Care Home: Felmingham Old Rectory

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What the care home does well The home was not functioning well previously and limited quality could be found due to poor staffing levels and a poor environment leading to a poor service. The home does have a core of staff who have remained at the home through the difficult times and are now able to show their dedication and experience as more resources are available. What has improved since the last inspection? The home has increased the number of staff on duty to ensure that throughout the waking day there is always 6 care staff on duty while 31 residents are living in the home. The kitchen now has a full quota of staff with a Chef in charge. The Activities Organiser can now concentrate on her role. The domestic staff are able to carry out their duties fully. This has allowed all staff to concentrate on the quality of the care provided in their areas of expertise. Each resident now as a designated key worker with photographs of that staff member in the residents rooms for recognition. The development of the person centred care plans are nearly complete. Details are much more personalised for staff to follow. The home has a large number of residents who need a lot of support, especially at meal times. The midday meal is now unhurried, staff from all departments sit at the table to help and encourage people to eat and choice is offered at the time of the meal. The home has allowed residents more choice in where they would like to eat according to how that person feels on the day. Finger style food has now been introduced and more is being eaten rather than dropped on the floor as found previously. Clothing and appearance of residents has improved. Hair is brushed, men are shaved and none appeared with bare legs and feet. The environment is slowly improving with areas painted that help orientation. There is still along way to go to complete this task. The new Manager appears more person centred focused and in only a few weeks has ensured that the home is running correctly to meet the needs of the residents. This has improved the care and staff morale and needs to continue. What the care home could do better: The staff need to develop further their daily recording practices to ensure all areas of the care provided is in the daily records. It has improved slightly and social care support is beginning to be included. The care plan formats are too cumbersome and make finding information difficult. Sometimes information is repeated or forms that are not relevant to the person are in the care plans but not filled in. Past requirement have talked of records of medication fridge temperatures not being recorded. This task should be done daily and although the recording has improved it is still not regular. The sitting room chairs are in need of replacing and more suitable chairs purchased to allow those who like to sleep to be able to do so in comfort. Key inspection report Care homes for older people Name: Address: Felmingham Old Rectory Aylsham Road Felmingham North Walsham Norfolk NR28 0LD     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: Ruth Hannent     Date: 0 2 1 0 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: Felmingham Old Rectory Aylsham Road Felmingham North Walsham Norfolk NR28 0LD 01692405889 01692405528 felmingham@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross BC OpCo Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 41 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: 41 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 41 Dementia Code DE, maximum number of places 41 Date of last inspection Brief description of the care home Felmingham Old Rectory is situated in the village of Felmingham, approximately 2 miles from North Walsham on the Aylsham Road. The building has two extensions and is registered as a care home to provide accommodation for older people with Care Homes for Older People Page 4 of 28 Over 65 0 41 41 0 0 3 0 4 2 0 0 9 Brief description of the care home dementia. There are 31 single and 5 shared bedrooms, many with en-suite facilities. The home is situated within two acres of landscaped gardens, including an enclosed area. There is parking space to the front of the premises. The home provides information about the services it provides and a copy of the most recent inspection report in the entrance foyer. Felmingham Old Rectory is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for the home is £402 to £651 according to need. 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 inspection was a Key Inspection 6 months after the previous, carried out in April. 7 hours were spent at the home looking at records, observing staff and residents, overseeing a meal and one to one time spent with two staff. Since the April Key Inspection two more Random Inspections have taken place due to the poor rating and concerns received at the Commission on the quality of the service. The Annual Quality Assurance Assessment (AQAA) was sent to us prior to this visit that had been completed by the new Manager. Information received from this document, surveys and notifications, information from other stakeholders and the random inspection have all been taken into consideration when writing this report. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The staff need to develop further their daily recording practices to ensure all areas of the care provided is in the daily records. It has improved slightly and social care support is beginning to be included. The care plan formats are too cumbersome and make finding information difficult. Sometimes information is repeated or forms that are not relevant to the person are in the care plans but not filled in. Past requirement have talked of records of medication fridge temperatures not being recorded. This task should be done daily and although the recording has improved it is Care Homes for Older People Page 7 of 28 still not regular. The sitting room chairs are in need of replacing and more suitable chairs purchased to allow those who like to sleep to be able to do so in comfort. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does assess needs prior to placements to ensure the person can have their needs met and does offer information allowing potential customers to choose if this is the correct home for them. Evidence: Since the last inspection the home has updated their information to circulate to potential customers. The AQAA completed by the new Manager also tells us that we welcome people to visit the home, meet the staff and ask any questions about the service we provide. The AQAA also tells us that all potential residents are assessed prior to admission and that the information is used to begin the process of care plan building. These assessments (seen) are held in the residents files and the information recorded appeared appropriate and enables the home to make the decision as to if the service provided can meet the individual needs. Care Homes for Older People Page 10 of 28 Evidence: Contracts are issued to individual residents and were noted in one folder looked at. The AQAA states People who live at Felmingham now have individual contracts for their placement within the home and this is kept in a safe place for them. 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. The home has improved the quality of the information recorded in the care plans and outcomes for the residents seem to have improved. Health care needs are met by the local GP practices. Medication administration is carried out safely but some recordings could be improved. Evidence: The home has made a big improvement in the person centred approach to recording in the care plans. The two looked at were far more descriptive than found six months ago at the last key inspection and gave a good picture of the individuals needs. The one care plan looked at in detail was also the person spoken to and who staff told us about. It was clear the staff knew this person well and were able to offer the care support suitable to her. The formats of the care plans are a bit difficult to follow and do not make easy reading for the staff team. In discussion we were informed that the company is developing new formats to make the care care plans less cumbersome and more user friendly for staff which should improve the value and usage of the care plans. Staff have now been allocated key residents to ensure that detailed needs and continuity of care is ongoing. The key worker has placed their photograph in the Care Homes for Older People Page 12 of 28 Evidence: residents room so that they will be able to recognise their allocated worker. Staff spoken to told us that they have two or three residents they are key worker to and how this has really improved the care for each person. Residents were noted to be suitably dressed and everyone was wearing appropriate clothing suitable for the weather. There were no bare legs and feet as found during previous visits and residents hair looked brushed and tidy. Throughout the seven hour of this visit it was noted that time, dignity and privacy was offered for all personal care tasks. With more staff caring for the 30 people in the home to date no one was rushed. The health care needs of the residents are met by two local GP practice. The AQAA tells us that the referral to the GPs are as proactive as possible and that specialist referrals are made via the GPs. The home is also supported by District Nurses and records of visits are recorded for continuity of care. The continence adviser visits and supports the home with aiming to maintain continence for residents and also ensuring the correct incontinence aids are used. At the last key inspection two people were noted to be in wet clothing and there was an odour in the home. This no longer appears to be the case with all residents observed to be clean and in dry clothing. The home is supplied with the medication for residents by Boots the chemist. They are all in blister packs and administered by the senior on duty. The lunchtime administration process was observed and was carried out unhurried and appropriately. One person was adamant that they did not want their medication after encouragement some time was allowed to elapse when the person was approached again. It was seen in this persons care plan that refusal does happen quite often and that the GP is made aware. The audits were not seen on this occasion but medication administration records were noted to be all correct. Past inspection reports have noted that the fridge temperature charts in the medication storage room have not been recorded regularly and although this has improved it is still not being done daily as required. 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. The home now has the staffing to allow stimulation and activities to be planned and carried out in a suitable and timely manner to ensure social support for residents is available. Visitors are welcomed to the home at anytime. Meals have improved with choices, support and correct food offered to meet the individual needs. Evidence: The home does have an allocated Activities Organiser who works full time hours. At the previous inspection this person was having to cook the meals as the kitchen had no Chef. This visit showed a significant difference. Residents were being encouraged to take part in activities with bingo and then old time cinema. Staff were supporting the activities to stimulate and include as many residents as possible. There were lots of smiles, people who had appeared agitated or shut themselves off with eyes closed at the previous key inspection now appeared involved and interested in their surroundings. Residents who like to wander are looking more relaxed and those who do like to sleep do look tired and are wanting to sleep. Staff are beginning to record Care Homes for Older People Page 14 of 28 Evidence: details of the social lives of the residents and stating which activity suits which person. The Manager tells us in the AQAA that more activity equipment is available and that rummage boxes are now available around the home. One room has been emptied and is to be turned into an old style bar with a shop next door and a sensory area between the two. The Deputy who showed us around the home appeared enthusiastic and gave full details of how soon this project will be in place. Although no relatives were seen during this visit the Deputy has asked the family members to comment on the recent changes within the home as she has received very good feedback and has now asked for this in writing. The home welcomes visitors at all times. Many signatures in the visitors