Care Home: Dulas Court

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What the care home does well The home provides a warm, friendly and welcoming environment for people to live in. There is written information available to help people decide if they wish to move into the home. They are also encouraged to visit Dulas Court before making their decision. The manager and the staff understand the importance of supporting the chosen lifestyles of the people who live there and support their privacy, dignity, autonomy and choice. There is a care manager who has responsibility to oversee and review people`s care arrangements. Each person has a plan of care that is kept up to date and provides information for the care staff about how to meet their needs. Their health and personal care needs are well met. We received many positive comments about people`s experience of living in the home including, "Care and atmosphere is all I could want." "I am very happy and contented at Dulas Court." "It is a magical place." There are a range of activities that people can choose to join in and residents are involved in helping to choose what they are. People also have access to the local community and there are trips out. Relatives are made welcome to the home and one told us that, "management seem to encourage contact between residents and relatives." The home has a Christian base and emphasis is placed on people`s spiritual needs whatever their religious beliefs. The home provides a varied range of nutritious home cooked food. Relatives and friends are welcome to join in mealtimes if this suits their visiting arrangements. There is a clear complaints procedure that is made available to all residents and their relatives. People are encouraged to talk with the staff or a member of the management team if they have any concerns or preferences. Dulas Court is well maintained and clean. There is a programme of upgrading and redecoration. Staff know how to prevent the spread of infection. The staff are kind and respectful to the residents who speak very highly of the way in which the staff care for them. They are well trained and available in sufficient numbers to meet the needs of the people who live there. The management team are readily available in the home to residents, relatives, staff and visiting professionals. They ensure that the home is run in a way that means the health and safety of the residents is protected. What has improved since the last inspection? The home has introduced a new system of assessing people`s needs before they are admitted to the home so they understand better the needs that people will have and whether they can meet them. This leads to a new system of care planning and greater care in ensuring that people`s needs are reviewed on a regular basis. The home has achieved a five star rating of excellent for their food hygiene from the local Environmental Health Department.The home has ensured that staff have had refresher training in how to protect vulnerable people from abuse or neglect. The home has continued a programme of redecoration and upgrading that has included replacement of some carpets, introduction of free standing lights to help some residents with poor eyesight, improved systems in the laundry and increase of the seating in the gardens and provision of a pergola for shade. The home has improved the induction training provided for staff so they can be sure that they know how to provide the right care from the beginning of their employment. What the care home could do better: This home is providing an excellent service that ensures good outcomes for the people who live there. They have met the outstanding requirements from the last report and shown through their AQAA that not only are they able to assess the strengths and weaknesses of the service they provide but that they seek to continue improving. They should develop the supervision and appraisal for staff so that it is carried out on a more formal basis and helps the staff with their professional development. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dulas Court Dulas Court Dulas Ewyas Harold Herefordshire HR2 0HL     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: Philippa Jarvis     Date: 1 3 0 3 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 27 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 27 Information about the care home Name of care home: Address: Dulas Court Dulas Court Dulas Ewyas Harold Herefordshire HR2 0HL 01981240214 01981240220 dulas.court@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Kathleen Barbara Keene,Mr Phillip Raymond Keene care home 25 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: Age: Physical disability - Code PD age 55 and above. The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 25 Physical disability (PD) 25 Date of last inspection 0 25 Over 65 25 0 Care Homes for Older People Page 4 of 27 Brief description of the care home The Providers and Manager are registered in respect of Dulas Court to provide personal care to twenty-five older people whose needs arise from the ageing process or through physical disability. The Statement of Purpose produced by the Proprietors describes the primary aim thus: The purpose of this home is to provide continuous and holistic care for elderly people in a Christian environment, enabling and supporting them in their increasing frailty. the premises are registered as a residential care home for a maximum of 25 older people whose care needs arise from the ageing process. The Home is located in a lovely rural setting and the house is situated in large grounds several acres of which are accessible to service users with mobility problems. There are 24 bedrooms most of which have ensuite facilities. One bedroom is dedicated to the provision of respite care. People are accommodated in single rooms on two floors. There is a passenger lift to enable people accommodated on the first and second to access their bedrooms more easily and a stair lift on small flights of stairs on the first floor. There are two lounges plus a large entrance hall with seating areas, a dining room, a library and a conservatory. The home provides communal bathrooms and toilet facilities. The current cost of a permanent room is from £500 - £640 per week. Respite care is £500 per week. Care Homes for Older People Page 5 of 27 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: Before we visited the service we looked at the information we had received about the service since the last inspection. This included an Annual Service Assessment(AQAA), an annual service review, notifications of incidents sent to us by the service and surveys sent to us by people using the service, their relatives, staff and health and social care professionals. The AQAA is completed by the service and is their assessment of what they are doing well, what improvements they have made and what they think they could do better. We visited the service for one day. We spent time talking with the people who live there, staff, the manager and the owners of the home. We also looked at some records that must be kept by the home to show that it is being run properly. This included records about the care of people who live in the home. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? The home has introduced a new system of assessing peoples needs before they are admitted to the home so they understand better the needs that people will have and whether they can meet them. This leads to a new system of care planning and greater care in ensuring that peoples needs are reviewed on a regular basis. The home has achieved a five star rating of excellent for their food hygiene from the local Environmental Health Department. Care Homes for Older People Page 7 of 27 The home has ensured that staff have had refresher training in how to protect vulnerable people from abuse or neglect. The home has continued a programme of redecoration and upgrading that has included replacement of some carpets, introduction of free standing lights to help some residents with poor eyesight, improved systems in the laundry and increase of the seating in the gardens and provision of a pergola for shade. The home has improved the induction training provided for staff so they can be sure that they know how to provide the right care from the beginning of their employment. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 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 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is written information available to help people decide if they wish to move into Dulas Court. People are encouraged to visit and to get to know the home to help them make up their minds. Evidence: People are provided with information about the service before they come to live in the home in the form of a service user guide. Several new residents come to know the home through the day care service or from a respite stay before making a decision about permanent residency. In their surveys people told us that they received enough information before they came to live in the home to help them make their decision. In their AQAA the home told us that, A detailed information pack is provided for enquirers/prospective Residents. Information about the Inspectors report is in the Statement of Purpose - people are encouraged to read our hard copy or look it up on CSCI website. (Now the CQC website.) Care Homes for Older People Page 10 of 27 Evidence: We spoke to the relatives of a newly admitted resident and they confirmed that they received good information prior to admission and that their relative was encouraged to visit the home through a respite stay to help them make their decision. The home keeps one room for respite stays. This is available to people who only want a short stay but also for people who want to make a decision about living in the home on a permanent basis. We looked at the records for people who use the service and found that the home carries out a pre admission assessment. This means that the home understands the care needs of people before they are admitted, can be confident that they can meet these needs and that they can let the staff know what care needs to be provided as soon as someone moves into the home. Care Homes for Older People Page 11 of 27 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 are met through the care planning process and their medications are managed safely. Their privacy and dignity are respected within the home. Evidence: We spoke with several residents during our inspection. They all told us that they were very happy living in Dulas Court and that they considered that all their health and social care needs were well met. One person when asked whether she was well looked after said, Yes, Yes, Yes. Another that, Ive lived here for four years and its the happiest Ive ever been. We found that the home pays attention to details around peoples care, for example a member of staff is allocated two one hourly sessions a week to attend to peoples nails and in the office there was a box with spare hearing aid batteries and a book with details about each persons needs in this area. One resident said to us, Its splendid. The girls remember little things which matter. Everyone was beautifully presented. Care Homes for Older People Page 12 of 27 Evidence: We looked at the experience for three people who use the service in detail. This included looking at their records, meeting them and speaking to their relatives if possible. Each of these people had a plan of care that was written within a standex recording system. There was information in each of the relevant asssessment sections and this led to a plan of care that described the actions that the staff needed to take to ensure that peoples health and personal care needs were met. The home carries out a nutritional risk assessment (MUST) on each person coming to live in the home. On one file we reviewed we only found one recording of their weight in the last nine months although we would expect the home would weigh people each month. On another file we saw an assessment for the use of bed rails which is good practice. The agreement of the resident or their relatives was not recorded as we would expect. They also carry out an assessment of the moving and handling needs of people with care needs in this area. The care plans were reviewed on a regular basis. The manager told us that a member of staff is due to pick up responsibility for making sure that they have good information about peoples life histories and also to ensure that they sign to indicate their agreement with their care plan. There was a daily record that was completed twice a day. Whilst the information was useful there were times when more follow up to issues could have been written. There is a handover between shifts and we sat with staff during one of these. We found that the information exchange was very detailed and considered so that incoming staff would know what issues and concerns they would need to take into account. Family members told us that there was good communication with them in the event of need about their relatives health. We spoke with a visiting health care professional who told us that they had full confidence in the home; that referrals were made to them appropriately and that they carried out their instructions to the letter. Some residents are taken to the local GPs surgery although he does attend the home on a weekly basis when he sees those with health problems. Details of outcomes are recorded in the residents file. There is also a physiotherapist who visits the home each week to see individual people and assist them with mobility. She also does a gentle exercise class every other week to assist people with flexibility and mobility. We looked at the records to show how medication is administered to the residents. We found that they