Care Home: Falcon House

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• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well The residents are very happy living at Falcon House. Comments included `they look after my needs and care for me to a high standard`, `I love the food and they always keep my room fresh and clean` and ` I have nothing but praise for the staff and all they do, nothing is too much trouble, I am cared for well". The home is very clean, well furnished, well maintained, comfortable and homely and residents are able to exercise choice, where they can, about how they spend their time and about their daily routines. Residents are very happy with the food provided and their individual preferences are well catered for. The home has a stable management and care staff team, who are generally well trained and the turnover of staff is low. Residents speak highly of the staff team and how the home is run. What has improved since the last inspection? There were no regulatory requirements made at the last inspection. The manager has been working on the development of person centred care plans and records whereby the individuals preferences and choices are highlighted more. What the care home could do better: Since the last inspection in 2006 standards in the home have not been fully maintained and developments in some practices and procedures have been limited. Policies and procedures have also not been followed and therefore there is a lack of evidence of some of the work that may be being undertaken. This may have been exacerbated by a period of leave taken by the manager. More work is needed on the care planning recording and management systems, especially around the care of residents` nutritional status, their risk assessments and the involvement of care staff in the process, so they become active documents. More could also be done to develop the social and activities programme to ensure that residents individual and group needs are met, along with promoting their independence and self worth. More evidence is needed that consultation goes on with residents and also that staff have the training that they need to undertake their role. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Falcon House George Green Little Hallingbury Bishops Stortford Essex CM22 7PP     The quality rating for this care home is:   one star adequate 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: Diane Roberts     Date: 2 7 0 7 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2010) 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 29 Information about the care home Name of care home: Address: Falcon House George Green Little Hallingbury Bishops Stortford Essex CM22 7PP 01279658393 01279758646 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Noel Gordon Griffiths care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 19 persons) Date of last inspection Brief description of the care home Falcon House is a large detached house located on the outskirts of the village of Little Hallingbury. The home provides accommodation for 19 older people (age 65 or older). The home provides care to meet the needs of people with low to high dependency needs. It has been adapted to meet the needs of residents with limited mobility. Falcon House provides personal and social care to those who live there. All bathrooms and toilets are fully equipped to provide a safe environment and promote independence. 0 Over 65 19 Care Homes for Older People Page 4 of 29 Brief description of the care home The charges on the day ranged from £735.00 - £750.00 per week. 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: one star adequate 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: We visited the home for most of the day and met with the proprietor, the senior carer in charge that day and some of the care team. The manager was not available on the day of the inspection but did submit further evidence to us after the fieldwork had been completed. Prior to the visit, we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. This is a self assessment required by law. The manager was asked to complete this and this tells us how well they think are doing, what they think they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to residents and staff at the home and prior to that we sent out surveys to other residents relatives and staff, asking for feedback on the home. The response was quite good and these comments are referred to in the Care Homes for Older People Page 6 of 29 report. Whilst at the home we also reviewed records and undertook a tour of the premises. 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 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 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 9 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. Residents would be properly assessed so they can be assured that the team at the home could meet their needs but they cannot always be assured that they would have the information they need about the home. Evidence: A brochure on the home was available in the reception area. This covered the philosophy of care, care planning, meals, laundry and activities. There were also some inserts available on advocacy, charter of rights and a checklist to advise you on what to look for when choosing a home. When asked, neither the administrator or the Senior in charge were aware of the homes service user guide. Whilst the information in the brochure is of use, it did not contain, as outlined in Standard 1 of the National Minimum Standards, information on the staff team, a copy of the most recent inspection report, the complaints procedure or residents views on the home. On discussion with the proprietor, we were told that the manager is currently updating this document. The home also has a website that gives general information on a range Care Homes for Older People Page 10 of 29 Evidence: of services that the home provides. A recently completed pre-admission assessment was reviewed. This was seen to be completed