Care Home: Felixstowe Care Home Ltd - Merryfields

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What the care home does well The service provides a safe, comfortable and homely environment. Visitors are made welcome and people tell us they like living there. Staff are competent, friendly and helpful, the food is good and the home is clean. Comments we received included; "I am very pleased with the staff. They are kind and look after me well", "Everyone is looked after very well" and "staff always show concern and consideration, sympathy and understanding". What has improved since the last inspection? This is the homes first key inspection. However, we have undertaken two random inspections during the past six months. In that time we have seen some improvements to recruitment processes, training provided to staff, residents care plans, medication procedures and infection control procedures. What the care home could do better: The service has only been registered since July 2009 and since that time the registered manager has left and a new manager is in post. The manager assures us that they will submit their registered managers application at the earliest opportunity and this will enable the Commission to assess their fitness to run the service. In the mean time the manager has assured us that lockable facilities will be provided in peoples bedrooms and they will continue to focus on improvements in areas such as assessment and care planning and the development of more thorough and robust recruitment processes. They should also implement a more formal quality assurance system so that they can effectively monitor their own service and do not wholly rely on other organisations or regulatory authorities to identify matters of poor practice or non compliance. Key inspection report Care homes for older people Name: Address: Felixstowe Care Home Ltd - Merryfields 7 Mill Lane Felixstowe Suffolk IP11 7RL     The quality rating for this care home is:   one star adequate 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: Tina Burns     Date: 2 1 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 28 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 28 Information about the care home Name of care home: Address: Felixstowe Care Home Ltd - Merryfields 7 Mill Lane Felixstowe Suffolk IP11 7RL 01394285528 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sue@felixstowecarehome.co.uk Felixstowe Care Home For The Elderly Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 10 The primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE(E) The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either Date of last inspection Brief description of the care home Felixstowe Care Homes Ltd - Merryfields has been registered as a care home since July 2009. It was initially registered to accomodate four named people but an application to vary their registration to increase the total number of places to ten has since been approved. Care Homes for Older People Page 4 of 28 0 0 Over 65 10 10 Brief description of the care home The home is situated in a residential area of Felixstowe close to the town centre and sea front. There is an enclosed garden at the rear of the premises with seating and flowerbeds and a car park at the front for staff and vsitors. The home provides a high standard of accomodation, all areas of the home are wheelchair accessible and have good disability access. Shared facilities include a lounge, sun room, dining room and two assisted bathrooms. Bedrooms are all single with ensuite toilet and hand wash basins. Care Homes for Older People Page 5 of 28 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: This was an unannounced key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection process included a tour of the premises and examination of a wide range of documents and records including three residents care plans and three staff files. We also observed activity at the home and spoke with several residents, visitors and care workers. Information has also been gathered from the homes Annual Quality Assurance Assessment (AQQA) submitted to the commission in October 2009, and survey forms completed by seven members of staff and six residents. It should be acknowledged that in some cases residents relatives provided assistance with surveys or where necessary completed them on their relatives behalf. Care Homes for Older People Page 6 of 28 This report also refers to random inspections on 29th July 2009 and 15th September 2009 when we visited the service to see how they were operating since it had become registered following the Commissions decision not to prosecute for initially running the home without registration. The current manager who has been in post since October 2009 was on duty at the time of our visit and fully contributed to the inspection process. Care Homes for Older People Page 7 of 28 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 28 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 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be given the information they need to make an informed choice about living in the home. Evidence: At the random inspection on 29th July 2009 we found that the residents records we examined did not include any evidence of local authority assessments. They did include copies of pre admission assessments that had been undertaken by the manager but it was not clear whether the assessments had been undertaken before or after admission. Further more the assessments were sparsely detailed and provided insufficient information to develop suitable care plans. At the following random inspection on 15th September 2009 we could see that where applicable copies of local authority