Care Home: Elmcroft Care Home Ltd

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What the care home does well The service offers a supportive and friendly home environment for service users with a wide range of needs. Service users care plans included all their needs and gave clear information to staff on how those needs are to be met. The accommodation in both units was of a good standard in decoration, furnishings and fitments, and the home overall is comfortable and bright. The home is in a quiet rural location with many rooms having good views of the surrounding countryside. What has improved since the last inspection? Complaints had been recorded properly and evidence had been kept of the investigations and the outcomes. Initial induction training for new staff now followed the best practice guidance for the service. Staff had received training on abuse awareness and dementia awareness. The registered provider had ensured that regular monthly regulation 26 visits had taken place. Repainting had taken place to walls and doorways throughout the home. The lounge in the GNU had a new fish aquarium and there was a new patio area with seating close to the garden pond. What the care home could do better: Evidence needs to be kept to confirm that all staff have been given regular recorded 1 to 1 supervision support. Staff who administered medication to service users should be re-assessed for their competency to undertake this role. Staff who are responsible for providing activities to service users should receive training specific to this role. Some carpets in corridors in both Units should be cleaned more frequently. Key inspection report Care homes for older people Name: Address: Elmcroft Care Home Ltd Brickhouse Road Tolleshunt Major Maldon Essex CM9 8JX     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: Alan Thompson     Date: 0 3 1 2 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: Elmcroft Care Home Ltd Brickhouse Road Tolleshunt Major Maldon Essex CM9 8JX 01621893098 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: jan@festivalcare.com Elmcroft Care Home Limited care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability physical disability Additional conditions: One named person, aged 40 years and over, with a learning disability, who requires nursing care by reason of a physical disability. One named person, over the age of 65 years, with a learning disability, who requires nursing care by reasons of a physical disability. Persons of either sex, aged 18 years and over, who require nursing care by reason of a physical disability (not to exceed 28 persons) Persons of either sex, aged 50 years and over, with a terminal illness (not to exceed 6 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 54 persons) The total number of service users accommodated in the home must not exceed 54 persons. Date of last inspection Care Homes for Older People 2 5 1 1 2 0 0 8 Page 4 of 26 26 1 28 Over 65 0 1 0 Brief description of the care home Elmcroft Care Home provides nursing and personal care with accommodation for up to 54 older people and younger adults. The home also provides respite care which may include a short term rehabilitation service. The home comprises of two separate units. One is designated as a general nursing unit (GNU), and the other as a dementia (DE) care unit. The GNU unit has twenty eight bedrooms of which three may be used as shared rooms. The manager advised us at the site visit that two of the shared rooms were currently being used as singles. The DE unit has twenty six single bedrooms. All bedrooms throughout the home have private ensuite wc. Communal space includes a lounge, a dining room and a visitors room in the GNU unit, and a lounge, a dining room and an activities room in the DE unit. Many areas of the home have views across open countryside and the surrounding gardens are attractive and accessible to service users. Elmcroft is located in a rural location near to the village of Tolleshunt Major, which is several miles from Maldon. There are no public transport links within easy walking distance. Vehicle parking for visitors is available in the large car park at the front of the home. The weekly fees are either the local authority commissioning rate or range from £600 depending on facilities and levels of support required. Additional costs apply for physiotherapy, chiropody, toiletries, hairdressing and newspapers. CQC inspection reports are available from the manager or are accessible on the CQC internet website, www.cqc.org.uk 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 unannounced key inspection commenced on Thursday 3rd December 2009 with a second announced visit on 10th December to complete the process. Our most recent inspection prior to this visit was completed on 25th November 2008. The content of this report reflects the inspectors findings on the days of the inspection along with information provided by the service and feedback by service users, staff and other parties. The manager was at the home on both of our visits and assisted us in a professional and helpful manner. The manager completed and returned their Annual Quality Assurance Assessment (AQAA) to us in time for the inspection. This is a self assessment required by law which gives homes the opportunity of recording what they think they do well, what they could do better, what has improved in the previous twelve months as well as their future plans for improving the service. Some of the information and detail provided Care Homes for Older People Page 6 of 26 within the AQAA has been included in this report. Discussions were entered into with the management of the home, service users, visitors and staff on duty. CQC survey questionnaires were also provided to service users, staff and stakeholders. We received eleven completed surveys and reference to feedback from these has been made within this report. Random samples of records, policies and procedures were inspected and a tour of parts of the premises and grounds took place. All matters relating to the outcome of the inspection were discussed with the manager of the home, with full opportunity for discussion given and/or clarification where necessary. Care Homes for Older People Page 7 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 8 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 9 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. People considering moving into the home can be confident that the admission processes ensures that the home can meet their