were all well kept. There was information in peoples files about the Care Homes for Older People Page 13 of 27 Evidence: medication they were prescribed and the record of administration was fully detailed with no gaps in recording. The home does carry out an assessment about whether people are able to take their own medications. The cupboard for the storage of medication is lockable and kept in an organised way. There is a separate cupboard for the storage of controlled drugs and the record of the administration of these is kept appropriately. A senior member of staff on duty administers the medication. We looked at the information about staff training and found that they had received appropriate medication training. The PCT carries out an audit of medication management in the home on a regular basis, the last time being in September 2008. Care Homes for Older People Page 14 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to maintain independence and choice in their daily lives. This includes activites, relationships and with the local community. There is an emphasis on peoples spiritual needs. There is a varied menu of well cooked nutritious food provided. Evidence: People told us that they can choose how to spend their day within Dulas Court and have full choice over their daily routine. They were able to tell us what they had been doing recently including their involvement in the activities provided. The previous day one person had celebrated their birthday; their family had been able to join them for lunch and there had been a concert in the afternoon to suit that persons likes. Guests are able to join residents for meals in the dining room or privately in the library. There is a planning team for social activities consisting of a group of residents and staff. They meet each month to decide on a programme of activities. Each person living in the home is provided with a copy of this and can decide whether to take part in these. In their AQAA the home said that there is a A wide variety of entertainment which includes live music, film shows and outings. In the surveys residents told us that there were always/usually activities arranged by the home. One person whilst saying there were always activities commented that I dont take part because its not my Care Homes for Older People Page 15 of 27 Evidence: scene. The home integrates with the local community where possible. There are two cars available for resident transport. Residents also enjoy spending time in the extensive gardens which are well maintained. There are numerous level paths on which they can walk or be taken in a wheelchair. The home is clear in the Service User Guide about the Christian basis for the home and that they seek to provide an environment that offers the individual opportunity to discover spiritual peace and fulfilment. In the AQAA they say Daily prayers are available for residents at 12 noon...Communion is brought by the available local minister each month on a Tuesday at 12 noon. The home is supported by ministers from the Church of England, Baptist, Methodist and Catholic churches. Residents are supported in their choice and will often receive visits privately in their rooms. They are also encouraged to attend local churches if they are able. Whilst the spiritual basis of the home is made clear residents can choose whether to join in religious based activities. The Service User Guide is very clear about the arrangements for visiting. People living in the home confirmed that their visitors are always made very welcome. One visitor to the home told us that they had been provided with Sunday lunch when they visited and this had helped to make visiting easier from a distance. They also told us that the meal was very good. We joined the residents at lunch in the dining room although they can choose to eat in their rooms if they wish and some do so. The environment is spacious and pleasant and the meal was well presented and tasty. A menu was displayed by the dining room. We spoke with the cook who told us that she ensures a variety of meals is provided. We were shown the minutes of a recent meeting with a group of residents in which the focus was on the food provided and what changes they would like to see. A nutritional assessment (MUST) is carried out when new residents move into the home so they understand any dietary needs that resident may have. Care is taken to ensure that the cook is informed about peoples needs for a special diet and she has taken training in the nutritional needs of older people. Drinks are provided at regular intervals throughout the day. The home has been awarded an excellent 5 star rating from the local Environmental Health Department for their food hygiene. Care Homes for Older People Page 16 of 27 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. Practices and procedures are in place to safeguard people who use the service from the risk of harm or abuse. Evidence: The home has a complaints procedure and a copy has been provided for everyone who lives in the home. Residents and their relatives told us about the open atmosphere in the home where they could talk to staff or members of the management team at any time. They also said they knew how to make a complaint in the event of need. The home has not received any complaints in the last year. The home has a copy of the local multi agency safeguarding policy and procedures. No referrals have been made by the home in the last year to the safeguarding procedures. The service provider makes sure that all staff receive training in this area so they understand the indicators of abuse and negelect and how to ensure that people are protected. People who llive in the home told us that they feel safe living there. In their AQAA the home told us that they make sure that new residents and their families know about the Mental Capacity Act and lasting power of attourney. The home has also had contact with the local citizen advocacy scheme, a member of which attended a residents meeting. Care Homes for Older People Page 17 of 27 Evidence: We looked at the files for three members of staff and the checks that must be carried out to ensure that they do not employ people who are unsuitable to work with vulnerable residents were all carried out. Care Homes for Older People Page 18 of 27 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. Dulas Court provides a safe and comfortable home for the people who live there. It is kept clean and tidy and there is an ongoing programme of upgrading and redecoration. Evidence: Dulas Court is set in large well maintained grounds and there are good views over the beautiful surrounding countryside. The grounds are accessible to wheechair users. During our visit we looked round some areas of the home. We found that it was all very well presented and maintained. There is a range of communal areas where people can sit and relax, watch television or take part in activites. The