Care Home: Elizabeth Fleming Nursing Home

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What the care home does well The home has a friendly atmosphere and the staff who work there are open and welcoming. The people who live their and their relatives or visitors feel comfortable supported and are put at ease. People who move to the home have their needs assessed by social or healthcare workers and the acting manager so that everyone is sure that this is the right place for them to live. This is very important as people often have complicated needs that require well managed and agreed ways of supporting them. Nursing and personal care is provided to people with a wide range of needs with varied expectations and backgrounds. This diversity is reflected in the staff team, giving the manager the opportunity to recruit staff from the same background as the people living in the home. This match helps staff to understand peoples needs and people who use the service are more reassured that they get support from staff who understand them. Both care practice and staff recruitment practices are governed by equal opportunity principles. There are always fully trained nurses available to meet peoples nursing care needs. People also have good support to get visiting health care services if they need it. As well as this there are enough well trained care staff employed at the home to make sure that peoples needs can be properly met and the way that staff are recruited makes sure that they are suitable for working with vulnerable people. There is an activities coordinator who helps people join in games and activities and go out from time to time, if they are able. In addition to this visiting entertainers provide musical shows for the residents. The home is warm, clean and safe and the bedrooms are nicely decorated. Staff has good training in care and many staff have had training in caring for people with dementia needs. The home is well run by a newly appointed but experienced and qualified manager. The provider makes checks to make sure it is run in the right way. Staff has had training in health and safety, and the home is well maintained to make sure it is safe for the people who live here. What has improved since the last inspection? The care records are now clearer and further improvements to make them more person centred are being planned. There is now a co-ordinator who provides better activities for people who live at the home and is developing more appropriate opportunities for people who have dementia type illness. People who live at the home now get the support they need from staff at mealtimes which are now relaxed social events and appear to be enjoyed by most. All staff have had training about how to give assistance to people who have mobility problems including use of equipment. What the care home could do better: The care plans and life history documents should continue to be developed so that they better reflect the person centred approach to personal and nursing care at the home. The acting manager should continue to explore and expand the range of daytime opportunities for people who have dementia type illness. The acting manager should continue with the programme of refurbishment and replacement of areas of the home which have been identified. The acting manager should carry out maintenance of those areas which were brought to her attention as part of this inspection. Key inspection report Care homes for older people Name: Address: Elizabeth Fleming Nursing Home Off Market Street Hetton Le Hole Houghton Le Spring Tyne & Wear DH5 9DY     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: Irene Bowater     Date: 0 6 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Elizabeth Fleming Nursing Home Off Market Street Hetton Le Hole Houghton Le Spring Tyne & Wear DH5 9DY 01915262728 01915266187 elizabethfleming@highfield-care.com www.schealthcare.co.uk Southern Cross Care Homes Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Paul Dawson Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia physical disability Additional conditions: The maximum number of service users who can be accommodated is : 36 The registered person may provide the following category of service only : Care home with nursing - Code N to service users of the following gender - either whose primary care needs on admission to the home are within the following categories: Dementia code DE, maximum number of places 36 Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places 36 Physical disability - Code PD, maximum number of places 9 Date of last inspection 36 36 9 Over 65 0 0 0 Care Homes for Older People Page 4 of 29 Brief description of the care home The Elizabeth Fleming Nursing Home is a 36-place bungalow style home. The home provides personal and nursing care for older and younger people with either dementia type illnesses or mental health needs. Originally the Elizabeth Fleming nursing Home opened in 1994, as a 40-place home for older people with dementia type illness that required nursing care. In February 2002 the registration changed so younger adults could be cared for and during this process five places were de-registered and could not be used. Two 8-place units and one 20-place unit have been created. The home is now registered as one unit, which can provide care for 8 younger adults who have nursing needs and a mental health or dementia-type illness. One unit can provide care for 8 older people with personal care needs and mental health need or dementia-type illness. The 20-place unit can provide nursing care for older people with a mental health need or dementia-type illness. The home is at the top of Market Street, not far from the main part of Hetton-le-Hole. It is opposite the post office and a range of shops. A bus stop is close to the home. The home has developed a Statement of Purpose and Service User Guide that informs people of the aims and objectives of the home. These are readily available in the home. The current fee ranges for this home are from GBP41700 to GBP61400. The nursing care element is extra and is set nationally. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit We looked at: Information we have received since the home was last inspected in July 2008. How the service dealt with any complaints and concerns. What management arrangements are in place. We looked at any changes to how the home is run, for example since the last inspection a new manager has been appointed. The providers view of how well they care for people. We asked them to examine their Care Homes for Older People Page 6 of 29 own service and write to us with the results. The Visit: An unannounced visit was made on 6th May 2010 . During the visit we: Talked with a number of the people who live in the home and also staff who were on duty. Talked to visitors and family members. Held discussions with the acting manager and deputy who were present during our visit. Observed staff working practices. Looked at information about the people who live in the home and how well their needs are met. Looked at other records, which must be kept in relation to health and safety and staffing. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it was well maintained, safe and free of any hazards. Had lunch with the people who live at the home. We also gathered information from looking at care records to assess how staff supports the peoples assessed needs. We also focused upon looking at care files for three people as a part of the inspection. We call this case tracking. And this involves looking at how all the records work for the care of one person. The owner also provided information to us in the Annual Quality Assurance Assessment confirming what improvements have been made in the last 12 months. And also what further improvements are planned over the next year. We told the acting manager what we had found as a result of our work. Although appointed by her employers, the manager at this home has not yet been assessed by the Care Quality Commission (CQC) to see if she has the skills qualities and experience to be the Registered Manager at this home. The report therefore refers to her as the acting manager to recognise that her application is yet to be assessed. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been Care Homes for Older People Page 7 of 29 deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 8 of 29 What the care home does well: What has improved since the last inspection? The care records are now clearer and further improvements to make them more person centred are being planned. There is now a co-ordinator who provides better activities for people who live at the home and is developing more appropriate opportunities for people who have dementia type illness. People who live at the home now get the support they need from staff at mealtimes which are now relaxed social events and appear to be enjoyed by most. Care Homes for Older People Page 9 of 29 All staff have had training about how to give assistance to people who have mobility problems including use of equipment. 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 10 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Trained staff from the home find out and understand the needs of people who wish to live there before they move in. This information helps to make sure that peoples needs can be met at the home and agree the ways in which staff are to support them. Evidence: By looking at the record kept at the home we could see that each persons needs are assessed before they move there, either by health services staff, local authority social workers and the acting manager. This is so that the acting manager has a good understanding of peoples health and social care needs and can be sure that the home is going to be suitable for people who are going to live there. Where possible the person themselves or their representative is involved in the assessment process. The acting manager also finds out what cultural and lifestyle needs people have to make sure that these can be met. The manager and senior nursing staff have also had Care Homes for Older People Page 12 of 29 Evidence: training which has given them the skills to find out what peoples needs are. As a result of these measures, all of the people living at the home at present have been properly placed and the home is able to meet their needs. One relative said, Once we had visited the home we knew it would be the right place for (our relative) and we were able to get the information (about the home) that we needed quickly. The home does not provide intermediate care for people who require specific rehabilitation after an injury or illness. Care Homes for Older People Page 13 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care and health needs are well supported at this home and the way that staff give out medication makes sure that they get the treatment that has been prescribed: And every person has a plan of their care which shows how their nursing and care needs will be met and gives the practice guidance that staff need. Evidence: Every person has an individual plan which records what the home will do to support them which are kept up to date and reviewed on a monthly basis. Better planning arrangements have started to be put in place since the new acting manager and deputy have taken over and although some have more information in them than others, all care plans give a description of the support that people need. Staff at the home know lots about the needs of people who use the service and how they prefer to be supported. Two staff were asked in detail about the ways that they support people and both could describe the needs of the people they care for in a lot of detail. The areas of their care, described by staff, matched the