needs. Evidence: The homes Statement of Purpose (SOP) and Service Users Guide (SUG) had been updated since the last inspection to include pictorial information. This was to try to ensure that people who have dementia know what the service has to offer. The SOP and SUG documents looked at included the information needed to help people make an informed choice when considering moving into Elmcroft. The manager said that a brochure pack including these both documents is sent to prospective new service users. Pre-admission assessments are currently only carried out by the manager. The format used had been updated since our last inspection to include a wider range of needs considerations. Completed pre-admission assessments were seen in files for some of Care Homes for Older People Page 10 of 26 Evidence: the people admitted since the last inspection. Assessments contained the information needed and covered areas of medication, nutrition, pressure care, mobility, safety, sensory, personal care needs, medical history, socialising, psychological needs including dementia care and behaviours, communication, eating and drinking and spiritual needs. The manager confirmed that prospective new service users are invited to visit with their relatives before they decide if they wish to move into Elmcroft. Discussions with people has confirmed this. One said we could look at the home before deciding if it was what we wanted. Comments in surveys returned to us also confirmed that the majority of people thought they received enough information to help them decide if Elmcroft was the right place for them before they moved in. Care Homes for Older People Page 11 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. The information in care plans ensures that peoples needs could be met in a way they would wish. Evidence: Three care files were looked. The format used for care plans had been expanded on since our last inspection to include more detailed information for staff on the service users medical history, medication profile, social profile and life history. Care plans inspected included a personal profile and background information, personal details, and next of kin contacts. Files had a care plan index, which itemised numbered areas of identified need. Assessments of identified needs were recorded with the aim of care recorded and instructions for staff on the care required to meet these needs. Areas of assessment were detailed and gave staff the information they needed to ensure service users needs could be met. Care plans seen also had a wound care and aspiration assessment and risk assessments on pressure care, continence, manual Care Homes for Older People Page 12 of 26 Evidence: handling, dependency, general identified risks, falls, nutrition and the use of bed guards. Risk assessments showed hazards, control measures, level of risk and the perceived potential for harm. The manager advised us that the use of bed rails is being phased out in the home with new low profile beds and mats being introduced as a preferred lower risk alternative. Care plans had been signed as agreed by the service user or their representative. Also seen on care files were records of reviews and of daily staff observations, weight had been recorded and records had been kept of GPs visits and treatment and on any other professional visit. Care plans are reviewed regularly by the named nurse ensuring that daily notes record any changing needs. Discussions with individual service users and comments made in surveys returned confirmed that they thought they were treated with respect by staff, and staff on duty were seen to be patient and helpful in their dealings with service users. Comments made included, the staff here are very good, the staff are helpful, I am quite happy here. Dentists, GPs, chiropodist and an optician all visit the home to provide for the healthcare needs of service users. Other healthcare services are accessed in the community. Records of visits and consultations with written outcome notes were seen. The home is served by several different GP practices but the manager reported that systems in place ensure good communication between the home and the different GPs. The medication system was looked at. Only qualified nurses deal with medication in the home and use a blister pack and bottle to mouth system. Medication policies and procedures were easily available for staff reference and an up to date list of signatures was maintained. There is a competency assessment in place designed to be used to review staffs adherence to good practice, however not all nurses had a completed assessment on file for the period since our last inspection. Medication administration records were looked at, no errors were noted. 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 living in Elmcroft can expect to have a lifestyle that matches their expectations through opportunities for activity, and enjoyable food. Evidence: Service users and relatives meetings had taken place to ensure that people who live in the home can make their views known and are kept informed about future plans. Minutes of issues discussed had redecoration, activities and staffing included. The manager said that meetings are usually held every three months with relatives invited. Since the last inspection changes had again been made to the provision of activities in the home with a new activities coordinator having started working there three weeks before our visit. This person works full time and is assisted by one part time (one day a week) person. The activities coordinator was spoken with and talked enthusiastically about the role and future plans for expanding the range of interests offered. There was a weekly programme of activities on display which showed quizzes, sing-alongs, one to one chats, bingo and games as regular options. Individual records seen included the above activities plus arts and crafts, films, reading and discussion, nail Care Homes for Older People Page 14 of 26 Evidence: care, indoor decorations, church services and hand massage. There are visiting entertainers brought into the home occasionally and the activities person was planning to improve the options for service users to go on outings. The manager told us that the home may soon be getting its own mini bus. We will check progress on this at our next inspection. The activities coordinator had not had any formal training relating to the role and specific to the wide range of needs of service users living in Elmcroft. We have recommended that this takes place