seating is arranged in groups to give a homely and relaxing feel. Most people chose to stay in their rooms except for mealtimes when they came to the dining room.There are 24 bedrooms most of which are en suite. Rooms are not shared unless by specific request. On the day of our visit one resident moved to another room. She had spent part of the previous day sitting in there so she could be sure she would like it and deciding how she wanted her many personal items arranged. This had been done by the afternoon we were there, and she was delighted with the assistance she had been given. All the residents rooms we saw were well equipped, presented and personalised. The home takes into account peoples individual preferences and has fitted a satellite dish for two residents who requested Care Homes for Older People Page 19 of 27 Evidence: this facility. There is an ongoing programme of redecoration and refurbishment. The home employs a maintenance man and a part time gardener. All areas of the home were clean with no unpleasant odours. There were four cleaners on duty the day of our visit. They told us they have time to maintain good standards of cleanliness throughout this large home and that they have all the equipment they need for the task. Residents also confirmed their satisafction with the cleanliness in their surveys. One said Cleanliness everywhere is excellent. We observed that the bathrooms and toilets had equipment to help with infection control. In their AQAA the home told us that ten staff have completed training in infection control. Care Homes for Older People Page 20 of 27 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. There are sufficient staff to meet the needs of the people who use the service and they can be confident that they are kind and caring. Staff receive good training to help them understand how to meet the needs of people living in the home. Evidence: We observed contacts between the staff and residents. They were all kind and appropriate. The staff were well motivated and committed to provide people living in the home with a good service. People we spoke with were very complimentary about the staff. They told us how kind and caring they are. One visitor to the home told us, The staff are very kind. We simply could not wish for better. In their surveys professionals expressed a high level of confidence in staff ability and attitude. People also told us that there were staff available to assist them when they needed help. We were provided with a staff rota for the week of the inspection. This showed that there were suitable levels of staff on duty in all capacities for the dependency levels of the current resident group. Staff told us that they enjoyed working in Dulas Court and this is reflected in the high levels of staff retention. The homes recruitment procedures are appropriate. Following recruitment staff Care Homes for Older People Page 21 of 27 Evidence: undergo a period of induction training. This is structured to meet the required standards. We looked in detail at the records of the newest member of care staff who started work in January 2009. We were told that she had started her induction but there was no information regarding this on her staff file. A certificate of completion was available on a second staff file of someone who had been employed longer. During this induction period staff take mandatory training so they know how to carry out manual handling, infection control, safeguard people and deal with fire safety. All staff take training in first aid and four people have done a First Aid at Work qualification. The home supports staff to take National Vocational Qualifications. Currently there are 14 staff with level 2 or 3. More staff are taking level 2 and some who have this are progressing to level 3. Care Homes for Older People Page 22 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Dulas Court benefit from having a management team who are committed to meeting their care needs. They manage the service in a way that promotes their health and well being. Evidence: There is a strong management team at Dulas Court comprising the manager and the two service providers who work in the home most days. The service has been recognised as providing a consistently Good service. They understand where improvements could be made and work towards meeting these. In their AQAA they told us about improvements they had made in the last twelve months and their plans for further improvement. They have met the requirements made following the last inspection. During our visit we spent time with the manager and the owners of the business. They all showed a good understanding of the needs of each individual resident in the home. In one survey the resident said Very good leadership - fantastic service from Mrs Care Homes for Older People Page 23 of 27 Evidence: Blake. The manager is supported by an administrative assistant and the office and record keeping was well organised. In the AQAA the home told us that they encourage residents to manage their own finances. Because they do not admit people with dementia related illnesses, they generally have the capacity to do so or to make arrangements for this to be managed on their behalf. The staff feel well supported by the management of the team. One said that it was The best home I have ever worked in. The home has a system for supervision and appraisal of staff. However we found that the evidence in staff files of this occuring regularly on a formal basis was limited. We saw no evidence of supervision in one file and for the new member of staff the manager said she did not carry out the first supervision until they had been employed for three months. The manager said that she did not carry out supervision with the staff unless there was a problem. She knew their work well because she worked shifts with them and therefore had a good understanding of their strengths and weaknesses. Shortfalls in this process were acknowledged in the AQAA. In the AQAA the home confirmed that equipment in the home is regularly serviced and the home employs a maintenance man to carry out minor repairs. They have also reviewed all their policies and procedures. The home uses an external consultancy to advise them on health and safety related matters. In their AQAA they reported that there are several improvements they have made over the last twelve months in this area e.g. upgrade of fire panel and fire doors, created a fire safety plan for evacuation of individuals in the event of fire and review of recording of water temperatures. Care Homes for Older People Page 24 of 27 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 25 of 27 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 36 The home should have a system in place to ensure that staff receive supervision and appraisal on a regular basis. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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