fully and contained enough basic information on the person and their needs to enable a decision to be made about whether the team at the home could meet those needs. The assessment also contained some person centred information on, for example, food preferences, daily routines and pastimes. It was noted that whilst there are food preferences on the assessment there is no information regarding the nutritional status of the resident or a prompt to record any notes regarding this. Either the manager or her deputy and a senior carer undertake the assessments. Residents who commented on our surveys generally said that they had enough information about the home on admission but some said that they did not. Residents spoken to about their admission to the home said that they had settled in well and that they knew the home through recommendation and felt it would be fine. Residents also confirmed that they had come to stay for a few days to see what it was like. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot always be fully assured that their needs would be met in a consistent way and whilst outcomes are generally positive there are potential risks for them, as systems are not in place. Evidence: The manager has a care planning system in place. Two care plans were reviewed along with 2 others in order to cross reference. One resident, who had been in the home a week had no care plans or risk assessments in place and had also not been weighed on or around the time of admission. Some daily notes were being recorded that did generally show that the resident was being supported and cared for. Some of the residents preferences were also recorded in the daily notes. Whilst it would be understandable that a new resident may not have all care plans fully in place after one week, as there may be ongoing assessments, it would be expected that some would be in place along with standard risk assessments, for example, manual handling and baseline recordings, so that staff had some guidance as to the level of support and care required. On discussion with the proprietor, he felt that even though the manager was currently away from the home, other staff should have been able to compete the Care Homes for Older People Page 12 of 29 Evidence: care plans required for this resident. Another resident had care plans in place. These were up to date and contained evidence that there had been ongoing reviews. The care plans were seen to contain sufficient detail on the care and support the resident needed. There was person centred information throughout the plan, relating to the residents preferences, such as wearing make-up, the choices they like to make and how often they like their hair done. Social care plans were however limited and these are discussed in Section 3 of this report. Care plans were also in place that covered specialist needs such as pain management. Staff spoken to about the residents had varying levels of knowledge about them. Some knew their care needs well but did not know them as individuals and others knew their social background well but were unsure why they were caring for them in the way they were. For example, staff were unsure why one resident was being cared for in bed, but had actually undertaken care tasks for them on several occasions. On discussion the care staff said I dont get to read the care plans - am not allowed to look - I dont want to be nosy and the other staff tell you what is going on, I have never been told to read them. This means that staff may be missing key information about the residents care and/or social background. This needs to be addressed to help ensure that residents receive a consistent approach. It was also noted that care staff knew some good detailed person centred information regarding the residents as individuals, but this was not always recorded. Residents who commented on the care provided in our survey nearly all said that they got the care and support that they needed and that the staff listened to them and acted upon what they they said. Comments included they look after my needs and care for me to a high standard and I have nothing but praise for the staff and all they do, nothing is too much trouble and I am cared for well. Relatives who commented said the care my relative gets is excellent, the staff at the home need to learn how to fit hearing aids, the staff approach is sensitive and caring and the communication is good and information is easily available. Residents had a range of risk assessments in place. It was noted that some residents had bed rails in place at the request of their families and the bed rails risk assessment in place identified this, but did not actually assess whether this piece of equipment was suitable and safe for the resident to use. A review of the assessment format would address this. One resident was noted to have challenging behavior and no risk assessment was on the care plan file to demonstrate the triggers for the behavior and how staff should manage, if an issue should arise. This needs to be addressed to ensure that residents and staff are protected as much as possible. On discussion with staff they said that the resident concerned had been exhibiting aggression for 3 -4 Care Homes for Older People Page 13 of 29 Evidence: months and had been referred for a review by the appropriate specialists but this was not evident in the records. It was noted that three different manual handling risk assessments are being used. It would be of value to streamline this so that staff can apply a consistent approach to the assessment and review of subject for each resident. Manual handling assessments were seen to have been completed in March 2009 but showed no evidence of review. Risk assessments were in place for residents at risk of pressure sores but again there was no evidence of review, even to say that the risk level had not changed. Residents were seen to be using a range of pressure relieving equipment in the home. The manager does not use a nutritional risk assessment. On discussion with staff