although the manager advised us that this training was already planned for the near future. A hairdresser visits every two weeks to provide hairdressing to service users, and some service users receive visits from local clergy. Five service users spoken with said they took part in activities and that they were usually enjoyable, although some spoken with were not interested in taking part at all. Some said that the range of activities available could be better. When asked, service users told the inspector that their family and friends could visit at anytime and that staff always made them welcome. Relatives spoken with confirmed that they visit regularly and at any time. Inspection of private rooms evidenced that service users had been permitted to bring their own personal items with them on admission. There was also confirmation of this direct from service users, who, when asked, told the inspector of the furniture and personal items they had brought in with them. Menus evidenced choice and variety of meals on offer. The manager confirmed that the main daily meal is lunch with at least two choices and that there is also a choice at tea. Cooked breakfasts are on the menu every day and are taken by some service users. Suppers are available to those who feel hungry at night. Food stocks were good and service users spoken with were generally satisfied with the food and confirmed that there was always a choice. Comments from service users about the food included, the food is good and there is enough of it, the food is good, the food is quite good and the portions are enough for me. There was however a comment that there could be a better variety of meals available. 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. Practices in the home safeguard service users and ensure that concerns are listened to and addressed. Evidence: The complaints procedure was seen and contained guidance on how to make a complaint and who to complain to. Also included were timescales for responses from staff. There was a standard template for staff to record any concerns with five complaints recorded in 2009. Evidence was seen to show that these had been investigated and this included the outcomes of what actions had been taken as a result of the findings. Comments in surveys returned to us and with service users and relatives spoken with confirmed that all knew who to speak to if they had any concerns. People also seemed confident that any concerns raised would be investigated properly. The homes policies on adult protection included the Essex Social Care guidance on recognising, responding and reporting of any suspected abuse. Notices were also displayed around the home with information on what staff must do if they come across any suspected abuse. The manager was aware of the local adult protection and reporting procedures and staff spoken with also displayed awareness of this subject and procedure. Staff spoken with all said that they had received training on this subject and that they knew what to do if they had any concerns. Training records showed that most staff had received update training on abuse since our last Care Homes for Older People Page 16 of 26 Evidence: inspection. There was also a written whistleblowing policy in the home which provided guidance to staff on their responsibilities to report any concerns to the manager. 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. Service users live in a comfortable, clean, homely and generally well maintained environment. Evidence: Elmcroft Care Home provides a comfortable and bright environment for people to live in. The site visit included a tour of the premises when it was noted that the home was clean and tidy, and generally well decorated and maintained throughout, with no evidence of any unpleasant odours. Since the last inspection redecoration had taken place in all of the corridors throughout the home, however corridor carpets in some areas would look better if cleaned more regularly. Furnishings seen throughout the home looked good quality and the lounge in the general nursing unit had a new fish tank. The home has four bathrooms in the general nursing unit and another three bathrooms (including a walk in shower room) in the dementia unit. All rooms seen were in good order and included aids and adaptations to meet the needs of the people using the service. There were sufficient communal toilets to enable easy access, and all private bedrooms had ensuite wc. Communal lounges and dining rooms were provided in both buildings and were generally bright and spacious. It was noted that the dining room in the GNU building was also the main staff access route to and from the kitchen. This means there is a Care Homes for Older People Page 18 of 26 Evidence: fairly continuous movement of staff through this room at mealtimes resulting in wear to the carpet. The manager told us at the inspection that new floor covering was due to be fitted in this room, as well as to the area by the laundry room. The manager confirmed to us in writing on 9th February 2010 that new carpet had been laid in both areas. People living at the home were happy with the way their home is kept clean, their comments included, the home is always clean and tidy, and in general the home is clean. When asked in surveys if the home was fresh and clean other service users replied always or usually. Comments from relatives about the environment and services have included the home is clean and looks well cared for. The laundry was sited in the general nursing unit with close access to the dementia unit. Equipment and space provided was regarded as fully suitable for the numbers of people accommodated in Elmcroft. The grounds are spacious and were well maintained. The Manager told us that since our last inspection a new patio area had been set up close to the pond to provide an additional outdoor relaxing area for people to use in good weather. There was also a new visitors room in the general nursing unit to ensure that service users could meet their visitors in private if they wished. 