assessments had been requested. There had been no further admissions due to the homes conditions of registration at the time and no Care Homes for Older People Page 10 of 28 Evidence: changes had been made to the homes pre admission assessment tool. In light of their application to increase to ten places the owner and manager agreed to review the homes assessment process to ensure that future residents would benefit from a more thorough assessment. At this key inspection we looked at the records of three new residents. All three were private customers and consequently there were no local authority assessments provided. We could see that more suitable pre admission assessments were undertaken and they covered areas such as medical history, medication, continence, nutrition, mobility, dexterity, personal care, sensory loss, communication and comprehension. The manager advised us that prospective residents are invited to spend the day at the home. This enables them to get a sense of what the home is like and whether they feel it is suitable. It also gives the manager an opportunity to undertake a prelimanary assessment and consult the staff about the compatability of the individual and other residents. At the time of the inspection the manager did not undertake home visits as part of the assessment process. The merit of visiting people in their own home was discussed and the manager said that they would consult the owner about the feasability of undertaking them in the future. Five out of six people that completed service users surveys told us that they received enough information about the home to help them decide whether it was the right place for them. One said that they didnt know. Four out of six confirmed that they had received a contract, one said they had not and one said they did not know. Four out of six told us that they always receive the care and support they need and two said that they usually receive the care and support they need. Five out of seven staff that completed surveys told us that they always had enough support, experience and knowledge to meet the needs of people who live at the home and two said that they usually have enough support, experience and knowledge. The homes certificate of registration was on display in the entrance of the home together with a wide range of other information including the homes certificate of liability, the complaints procedure, information for visitors and the previous random inspection report. Care Homes for Older People Page 11 of 28 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. People who use this service can expect to be treated with respect and have their individual needs met. Evidence: At our random inspection of the home in July 2009 the care plans we looked at did not clearly specify the needs and preferences of each resident or the tasks that needed to be undertaken by staff. Although daily records regarding the health and personal care of residents were maintained the lack of detail in care plans meant that it was difficult to assess whether the care provided matched the residents needs. However at our random inspection on 15th September 2009 we looked at the care plans of the four people resident at the time and found that they had been developed so that they were more detailed and logically set out. Further more people we spoke with and observations we made evidenced that staff had a clear understanding of residents needs and preferred routines and residents were appropriately supported and cared for. At this inspection we looked at the care plans of three residents recently admitted to Care Homes for Older People Page 12 of 28 Evidence: the home. They were adequately detailed and specified their preferred daily routines and personal and health care needs. However the new manager told us that they were in the process of transferring everyones care plan to a new computerised system. They showed us an example of a care plan that had been transferred to the new format. They told us that they preferred the new format because it asked for specific data and helped to more clearly identify individual needs and risks. They advised that the new system would be up and running for everyone in January 2010. Out of the six surveys returned to us by people that use the service four said that they always receive the care and support they need and two said usually. Four said that they always receive the medical support they need and two said usually. Comments were highly positive and included Everyone is looked after very well and staff always show concern and consideration, sympathy and understanding. At our random inspection in July 2009 we observed that at the start of their medication round the member of staff responsible had dispensed the medication for three residents from blister packs into pots and put them on a tray, with no form of identification. To ensure that residents were protected from medication errors we made a requirement that medication must be administered directly from the original container or blister pack and the practice of secondary dispensing must not take place. At the following random inspection in September 2009 we found that medication was being appropriately administered and the practice of secondary dispensing had ceased. At this inspection we observed a carer administering the lunch time medication safely and appropriately. A monitored dosage system (MDS) was used, so blister packs were filled by a local pharmacy and delivered to the home on a monthly basis. Medication Administration Records (MAR sheets) examined were appropriately completed, signed and dated and staff responsible for the handling and administration of medicines had undertaken