descriptions that were written in each care plan. The acting manager and senior staff from the Care Homes for Older People Page 14 of 29 Evidence: organisation are working with the care team to show how their plans can be expanded so that they better reflect the homes current approach at providing personalised care that people are actually getting at the home. The acting manager confirmed that she is reviewing each residents care plan and how the organisations documents can be best used to describe their co-ordinated approach to care planning. The care records also show that peoples health care needs are assessed and regularly checked. The home has clear assessment records of peoples mobility, nutrition, risk of falling, and risk of skin pressure damaged. These are reviewed every month to check any changes or more regularly should an issue arise. This home provides nursing and personal care and as such, is able to access community health care services such as Doctors, community nursing services, and psychiatry services who are all used to provide specialist interventions as well as ongoing support and advice for nursing and care staff. There were many examples in care plans which showed how the use of specialists is working effectively and there are records available to confirm when a visit has been made from a health professional and the details of their work. People who live at the home and their relatives made positive comments about the approach of staff and they stated they are treated with courtesy and that staff are always polite. Those asked said that staff upheld their privacy, which is promoted by a stable staff team who know the people they care for well. Staff were seen to knock on doors before entering, talk to people in a respectful way and call them by the names or titles they prefer, all of which are good practice. Staff are also trained and monitored to make sure that the homes policies on privacy and confidentiality are maintained. Observations made during the visit confirmed that staff address people by their chosen form of address and a good rapport was evident between staff and residents. All people who were asked made positive comments about the service they received and how staff and the support from the home helped them to remain as independent as possible. The home also helps people to exercise their rights by giving the details of other support available, for example advocacy services. Due to their levels of need, most people who live at the home are not able to organise their own medicines, and appointed staff therefore help in this area. The trained nurses take responsibility for managing medication. Medication is stored securely and Care Homes for Older People Page 15 of 29 Evidence: safely, and records of the administration of medication were up to date although there were two minor mathematical errors which were investigated and resolved by the deputy manager. Fridge temperatures are taken twice daily and the nurses ensure that regular audits of the medicines records are carried out. In discussion with nursing staff they confirmed that their accredited training in the safe administration of medicines had been completed. Staff at the home have good strategies in place which monitor the expressions and responses of people who live at the home to make sure that they are not experiencing pain. For example one persons behaviour changes dramatically when they are experiencing more pain than usual. These techniques carried out by senior staff and are recorded in the care plans. Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are encouraged and supported by the staff to lead fulfilling lives with their rights as individuals being respected, and to eat healthily which supports their physical and emotional wellbeing. Contact with family members and friends are supported where possible so that people keep up links with those outside the home. Evidence: Staff at the home welcome visits from residents friends and families and they are good at encouraging people to talk, be included and feel comfortable. People living at the home and staff talked about the things that they do at the home. There is an activity co-ordinator at the home who helps to think up ideas, plan and support people to take part in meaningful pastimes. For example games sessions, social events, open days and celebrations, bingo, seasonal social events, performers and entertainment. Events are organised so that family members can attend and some people go out from the home with their friends or relatives which helps them to stay in touch. The acting manager is looking at ways to expand the activities of people who have dementia type illness which may prevent them from taking part in group activities. For example some people may have a short attention span due to their dementia type illness and therefore need shorter and more frequent activities. Care Homes for Older People Page 17 of 29 Evidence: The homes gardens have previously been well planned and maintained, however at the time of inspection were looking in need of attention so that they can be used by people at the home. The home are able to access transport that is shared with the other services run by this provider nearby and this enables outside activities and trips to take place. People living at the home have the opportunity to attend religious services and this offers residents some opportunities for continued contact with the local community. People living at the home are encouraged to make choices about their diet. Most said that they like the meals at the home and that they are asked what they would like to eat. Staff were seen asking people about their choice of meal and size of portion to make sure that people got what they wanted. People are verbally asked for their main meal choices and should they change their mind, which is likely considering that some people have dementia