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 a properly recruited and trained staff team. Evidence: The homes staffing rota was inspected and showed minimum daytime staffing levels in the GNU main building as one nurse and three carers on duty. Night staffing was one nurse and two carers. Minimum staffing in the dementia unit was one nurse and four carers during the day, and one nurse and two carers at night. Staff comments to us indicated that the majority thought there were always or usually always enough staff to meet peoples needs. In addition to the nursing and care staff there are six catering staff, one full time and one part time activities staff, domestic and laundry staff, one administrator and one maintenance person. The manager reported that agency staff are only used when necessary and that the home has a list of bank staff who work at there regularly, and so know peoples needs and the homes routines. Comments received from service users and relatives about staff attitudes included, the staff are friendly, you are looked after very well here, the staff are mostly very pleasant, the staff are kind and helpful. There were two comments that there could be more staff and that the call bell system is a long wait sometimes. Two staff recruitment files were inspected for staff employed since the last inspection. Care Homes for Older People Page 20 of 26 Evidence: Evidence was seen to confirm staff had been properly recruited with application forms completed, interviews held and a report of this kept on file, written references obtained, nurse PIN numbers had been confirmed through the internet, written terms and conditions issued, and criminal records checks undertaken. Copies of proof of ID, photographs and job descriptions were also on files. Files for staff employed since the last inspection showed that new staff undergo initial induction training. This includes orientation training, conduct, abuse awareness and whistleblowing. After this staff move onto a twelve week programme which is based on the Common Induction Standards for social care workers covering principles of care, role of the worker, safety, communication, abuse and personal development. Comments in surveys returned to us and during discussion with staff confirmed they received induction training and that this very well or mostly covered what they needed to know when they started their jobs. All staff have an individual training record and there is a training matrix which identified training undertaken for the whole team. Training records seen and discussion with staff confirmed that staff had been provided training on, induction, dementia awareness, health and safety, adult protection, first aid, fire awareness, manual handling and food hygiene. The manager also confirmed that staff in the dementia unit had been trained on deprivation of liberty awareness. NVQ training had been provided to some staff, however the numbers of staff with this award did not meet the recommended 50 of the care staff team. Staff spoken with said they received training appropriate to their roles. Comments in staff surveys returned to us indicated that all thought they received training relevant to their roles and most thought this helped them to understand and meet the individual needs of service users. 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. People live in a well run home that is managed in their best interests. Evidence: A new manager had commenced working at the home in April 2009. The manager is a qualified nurse with seventeen years experience of neurological nursing care and residential care. The manager also holds the registered managers award and said he had management experience in residential including nursing settings since 2004. The manager had begun the process to gain registration with the Commission. The service has a quality monitoring process which involves sending surveys to service users and relatives to ask their views on the care, facilities, catering, activities and support provided. The manager said that surveys had been sent out since he began working at Elmcroft. We saw evidence to confirm this and also that the comments and feedback from people had been actioned where appropriate. This showed us that service users and stakeholders views on the service provided are listened to and acted upon. Care Homes for Older People Page 22 of 26 Evidence: The administrator confirmed that the home still holds some personal allowance monies for safe keeping for the majority of service users. Records had been kept of the balances held and of receipts for expenditure. A random sample were checked and found to be in good order. There was a staff supervision process and format in place and some recorded supervision meetings had taken place. Records looked at showed the areas discussed included training needs, support needs, development and work targets. Some staff had received more formal supervision than others and some group supervision had been provided, however some comments to us from some staff indicated that they would prefer more support. Records of regulation 26 reports (monthly reports required to be carried out by the registered provider) were examined and included the views of service users, relatives, staff and a report on the state of the environment. The frequency of these had improved since the last inspection with regular reports in place throughout the period. This shows that the manager is now properly supported by the provider. Discussions with staff, management and inspection of records confirmed that training is provided to staff in health and safety, moving and handling, fire safety, first aid and basic training in infection control. Certificates and service records were seen to confirm that the homes hoists, fire equipment and alarms, gas supply, portable electrical appliances and electrical installation supply had all been tested/serviced. Hot water temperature is regulated and regular manual checks had been carried out. Fire drills had been held and a fire risk assessment was in place. The water tanks had been tested for legionella to try to minimise risks in this area. 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 36 18 Evidence must be available to confirm that all staff are properly supervised. This is to show that staff are supported in their roles. 31/05/2010 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 9 All staff who administer medication to service users should be assessed to ensure that they continue to be competent for this role. Staff who are responsible for providing activities to service users should receive training for this role. Corridor carpets in some areas of both units should be cleaned. The numbers of staff trained to NVQ level 2 or equivalent should total at least 50 of the care staff team. 2 3 4 12 19 28 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. Re-publishing this information is in breach of the terms of use of that website. 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