suitable training. On the day of inspection people we spoke told us that the home was good at keeping their relatives informed if they were unwell. They also told us that they had every confidence that their GP would be contacted if required. Observations were that staff interacted positively with residents and were polite and respectful at all times. Residents spoke highly of care staff and confirmed that their privacy and dignity was respected. Care Homes for Older People Page 13 of 28 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 use this service can expect to maintain contact with their friends and family and enjoy a lifestyle that reflects their preferences. They can also expect to enjoy healthy and appetising meals. Evidence: People we spoke with and observations made during this and our previous inspections confirm that residents friends and families are made welcome. There was a warm and sociable atmosphere and people were seen coming and going throughout the duration of our visits. The AQAA tells us that the home organises a range of activities and this was confirmed by most people we spoke with. However we found that activities were mostly spontaneous and depended largely on the staff on duty. On the day of our visit some people had enjoyed a quiz and some singing but this differed from the activities specified on the programme displayed which said Hoopla and Scrap Booking. One visitor we spoke with told us that there was a lack of activities available and this was an area that the home could improve. However residents we spoke with told us that they were satisfied with the activities on offer and made comments such as They Care Homes for Older People Page 14 of 28 Evidence: keep trying to occupy us and They do try. They also told us that they liked to amuse themselves reading and watching television, sometimes in the privacy of their own rooms and at other times in one of the communal areas. The bedrooms we saw were all highly individual and personalised with peoples own belongings. People clearly felt at home in their rooms which provided good private facilities where they could enjoy their own company or entertain their guests. People also told us that they were able to continue with their preferred daily routines, for example maintaining control about the time of day they liked to get up and go to bed. People we spoke with and photographs displayed evidenced that the service does provide people with assistance to access community facilities, since our last visit people had enjoyed walks to the promenade for ice creams, shopping trips, restaurant meals, a trip to the local theatre and drinks at a local pub. There had also been some organised entertainment arranged for the enjoyment of residents, for example an Elvis Presley impersonator, a magician, a pianist and some singers and musicians. Three out of six residents that completed surveys told us that the home always arranged activities to take part in if they wished, two said that they usually arranged activities and one said sometimes. The manager told us that staff were undertaking training in dementia through the local college and once that was completed they would be able to undertake activities training with the same college. The home had a three week rolling menu in place. The range of meals looked varied and people could chose from two main options. On the day we visited the main lunch time meal was ham, egg and fries with bread and butter pudding for dessert. With the exception of one person who told us The food isnt great everyone else we spoke with was complimentary of the food. The lunch time meal we sampled looked and tasted appetising and the atmosphere in the dining room during the lunch time meal was pleasant and friendly. Tables were also nicely laid with suitable crockery, condiments, glasses and jugs of water or squash. Out of the six residents surveys returned four people told us that they always liked the meals, one said usually and one said sometimes. Information provided to us by the local authority quality monitoring team and observations on the day of inspection evidenced that the manager had responded to their concerns about carers frequently accessing the kitchen by providing them with suitable protective clothing. We could also see that suggestions made about increasing Care Homes for Older People Page 15 of 28 Evidence: the availability of soft drinks had been taken on board as jugs of assorted squash were widely available. Care Homes for Older People Page 16 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect their complaints to be listened to, taken seriously and acted upon. However, they cannot be fully assured that they will safeguarded from abuse. Evidence: The AQAA tells us that Merryfields is committed to an open culture that enables people to to raise concerns or complaints and be assured that such matters will be taken seriously and acted upon. It also tells us that since registration they have not received any formal complaints. The homes complaints procedure was on display in the entrance to the home and included in the Statement of Purpose and Service User Guide. It was clearly detailed and included relevant contact details and information about the different stages of the complaints process. People that completed surveys told us that they knew how to make a complaint. They also told us that they knew who to speak to if they were not happy. At our random inspections in July 2009 and September 2009 we were concerned that care staff had been appointed prior to Criminal Record Bureau (CRB) clearance and on the basis that they had had satisfactory POVA first checks. We also had concerns that pre recruitment checks were not suitably