care needs. Then they can have the alternative dish that is provided. Comments from some of the people living at the home were, I enjoy the food and they will cook anything I like. And, You can get food when you want it even during the night. Staff are available during meals to offer support and assistance where needed.Several people need assistance at mealtimes, from full physical support to verbal prompts. And care staff did spend time sitting next to each person providing full physical support with their meals. This was carried out in a sensitive manner, at the persons own pace and demonstrated staffs skill and knowledge of individuals needs. The cook has a good knowledge of the meals which people living at the home prefer. She understands the benefit of using fresh ingredients to help people to remain healthy. Menus were available which confirmed that a range of meals are provided which give people a balanced diet and refreshments are available throughout the day and night. Where people need it food supplements are available to help people to maintain their health for example if they have diabetes or have difficulty maintaining their weight. Records are kept which help staff to monitor peoples weight and make sure they remain healthy. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home and their families can make a complaint if they are unhappy, have a grievance or dispute which helps them to have control over their lives and there are measures in place which protect people who live at the home from being harmed which helps to promote their safety and security. Evidence: There is a complaints procedure which tells people what to do if they are not happy. This informs people about who they should make a complaint to, and how much time that a complaint will take to look at. There is a record kept at the home of all complaints, which includes details of any investigation and the outcome. No one has approached the Care Quality Commission (CQC) because they have been unhappy with the way that the home has managed their complaint. A relative said, I dont have any complaints about the care of (my relative) but I know how to complain and would go directly to the manager..... she is approachable and I am confident she would sort it out. Whilst there have been no instances where abuse has taken place, the home has a safeguarding which can be used where necessary to protect people living at the home. Staff have guidance and all have had training about what to do if they see or suspect abuse is taking place and all staff spoken to showed that they knew what to do and what they expected to happen so that people remain protected. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment, which promotes their privacy, independence and comfort during their stay at the home. The home is clean, pleasant and hygienic which supports the health and lifestyles of people living there. Evidence: All communal areas and some of the bedrooms were viewed during the inspection. The home has had recent repairs and there is ongoing maintenance taking place. The home has been designed so that all the people who live there can have safe access to the areas where they live. Everyone is able to lock their bedroom doors so that they can have privacy and there are areas where people can meet and talk in private. There are separate garden areas which are accessible to everyone and popular when the weather is good. Although none of the areas of the home were seen to be below the minimum standard, there were areas that the acting manager has identified that are in need of improvement, either because the fabric and furnishings were older, or were better use could be made of spaces and decor for example to support the lifestyles of people who live there. One area of the home where people who have dementia type illness live has recently Care Homes for Older People Page 20 of 29 Evidence: had adaptations made made to some of the corridors and communal areas which by including familiar items and photographs, has made it more relevant and recognisable for people who have memory problems. The acting manager plans to further extend this work. The bedrooms are pleasant areas, which have a useful range of comfortable furniture and fittings. Most people have decorated their rooms with their items, photographs and keepsakes. There are enough toilet and bathrooms available, all of which have been designed to help people who have mobility needs to use them. The home is kept clean by staff who take effective steps make sure that there are no unpleasant smells. There are laundry facilities are in place to make sure that that peoples clothing and linen is hygienically cleaned and the risks of passing on any infections is reduced. Arrangements are in place to make sure that clean clothing is always returned to their owner and mistakes are avoided. There is a large well equipped kitchen, which has good facilities for the storage of foodstuffs and the production of meals. The home is inspected by the Fire and Rescue Service and the Health and Safety Executive (HSE) to make sure that the building and safety systems are suitable for the protection of those who live and work there. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff working at the home to meet the needs of the number of people who presently live there and most staff have been trained to make sure that their care practice is good. Evidence: The acting manager, deputy and senior staff have organised the home so that overall there are sufficient staff available to meet the needs of the people who currently live there. Nursing and care staff support each other and their manager and have established themselves as an effective team in a short period of time. Staff show that they know a great deal about the needs of the people who live at the home and can describe these in detail; they get on well together and with people who live at the home and promote an inclusive and supportive structure there. Staff work in teams and they have structured ways of working so that people get consistent support across all three areas of the home. One person living at the home said, I trust the staff here, they are reliable. Another said, The staff are what has kept the home running even when the bosses (manager) has changed. Staff spend time with people who live at the home, listening to their opinions and Care Homes for Older People Page 22 of 29 Evidence: experiences and taking part in discussions and laughing together which creates a happy atmosphere. There are qualified nurses at the home who have taken further training over the years to improve and review their skills. As well as this over half of the care staff team have now achieved National Vocational Qualification awards in care at level 2 or above. The remaining staff are either working towards either Level 2 or higher levels. There is a plan in place which describes the training which staff are to undertake based on the needs of the home and their personal training requirements. Records showed that all staff have received fire, food hygiene, infection control, moving and assisting, safeguarding adults and COSSH training. The acting manager makes deliberate attempts to recruit staff from similar cultural backgrounds as the people living at the home. In some cases they share the same community and social links, which helps to ensure that people are confident with the way in which they are supported. Examination of files for staff newly appointed in the home confirm that robust checks are carried out before they are employed to work in there. This includes receiving appropriate references and completing the necessary criminal record check to make sure that staff are suitable to work with people who are vulnerable. Staff files contain employment history, records of training and any training certificates. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, organised and efficient; and people are asked for their views about their care. All of which gives people who use this home the confidence that they will continue to have their needs met by staff who support their best interests. Evidence: The acting manager is a first level registered nurse. She has extensive experience with over 20 years experience as a manager of care and nursing services. As well as nursing qualifications she has recognised management and teaching qualifications. She is also a qualified dementia mapper which will help to further develop services for people with these needs. The manager is in the process of applying to the Care Quality Commission(CQC) so that her fitness to be the Registered Manager at this home can be assessed. The deputy manager is employed as the lead qualified nurse and has responsibilities over the day-to-day running of the home. Care Homes for Older People Page 24 of 29 Evidence: The acting manager is supported and supervised in the management of the home by an Operations Manager of Southern Cross so that she has the support she needs to be able to run the home properly. Southern Cross quality assurance processes include a number of checks of the home and at least monthly visits by a representative of the organisation to check on its operations and progress. The area manager is available on a daily basis and offers support to the acting managers if when she needs it. Evidence of their work to verify present standards of care and potential areas of improvement were viewed at this inspection. If requested the home will support residents to keep their personal monies safely. Their monies are kept in a group bank account. Using computerised statements, the home can then debit their account for services and purchases, such as hairdressing, chiropody and toiletries. Receipts are kept for each transaction. An amount of cash is securely stored in the home so that any resident who wants to withdraw money for trips out can do so. This system also provides clear printed statements for residents or their representatives. Staff are well trained in health and safety matters, for example there were clear records of recent fire drills and fire safety training. The maintenance staff carry out and record routine health and safety checks of the building and equipment, for example water temperatures and fire alarm systems. These were in good order and up to date. There were no health and safety issues noted during this inspection. The staff has completed training in moving and handling. All catering staff have completed training in food awareness training. External contract certificates are up to date and the home is inspected by the Fire and Rescue Service and the Health and Safety Executive to make sure that the home is safe for people to live and work there. People living at the home said, The Boss listens to what I have to say. Another said, She seems okay. Care Homes for Older People Page 25 of 29 Evidence: The acting manager makes sure she is available if people living at the home or their families need to talk to her. Throughout the inspection numerous people came for advice, direction, comfort and support. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The care plans and life history documents should continue to be developed so that they better reflect the person centred approach to personal and nursing care at the home. The acting manager should continue to explore the range of opportunities for people who have dementia type illness. The acting manager should continue with the programme of refurbishment and replacement of areas of the home which have been identified. The acting manager should carry out maintenance of those areas which were brought to her attention as part of this inspection. 2 3 12 19 4 19 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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