people whose needs can be met. People who live in this home will know what to expect when they come to live here. Peoples health and personal care needs will be met and they will be cared for with respect for their dignity and individuality. Medications are well managed. People are able to spend their time as they wish and have the opportunity to participate in a range of different activities. They are able to maintain contact with family and friends and are provided with a well balanced and nutritious diet. The people who live in the home and relatives can be assured that any concerns or complaints they have will be addressed appropriately. The staff will ensure that people are safeguarded from harm, and know what to do if any concerns are raised. Down`s View is a comfortable, safe, clean and well maintained home. It is currently undergoing a programme of refurbishment to improve the environment further. People are cared for by staff who are skilled and competent to do their jobs, they can be assured that their needs will be met. Recruitment procedures ensure that the right staff are employed to work in the home. Down`s View Care Centre is a well managed home, where clear and effective leadership means that it is run in the best interests of the people who live there. The welfare of each person is paramount is all decision making. What has improved since the last inspection? Although this service was inspected in October 2008, a report of the visit was not published. We are aware though that significant improvements have been made in the management of medications and with the fabric of the home. What the care home could do better: It has only been necessary to issue one requirement and this is in respect of safe systems of work for each person being devised following a manual handling risk assessment being undertaken. This is so that staff have clear instructions on what actions and equipment is necessary when they have to move or transfer a person from one place to another. Key inspection report Care homes for older people Name: Address: Downs View Care Centre Badbury Chiseldon Swindon Wiltshire SN4 0EU     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: Vanessa Carter     Date: 1 1 0 5 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 26 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 26 Information about the care home Name of care home: Address: Downs View Care Centre Badbury Chiseldon Swindon Wiltshire SN4 0EU 08453455795 01793741499 coatewatercare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Coate Water Care Company Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 51 The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category (Code OP) Dementia (Code DE) Mental Disorder (Code MD) Date of last inspection 51 10 0 Over 65 0 0 51 Care Homes for Older People Page 4 of 26 Brief description of the care home Downs View Care Centre has been run by the Coate Water Care Co. Ltd since April 2008. They have other care services in and around the Swindon area. The service has recently had a variation in the conditions of their registration and now only provide personal care for 51 people of either gender, in the OP (older person) or DE (dementia) category groups. Downs View is a purpose built care home situated in the rural village of Badbury, outside of Swindon. Care Homes for Older People Page 5 of 26 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: This report has been written following an unannounced visit to the service. A total of six hours was spent in the home. During the site visit, we spent time speaking to people who live in the home, staff who were on duty, the home manager and visitors who were visiting their relatives. Because it was difficult to engage with some of the people who live in the home, we spent time observing them and watching the interaction between the staff and the people who live there. We also looked around the home and looked at records kept about the people who live there, staff and home records. We were told that at the time of this inspection, the fees ranged from 359 to 600 pounds per week and depended upon assessed care needs. There are a number of items where additional charges may be made, and these are referred to in the homes brochure. Care Homes for Older People Page 6 of 26 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 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 7 of 26 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 8 of 26 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. Information made available about the home and the pre-admission assessment process ensures that placement is only offered to those people whose needs can be met. People who live in this home will know what to expect when they come to live here. Evidence: The homes Statement of Purpose and Service Users Guide were looked at, both documents are up to date and contain all the necessary information to enable any prospective person and their representative, to make an informed choice about moving to Downs View. People who live in the home and visitors who were spoken to during the course of the inspection said that they had been given information about the home that helped them make a decision to move to Downs View. Upon admission each person is provided with a Residents Contract. This includes the fees payable, the room number that will be occupied and the terms and condition of Care Homes for Older People Page 9 of 26 Evidence: the stay. When people are part funded by a local authority a separate schedule of payments is set up between the home and the council. Prior to any person coming to live at Downs View a pre-admission assessment is undertaken. This ensures that placement is not offered to any person whose needs could not be met. The assessment document called the Daily Living Assessment is comprehensive and covers the full range of personal care, mobility, behavioural traits, social and personal safety needs. Any specific cultural or religious needs would be identified to ensure that the appropriate care can be provided. We saw the preadmission assessment for one person and could see that this had been carried out some time before admission and had happened elsewhere. We saw that supporting documentation from social care and healthcare colleagues, and family members, had been gathered in order to gain as much information about the person. We saw that a new assessment of needs had been undertaken for a person who had lived at the home for some time. This ensures that any new needs will have been identified and incorporated into their plan of care. People where possible, and/or their relatives, are invited to visit Downs View and have a look around so that they can see what the home has to offer. One person commented during the