thorough and did not adequately safeguard Care Homes for Older People Page 17 of 28 Evidence: people. At this visit we found that the new manager had permitted another employee to start work before their full CRB clearance on the basis that they were able to produce an Enhanced CRB from a previous employer. This may meet the minimum requirements of legislation but it does not evidence that the screening of new staff is thorough and robust. Feedback from staff and records we examined confirmed that staff had undertaken Safeguarding Adults training. The Commission has not received any complaints or safeguarding alerts since the home has been registered and the manager confirmed that they had adopted the local authority procedures for safeguarding vulnerable adults. Care Homes for Older People Page 18 of 28 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 who use this service can expect to live in a pleasant, homely and comfortable environment that is safe and clean and meets their needs. Evidence: The home is situated in a residential area of Felixstowe close to the town centre and sea front. There is an enclosed garden at the rear of the premises with seating and flower-beds and a car park at the front for staff and visitors. All areas of the home are wheelchair accessible. Shared facilities include a lounge, sun room, dining room and two shared bathrooms. All bedrooms are single with ensuite toilet and hand basins and the ones we visited during the inspection were highly individual, appropriately furnished and personalised with residents own belongings. At the time of inspection all areas seen were tidy, safe and clean and there were no unpleasant odours. Five out of the six residents surveys returned said that the home was always fresh and clean and one said it was usually fresh and clean. The decor and furnishings are domestic in style and of a high standard and the environment is considerate of the needs of people with dementia. There are contrasting colours around all doorways and strategically placed clearly visible pictorial signs throughout the building. Residents doors included framed pictures or photographs which they had selected for the purpose of recognition. All handrails had Care Homes for Older People Page 19 of 28 Evidence: contrasting strips running next to them to assist with orientation. The consideration given to the environment is evident and the attention to detail has achieved a very homely, comfortable and attractive environment. At our random inspection in July 2009 we had some concerns about the laundry facilities and infection control procedures in place. However, since then the provider has changed the procedures in place for the management of soiled and dirty linen so that they reflect the guidance provided by the Environmental Health Agency. Staff were provided with disposable gloves, aprons and handwash and infection control procedures were clearly displayed in the laundry area and the linen cupboard. Care Homes for Older People Page 20 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be supported by staff that are appropriately trained and competent to do the job but they cannot be fully assured that they are safeguarded by the homes recruitment procedures. Evidence: The manager advised us that there is a minimum of two care staff on duty every day, one of whom is a senior carer. Additional staff are rotad on duty to accommodate residents appointments or outings so that there are always two staff in the building. The manager told us that they are usually supernumerary. At night there is one awake night staff and another who sleeps-in and can be called to assist if required. The matter of night time care was discussed and the manager told us that they were confident that the staffing levels matched the service users needs. They had looked at the Commissions guidance and further guidance available about night time care for people with dementia. They had also undertaken an appropriate risk assessment which they said they would periodically review. On the day of our visit our observations were that there was a good staff presence and care staff were available at all times to attend to peoples needs. Four out of six residents that completed surveys told us that staff were always available when they needed them and two said that they were usually available. Four said that they always Care Homes for Older People Page 21 of 28 Evidence: received the care and support they need and two said usually. Comments we received from residents and their relatives gave high praise to staff and included: I am very pleased with the staff. They are kind and look after me well, Theyre all so kind and They are very friendly and very helpful. At our random inspections in July 2009 and September 2009 we were concerned that care staff had been appointed prior to Criminal Record Bureau (CRB) clearance and on the basis that they had had satisfactory POVA first checks. We also had concerns that pre recruitment checks were not suitably thorough and did not adequately safeguard people, for example references had been supplied by the manager at the time for applicants that they had worked with rather than requesting them from their current employer. At this visit two out of three staff records we examined related to people who had been employed since our last visit. They included appropriate references, evidence of ID checks, health declarations and work histories but one of them had started work prior to CRB or POVA clearance on the basis that they were able to produce an Enhanced CRB from a previous employer. This may meet the minimum requirements of legislation but it does not evidence that the screening of new staff is thorough