they said that they did not weigh residents and only have a set on stand on scales. Care records do not show that residents are being weighed or nutritionally assessed. The manager in her AQAA said that she carried out nutritional screening on everyone admitted to the home and that this screening was repeated and acted upon. There is no evidence in the home to show that this is the case. The manager said in her AQAA that all staff have received training in malnutrition care and assistance with eating but the training records submitted do not evidence this. The manager, in her AQAA said that care plans and review systems are of a high standard. Based upon the evidence seen, we would not fully concur with this statement. Care records showed that residents saw their GPs promptly when needed and that residents had access to other health care professionals such as chiropodists and opticians. The medication system at the home was reviewed and a nomad and box to mouth system is used. Medications that are boxed or are liquid are signed in correctly on the medication administration sheets but the tablets in the nomad packs which are delivered every week are signed for as, for example, 28 tablets when only seven have been delivered. The team need to sign for the actual medication received, checking the items in weekly if needed. Where residents are taking warfarin and there are more than one prescription for it on the administration sheet, as good practice, a note should be made on the sheet for staff to check the INR (blood test) results, to reduce the risk of the wrong dose being given. It was also noted that when staff are adding hand written prescriptions to the administration sheets during the month, the person adding the prescription should sign the sheet so that any queries can be rectified. Staff are generally signing the charts and using omission codes, for example, when medications have been refused. However, staff are not consistently using the code system and one resident had not had any of their medication signed for on the previous day even though they were in Care Homes for Older People Page 14 of 29 Evidence: the home. Dates of opening should be noted on boxes for auditing purposes. The senior in charge was not aware of any auditing systems in place for the medication but on discussion the proprietor said that the manager undertook these but there was no written evidence available. There was policy advice available to staff along with information sheets on the medications given. Training records showed that four staff, including the manager, had up to date medication training. Care Homes for Older People Page 15 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. Residents experience variable outcomes with regard to choices within their daily lives. Evidence: From discussion with residents, staff and from records and observation, it is clear that the routines of the day are primarily resident led. On the day we visited, residents were observed to be having a lie in, with staff still being mindful of their need to have any key medication and breakfast and fluids at some point. Residents said I have choice about when I get up and go to bed, It my routine not theirs and The night staff do not disturb me as I have asked them not to. The care staff take the lead in providing activities in the home. This is supported by a person coming in on a regular basis to undertake music and movement. No programme is available and staff spoken to said we just give them daily options, they like manicures and there is no programme. The senior in charge of the home, after checking, confirmed that they do not keep any records in relation to activites offered or undertaken. The manager in her AQAA said that there is a comprehensive activity programme for residents to attend and activity records evidence that they do this well. Care Homes for Older People Page 16 of 29 Evidence: Some of the daily records show that residents do go out for walks and out with their family members. There were photos on the wall that showed some group activities or entertainment. Residents who commented said I am in my room all of the time and the staff are too busy to come and spend time with me, I dont do a lot, they do have some activities but I do not take part as I cannot do most of the things they do, I often go for a walk, they do have music and movement come in, they need to have more activities that I can take part in, I would like the staff to spend more time with me, I like to chat and have their company, they do come to chat but I would like them to stay longer and they need to arrange more trips and outings. The result of our surveys were variable with residents saying that there needs with regard to activities were either always, usually or sometimes met. Social care plans were limited and did not assess the needs of the resident and therefore show how a social activity could promote their independence, self worth or the retention of skills for an individual. Care plans identified preferences like talking to family and friends and listening to the radio with the action for staff being encourage the staff to interact with X. There is limited evidence to show that residents group or individual social needs are being met. Lunch was observed. Residents clearly exercise choice about where they would like to eat. About half choose to eat in the dining room and others choose or need to eat in their rooms. Residents were seen to have their visitors eating with them. The tables are nicely laid and condiments are freely available. Drinks were seen to be freely available throughout the day and at lunch residents had the specialist equipment they needed to help them maintain their independence during mealtimes. Residents were seen and heard to be helped sensitively by staff and given choices about their meal. The menu is displayed and today the choices were gammon or chicken curry with chocolate roulade for desert. Fresh fruit was seen to be available in the hall and residents are able to help