inspection My family visited and made the decision for me to move here. They made a very good choice. Care Homes for Older People Page 10 of 26 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. Peoples health and personal care needs will be met and they will be cared for with respect for their dignity and individuality. Medications are well managed. Evidence: Three peoples care files were looked at in order to determine the processes that the home follows to arrange the care and support for each person. The plans were each person-centred and had been written in conjunction with the person and/or their family. We saw that in some instances the family had agreed the content of the care plans, this being where the person themselves lacked the capacity to understand the process. The plans include the persons preferred choices, information about their family life and any other specific care and support needs. A challenging behaviour checklist is completed so that any specific behavioural traits can be identified, and management strategies be devised. Due to the mental health needs of people who live in Downs View, a mental health act (MCA) assessment is completed, and those areas where a person cannot make decisions are highlighted. This information is incorporated into the care planning Care Homes for Older People Page 11 of 26 Evidence: process and ensures that the care staff know when to make best interests decisions on behalf of the person they are looking after. Identified care and support needs will be detailed in the plan of care drawn up, and will contain detailed instructions for the staff so that they know how these needs should be met. Where behaviours are known that could affect the safety of other people who live in the home, or the staff team, specific ways of dealing with, and approaching the person are recorded. This ensures a consistent approach to managing any situation. Discussion with the manager regarding one specific example demonstrated that their approach had led to a significant reduction in the behaviour. The plans are reviewed on a monthly basis and amended where necessary. The plans are supported by a number of risk assessments in respect of the likelihood of falls, moving and handling tasks, nutrition, pressure sores and other individually determined risk factors. Further to the moving and handling risk assessment, a safe system of work plan should be devised so that staff have clear and easily accessible instructions on how to support people with specific tasks. A requirement has been issued under standard 38 in respect of this. Daily records are kept for each person and the sample seen were detailed and informative and evidenced the care provided. We saw that people were able to choose what support they received, for example wanted to stay in bed all morning and got up after lunch and asked to have a bath today. One visitor said that their relative was very well looked after and that their hair was always nicely brushed. Another visitor said they visited often and staff always kept them informed of any changes or told them about things that had happened. The medication procedures were discussed with the manager and one of the senior care staff. In October 2008 a visit to the home was made by our Pharmacy Inspector and a number of areas of concern were found in respect of medication training, the records kept in respect of medication administration, stock control arrangments, people being able to choose how their medications are given, dates not recorded when some containers are opened, safe storage of controlled medicines, and the lack of a current Coate WaterCare Ltd medication policy. It is pleasing to note that all of the issues had been addressed. A new written medication policy and procedure is in place so that staff are clear about all the arrangments for the management of medication in the home. A Homely remedy policy and PRN protocols (for those medicines administered as and when needed) have been drawn up. Those staff who are responsible for adminsitering medications have completed further training and ongoing competence is assessed by the home manager. We were told that some staff Care Homes for Older People Page 12 of 26 Evidence: will be starting additional medication training at Swindon College at the end of May. Examination of a sample of medication administration records (MAR charts) found them to be completed correctly and where medicines were omitted, a reason for this had been recorded. When handwritten entries are made on the MAR charts, in general they were checked and signed by a second person as being correct - one person had been admitted to the home the day before but the handwritten MAR chart was not double signed. This was rectified immediately and the medications were checked again. A photograph of each person was kept with the MAR chart. We were told that medications are supplied mainly in monitored dosage boxes and that the ordering of medications is designated to two specific staff members (one on each unit). The controlled medicines were checked and all in order, and there was only a minimal level of stock. We saw the procedures in place for the disposal of unwanted medications and they are in line with good practice. The arrangements that the home now have in place in respect of medicines management mean that the people who live in the home are protected from any unnecessary risks with medication. People who were spoken with during the course of the inspection said that they were well cared for and that the staff were respectful and kind. One relative said the staff are always calm even though my relative can be very difficult at times. We saw that personal care was provided in private and that staff were always polite and courteous in their interactions with the people they were looking after. Care Homes for Older People Page 13 of 26 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. People are able to spend their time as they wish and have the opportunity to participate in a range of different activities. They are able to maintain contact with family and friends and are provided with a well balanced and nutritious diet. Evidence: Downs View have two dedicated activities organisers, each one responsible for one of the units. Between them they arrange activities on a unit basis, a group basis and an individual 1:1 basis. A plan of the months activities is displayed on noticeboards in several places throughout the home, and for the month of May included a balloon exercise game, collage making, a pampering session, room visits to those who benefit better from 1:1 interaction, board games and quizzes, music and sing alongs. Whilst walking around the home we noticed that a group of people were playing indoor netball. One of the activies organisers