and robust. Discussion with the manager, feedback from staff and records seen evidenced that staff training had improved since our last inspection in September 2009. New and existing staff had undertaken training in areas such as moving and handling, safeguarding adults, food hygiene, fire safety, funerals - dispelling the myths, living life after a stroke, sensory loss, mental capacity and dementia awareness. The manager also advised us that all staff without a relevant NVQ qualification have started NVQ training and those that have not completed a certificated dementia course are undertaking a modular course via Otley College. Six out of seven staff that completed surveys told us that their induction programme covered everything they needed to know very well and one said partly. Seven out of seven said that training was given that was relevant to their work, helped them to understand residents needs and provided them with the knowledge they required to do the job. Care Homes for Older People Page 22 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is adequately managed and people can expect to have their health, safety and well being promoted and protected. Evidence: The home opened for business in June 2009 before the relevant applications to register had been approved. This was an offence under Section 11 of the Care Standards Act 2000. However we made a decision to grant the application with conditions and consequently the home was registered to provide care to four named people under the categories of dementia and old age, not falling within any other category. Following their initial registration the provider submitted an application to increase their numbers to ten and this application was approved soon after our last random inspection in September 2009. We were then notified that the registered manager had resigned and been replaced by the deputy manager. At the time of this key inspection the new manager advised us that they had been to the Commissions London office to Care Homes for Older People Page 23 of 28 Evidence: submit their CRB application and they would submit a registered managers application as soon as they had received CRB clearance. We undertook random inspections in July and September 2009 because we wanted to see how the service was operating following the Commissions decision not to prosecute for initially running the home without registration. At our first random inspection we found that the home offered a high standard of accommodation but there were weaknesses in areas such as assessments and care plans, administration of medication, the management of soiled and dirty linen, and staff recruitment checks. There was also little evidence of staff training and activities offered to residents. At our second random inspection there was good evidence that people were being well cared for and we found that our statutory requirements had been met. However, there was little evidence of a drive or commitment to improve beyond the minimum requirements of legislation in areas such as staff training and staff recruitment checks. At this inspection the new manager was highly co-operative and provided all of the information we requested promptly, openly and in a professional manner. They were keen to hear our feedback and displayed a commitment to raising standards and providing a good quality service. Since becoming manager they had focused on improvements to care planning and staff training. Feedback from staff, residents and visitors confirmed that they found them competent, helpful and approachable. However, they were still settling in to their new role and at the time of writing this report their fitness to manage the home has not been assessed by the commission. The homes AQAA was adequately completed and submitted to us within the given timescale. It demonstrated that the manager had an understanding of National Care Standards and included information about what the service does well and how they intend to improve. At the time of our visit the manager had not considered implementing a formal quality assurance process or auditory system but there were routine checks in place to monitor matters such as health and safety. Staff and residents meetings had also been introduced to give people an opportunity to contribute their views to matters relating to the home. The home does not handle large sums of residents personal monies or manage anyones personal accounts. We were advised that all current residents manage their own finances with support, if necessary, from their relatives or representatives. There were no lockable facilities provided for residents cash or valuables in their own Care Homes for Older People Page 24 of 28 Evidence: bedrooms. This matter was discussed and the manager agreed to ensure appropriate facilities were provided before the end of January 2010. Cash belonging to four residents was being held for safe keeping, we found appropriate records relating to this were maintained and matched the balance of monies held. Staff training included health and safety, food hygiene, moving and handling, first aid and fire safety. The AQAA tells us that manual handling equipment and fire protection equipment is appropriately serviced. During our visit there was good evidence of routine health and safety checks such as hot water temperature tests, call system tests, portable appliance tests and fire equipment tests. Care Homes for Older People Page 25 of 28 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 28 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 Care Homes for Older People Page 27 of 28 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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