themselves. Staff were heard to be discussing what was for dinner with the residents during the morning.On observation, it is clear that the chef knows the residents and their preferences well and was altering the food orders to accommodate these. Residents who commented said that the food is good here and there is a choice, the food is very good, there is always a choice and its nicely served, the kitchen staff know what you like and what you dont like, The cook asks us what we would like if she is going to change the menu, I love the food and I think the food is very good. Care Homes for Older People Page 17 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. Residents can be assured that their concerns would be listened to and that they would be protected, as far as possible, from abuse. Evidence: At the time of our visit the proprietor told us that the manager was currently updating the complaints procedure. Guidance as to complaints was found on the residents notice board and this had a nice friendly and open approach. Residents spoken to said the manager and the deputy are very approachable if you have concerns. Nearly all those who commented in our surveys said that they knew how to raise a complaint if required. No complaints had been received in the last year and there were no records to review. The proprietor said that the manager had system in place for recording complaints should the need arise. The manager in her AQAA said that there was a complaints investigation log but this was not found on the day of the inspection. The team at the home have had many compliments and it was possible to see these. Comments included great team, always happy to help, homely and friendly atmosphere, exceptional and compassionate care, nothing is too much trouble and the loving care shown exceeded our expectations. Staff spoken to showed and understanding of adult protection matters and the most up to date guidance was available. The training records submitted showed that some staff had this training but numbers were not available. It was also noted that further Care Homes for Older People Page 18 of 29 Evidence: training had been booked for later in 2009. The manager in her AQAA said that there is a high emphasis on staffing training in adult protection. 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. Residents live in a clean, well maintained and generally safe home. Evidence: A tour of the home was undertaken with the senior carer in charge of the home. All communal areas were seen along with bathrooms and a number of bedrooms. Overall the home is very well maintained, has a homely atmosphere and is decorated to a high standard. No odours were noted. The bedrooms are personalised and residents have been able to bring in small piece of their own furniture etc. All the bedrooms have lockable facilities and are en suite. There is a main lounge and two conservatories for residents to use. These overlook a large, well maintained garden, with a large patio, which also has good views of the surrounding countryside. The lounge is very homely and contained ornaments and books etc. for residents to enjoy. All of the furniture seen was in a very good state of repair. The manager employs a maintenance man who visits the home as need be. Residents who commented all said that the home was always kept fresh and clean. Comments included its a well maintained home with high standards throughout. In the bathrooms it was noted that un-named items of toiletries had been left and also cleaning chemicals that pose a potential risk under COSHH. This needs to be addressed in relation to infection control as the toiletries can potentially be shared and Care Homes for Older People Page 20 of 29 Evidence: any COSHH items should be risk assessed and stored appropriately. A basic fire safety risk assessment was in place and this was dated January and April 2007. This document should be kept under review and consideration should be given to undertaking a more robust assessment. Records show that the fire safety systems in the home are checked but this is not always on a consistent basis. Records also show that the emergency lighting is not checked regularly with the last record showing October 2007. Training records show that out of the 28 staff working in the home 21 have up to date fire safety training. 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. Whilst residents benefit from and stable and generally well trained staff team to care for them, they cannot be fully assured that they would be protected by the recruitment procedures. Evidence: The staff turnover at the home is low. Many of the staff have worked at the home a long time. On discussion the feel that its a good team and its a small home and it has a very family type approach. Residents spoken to said the staff are good, very helpful, sometimes a bit humpy but then again we are too,the care staff are friendly, smiling and kind and I love the staff and enjoy the interaction. At the current time there are 3 care staff on an early and late shift and two on at night. The rotas show that these levels are generally maintained although there are odd shifts where the rota shows that only two staff were on duty on late shifts. The managers AQAA confirms that no agency staff are used. The rota should identify the staff names and their designations in full, as this is a legal record of the staff on duty in the home. In addition to this, on the day of the inspection, the proprietor and administrator were working in the office and ancillary workers such as kitchen staff were also on duty. The proprietor reports that there is a management on call system in place to support the team at the home. The managers AQAA confirms that 80 of the staff have completed their NVQ level 2 Care Homes for Older People Page 22 of 29 Evidence: qualification. Two staff files were checked at random to assess the recruitment procedures in the home. The standard of the files was variable. One file was good and contained all the required checks and documentation, including