told us that they are planning a garden party for the summer, that they hope to introduce some mens activities, gardening in the courtyard, and arrange trips out to the local Coate Park for one or two people at a time. The actvities staff like to find out as much as possible about peoples previous life so that they plan actvities accordingly - My Life before You Knew Me. One person told us that they liked to spend their time sitting in a sheltered spot in the courtyard having a smoke, whilst another said they enjoyed knitting and chatting to the other Care Homes for Older People Page 14 of 26 Evidence: people. People are able to choose whether they remain in their own room, or spend their day in the communal rooms. In order to protect peoples belongings from other people entering their bedrooms and removing them, some of the bedrooms are kept locked during the day. This will always be agreed with the person involved and/or their family representative. There are open visiting arrangements to the home and people can go out with their family at any time. Visitors told us that they are always welcomed and provided with refreshments. Despite peoples varying degrees of mental ability, they will still be encouraged to make decisions about aspects of their daily life, however staff will make best interest decisions where necessary. We discussed mealtime arrangements with the manager and were told that people are asked what they would like to eat for the next meal but can then make a visual choice when the meal is being served. This may mean a change of mind but the kitchen always ensures it caters for this. Special diets including vegetarian will be catered for and where culturally specific dietary needs are required, these will be met.There is a choice of two meals at dinner time and teatime and although every effort is made to meet individual peoples preferences, an a la carte menu is not provided. This is clearly stated in information made available about the home. We spoke to people after they had had their lunch and they all said that the food was good and varied. Care Homes for Older People Page 15 of 26 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. The people who live in the home and relatives can be assured that any concerns or complaints they have will be addressed appropriately. The staff will ensure that people are safeguarded from harm, and know what to do if any concerns are raised. Evidence: The homes complaints procedure is contained within the Statement of Purpose and the information provided to each person, or their relative, upon admission to the home. A copy of the complaints procedure is displayed in the main reception area. The complaints procedure also includes details of the Care Quality Commission, so that if people are dissatisfied with how their complaint has been handled, they are able to let us know. We have not received any complaints about this service. The manager has dealt with one formal complaint, and records are kept evidencing how this was dealt with and what actions were taken a a result of the complaint. It was difficult to determine whether people who live in the home feel okay about raising complaints, because of their dementia, but we saw them interacting with the staff and being listened to. Relatives who we spoke with said the home manager and staff team were very approachable and always ready to listen. Staff who were spoken with during the course of the inspection demonstrated awareness of protection of vulnerable people (POVA) or safeguarding issues and stated what they would do if something unacceptable were observed or they were told something had happened. Junior staff would always report concerns to the person in Care Homes for Older People Page 16 of 26 Evidence: charge or the home manager. A copy of the Wiltshire Safeguarding Adults Procedure and No Secrets Guidance are available. The manager is fully aware of who the Safeguarding Adults Co-ordinator is for Wiltshire Council and is currently in the process of arranging further POVA training for the staff team. People who live at Downs View can be assured that the staff team will ensure they are protected from coming to any harm. Care Homes for Older People Page 17 of 26 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. Downs View is a comfortable, safe, clean and well maintained home. It is currently undergoing a programme of refurbishment to improve the environment further. Evidence: Downs View Care Centre is located in the village of Badbury, near to Swindon and close to junction 15 of the M4 motorway. It is a purpose built two storey building with lift access to the upper floor. The majority of living accommodation is on the ground floor with only 13 bedrooms on the upper floor. The building is arranged around a central contained courtyard, providing outdoor space for people that is safe and accessible. To the front of the home there is short term car parking and there is another car park to the side of the home. The home is surrounded by established shrubbery and a small lawned area. There are plans to make greater use of the paved courtyard by making raised flower beds, growing vegetables and having shaded areas to sit outside. Some parts of the home are currently in the process of being refurbished and redecorated. New larger laundry facilities are being created. The home is run as two units (Marlborough and Mountbatten) and each has a lounge room and a dining area. The furniture and soft furnishings are matching and tasteful and provide a pleasant place to sit and relax in. Corridors around the home are fitted with handrails. The corridor leading from the front door to the lounge area in Mountbatten is gently sloping downwards. Care Homes for Older People Page 18 of 26 Evidence: There are five communal bathrooms fitted with assisted baths plus ten of the bedrooms en-suite facilities, have either a level access shower or bath. There are a number of separate toilets located throughout the home and these are easily identifiable. There are 45 single bedrooms and three shared rooms. All but two rooms have ensuite facilities of at least a toilet and wash handbasin. Two of the bedrooms were currently being refurbished with new en-suite facilties. Most of the rooms were seen during the inspection and each was well furnished and pleasant smelling. The whole home was well lit, maintained at a comfortable temperature, clean tidy and fresh smelling. Care Homes for Older People Page 19 of 26 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 are cared for by staff who are skilled and competent to do their jobs, they can be assured that their needs will be met. Recruitment procedures ensure that the right staff are employed to work in the home. Evidence: The staff team consists of the home manager, two