a POVA and CRB check completed at the appropriate times. The other file, for a temporary member of staff, who had worked at the home before, contained insufficient references and no CRB or POVA check. The person in question was on duty that day as a carer. This file also did not contain a photograph or any form of identification. This was discussed with the proprietor who felt that this was an oversight as the person had an old CRB from another place of employ/study. This is unacceptable and does not protect the interests of residents in the home. The manager in her AQAA said that we have in place a range of recruitment policies and procedures which ensure that new employees have POVA and CRB checks. Staff spoken to confirmed that they had attended an in house induction and that they were, where appropriate, completing the Skills for Care induction. Training records show that out of the 21 care staff, 15 have completed infection control training in 2009 and 6 members of staff have completed first aid training in July 2009 and 1 has completed the Foundation in Palliative Care. Further records show that staff have attended training in fire safety, food hygiene and moving and handling, although no numbers are available to show that all staff are up to date with their training. Further training has been supplied on managing falls, dementia and the deprivation of liberties but again no numbers of staff attending have been submitted. We saw that the manager has booked further training sessions for 2010 on moving and handling, fire safety, food hygiene, dementia awareness, challenging behavior awareness, first aid and adult protection. 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. Residents benefit from a generally well run home. Evidence: The manager has many years experience working as a nurse and working in management and care of elderly people. The manager is registered at the home and has achieved the NVQ level 4 in management. Residents, relatives and staff all say that the manager is approachable. The manager holds team meetings and staff confirm that they also have supervision with her. The manager in her AQAA says that she plans to improve by having more management and staff meetings in the future. The manager has a resident feedback survey form in place as part of the quality assurance system for the home, although these were not availbale to see at the inspection and residents comments are also not detailed in the information available on the home to potential new residents. The manager says that residents meetings take place and the minutes were available. The minutes stated that primarily all residents were seen individually and any comments made were recorded in their care Care Homes for Older People Page 24 of 29 Evidence: plans. On examination of the care plans, evidence of this was not seen. Residents spoken to said there are no residents meetings. The manager needs to make the evidence of consultation with residents more available and show what action, if any, has been taken to address any queries, concerns or requests made. This would also show if there were any patterns or areas for further development. General comments from residents made to us via the surveys included I am very happy and they could do the laundry and the ironing a bit better. Relatives who commented said I have a high opinion of the staff and the way the home is run, my relatives laundry is labeled but x clothes still go to other residents and them to x, my relative is very happy at the home and Falcon House is a shining example of all that is good within the care services. Consideration should also be given to undertaking internal audits to ensure that the systems in the home are working properly and that policies and procedures are followed, for example, with care planning, medication and recruitment. The proprietor confirmed that they do not hold any monies on behalf of residents and families are encouraged to take on this responsibility. Families or individuals are then invoiced for any monies owned. Accident records were reviewed and found to be completed well. There were no causes for concern noted. Care Homes for Older People Page 25 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 26 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 1 7 15 Every resident must have a care plan in place that details their needs and the support that will be provided. So that residents needs are met in a way that they would wish. 07/10/2009 2 8 12 Risk assessments must be completed and kept under review. So that risks to residents are reduced as far as possible. 14/10/2009 3 12 16 Following consultation with residents develop an activities programme that provides individual and group activities. So that residents needs are met in full. 14/11/2009 Care Homes for Older People Page 27 of 29 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 4 29 19 All the require recruitment 30/10/2009 checks and documents must be in place before a member of staff starts work at the home. To ensure, as far as possible, that residents are protected. 5 33 24 A more robust quality assurance system should be developed. So that the services offered are developed and improved upon. 30/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 1 7 9 Review the service users guide and ensure that it is made available to residents. Put systems in place for staff to ensure that they use the care plans as active working documents for reference. The manager should ensure, through auditing, that staff are following good practice and the homes medication polices and procedures. Develop the social care plans for residents to show their assessed needs and the input to be provided to meet those needs. Review the fire safety risk assessment and ensure tests of equipment are carried out consistently. The staff rota should show the full names and designations of the staff on duty at any one time. 4 12 5 6 19 27 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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