units leaders, senior carers and care assistants. The home currently has a few vacancies, however staffing levels are based upon the collective dependency levels of each person who is in residence. We were told that there is a general rolling duty rota, that at night there are four staff on duty, two senior carers and two care assistants. During the day there are four care staff plus the unit leader or a senior carer. The actvities staff are in addition to these levels. We were told that there is no agency use and the staff team pick up any extra shifts. This means that people will be looked after by staff who are familiar with their care and support needs, and they will receive consistent support. Discussions with care staff verified this information. The manager explained that she is currently reviewing twilight staffing levels. In addition to care staff, there are a team of administrative, housekeeping and laundry, maintenance and catering staff to meet peoples daily living needs. All but the most recently recruited staff have achieved, or are working towards, a National Vocational Qualification (NVQ) in Care at level 2. Some staff are also doing an Care Homes for Older People Page 20 of 26 Evidence: NVQ Level 3. There is a real committment by this service to provide well trained staff and the majority of staff have completed a Certificate in Dementia Awareness. Staff spoken with during the inspection were very positive about this training and said that it helped them have a greater understanding about dementia and how to care for the person. Other training that is currently being provided is infection control, medication administration, emergency first aid and sensory deprivation awareness. New staff will complete an induction training programme at the start of their employment, and one staff member said that they had been given a mentor and their training had included fire safety and moving and handling training. The manager and senior staff have recently attended Mental Capacity Act and Deprivation of Liberty Safeguards training. The home has recruited new staff and we looked at the procedures the home follows to select staff. Prospective employees are expected to complete an application form and attend for an interview. Two written references, CRB and POVA1st clearance is obtained for all new recruits. The records that we looked at verified these arrangements and will ensure that the right staff are employed at the home and the people who live there will be cared for by staff who will safeguard and protect them. Care Homes for Older People Page 21 of 26 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. Downs View Care Centre is a well managed home, where clear and effective leadership means that it is run in the best interests of the people who live there. The welfare of each person is paramount is all decision making. Evidence: Since the home was registered with the new owners in April 2008, there has been a change in the home manager. The current manager has just made application to the Care Quality Commission for registration. She has 11 years experience in care, working in both the NHS and the private care sector. She has already completed the Registered Managers Award and an NVQ Level 4 in Management. She has previously been the registered manager at another care service and has demonstrated her fitness for the post during this inspection process. People who live in the home, visitors and staff who were spoken with during the inspection were very complimentary about the management style and felt included in all decisions being made. We were told that the manager is very visible and always Care Homes for Older People Page 22 of 26 Evidence: around to talk to. One visitor said You can see her any time, her door is always open. Resident and Relative meetings are held on a regular basis as are staff meetings. Customer Surveys are completed twice a year and the results of the last survey were very positive with excellent scores for domestic standards, care and food sections. Comments included homely atmosphere, always very clean and pleasingly fragrant, staff are very kind and I couldnt wish for a better care home for my relative. A number of other audits are completed to ensure that the service remains on track. Any falls, accidents or incidents are monitored in order to identify trends so that actions can be taken to reduce the likelihood of events happening again. Care plan and risk assessment reviews will ensure that the care and support people receive is as they need. The home holds personal monies for those people who require the service. Good administrative procedures and record keeping evidenced that peoples money is safe. A random sample of four accounts were checked against the funds held and each was correct. We looked at records relating to the servicing of equipment used in the home, maintenance records in respect of fire safety equipment, electrical appliances, hot and cold water temperatures and clinical waste disposal arrangements. All were in order but legionella testing of the cold water storage tank has been over looked. Arrangements for this to be done were made during the course of the inspection. The fire risk assessment was completed in February 2008 and is now due to be reviewed. A review of the fire log evidenced that all weekly, monthly and quarterly tests were up to date. It showed that fire training for new staff is given when they start working at the home and that fire drills are undertaken regularly. Staff confirmed that they have recent fire safety training. The Environmental Health Officer last visited the home in January 2009 and awarded the kitchens a four star rating for food hygiene measures. No Health and Safety concerns were raised as a result of this inspection, however there must be a safe system of work devised for each person where staff are required to assist in the moving or transfer of people. This would ensure that the staff always follow safe procedures and do not injure the person they are assisting or themselves. We were advised by the home manager, in response to the draft report, that a safe sytem of work has now been devised for each person in reponse to the requirement made. Care Homes for Older People Page 23 of 26 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 24 of 26 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 38 13 The registered person must ensure that following a manual handling risk assessment, a safe system of work is devised, with clear instructions for staff to follow. This is so that people are always moved safely and they will not be harmed 11/06/2009 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 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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