book show the different days and times families and friends do visit. The Manager has also placed her office near the front door and makes herself available when families or friends visit. The home has had problems in the past and requirements were made on the whole mealtime process. This has changed and the home has spent time and thought on the improvement of meals and the environment. After trials in various areas the home has now settled into providing meals in two areas. The people who need support to eat are in the one dining room and people who can manage there meals themselves are in another. The home has a large number of people who need help with eating and on the day of the inspection 8 staff members were sitting at tables of four supporting two people on each table with their meal. Pleasant and encouraging conversations were overheard as the meal was served by kitchen staff that offered choice, finger foods and pureed meals as required. It was noted how well the domestic and laundry staff stop their chores, joined the care staff and helped out with the meal activity. Words of encouragement were constantly heard and what was placed on the spoon/fork was described to the person before it was offered. The whole meal process was calm and appeared to be enjoyed. The second dining area where approximately 12 people were sitting were enjoying their meals in a much calmer manner than before. Two residents had bowls of finger food where they sat in the lounge, and ate everything and were then offered more. At the last inspection one of these residents had been very distressed but was now offered food in a way that suited her needs and who appeared calmer and happier. The Chef was spoken to who now has a full quota of staff to ensure the home can offer meals appropriate to the needs of residents. It was noted the way food was pureed individually for one resident to allow the flavours and textures to be tasted and how the fish was offered as fishcakes to those who prefer to pick up food. The pudding was tart and custard so those who preferred could pick up the tart if required or offered help with the custard or yoghurt. The kitchen staff now serve the food in each dining area allowing residents to see the food when making choices. The Deputy Care Homes for Older People Page 15 of 28 Evidence: Manager also informed us that pictures of food, that will be laminated, are being prepared so residents can picture the food when making choices. 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. The home will act on complaints and concerns as stated in there policies and procedures ensuring that everyone in the home is listened to and the complaint is acted upon. Residents are cared for by safe hands but knowledge of safeguarding could be improved for all staff. Evidence: The home has not received a complaint since the new Manager has been in post (July 2009). Prior to this the Commission was receiving calls of complaint. The new Manager met the complainant within the first week of being in post, listened to the concerns and rectified them. No further complaints have been received. The AQAA tells us that complaints will be listened to and acted upon whether formally or informally and this appears to be correct. This document tell us that records are kept within the home no matter how small the complaint/concern may appear to be. The home does ensure that staff are POVA and CRB cleared before allowing them to work in the home. This was evidenced on the arrival of two new staff since the last inspection who have the relevant checks completed. The home does offer training on the safeguarding of vulnerable adults but some of the staff have not completed the training in the past 12 months. The records show only 20 of the 33 staff employed at the home are up to date with this training. To ensure all staff are up to date with their Care Homes for Older People Page 17 of 28 Evidence: knowledge this training needs to take a priority for staff who are behind with their training. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is improving the environment slowly but still has a distance to go to ensure the home is suitable for people with dementia. Evidence: A tour of the building took place and the home environment is beginning to improve. Parts of the home have been decorated in colours that are more suited to people who live in this home. The lighting has much improved and allows safe movement around the home for older people who need suitable bright corridors. The signage to direct people is still not in place and will be added as areas of the home are completed. The gardens are looking overgrown, especially at the back of the property. The Maintenance Officer position has been vacant for some time and another officer from another home is covering 2 days per week. The home does require more hours for all jobs to be done both inside and out the home. Residents rooms appeared clean and fairly tidy and no unpleasant odours were detected. The home now has in situ a good quality carpet shampooer and rooms are cleaned thoroughly. The laundry now has systems in place to ensure soiled linen is handled correctly and as instructed, follow procedures for infection control. Previous concerns regarding clinical waste in bathrooms has been addressed with suitable containers and yellow bags inserted that are emptied regularly as stated by the Care Homes for Older People Page 19 of 28 Evidence: Deputy Manager. No bins were overflowing and nothing was on the floor as was found at a previous inspection. Residents have the opportunity to bring in small possessions to make their rooms homely and personal. Some of the surroundings around the vanity units in the bedrooms are very knocked/chipped and missing trims making some areas difficult to clean and looking shabby. The main bathrooms are improving and one new assisted bath is about to be commissioned and then ready for use. Some of the lounge chairs are in need of replacing that appear stained and also very upright. People who fall asleep slump forward or over to the side due to the very straight backs of the chairs. The home does posses hoists and a number of transfers were observed in the lounge. Some of the equipment is old and although serviced regularly, it was noted that the pump style hoist was not allowing a smooth lift action and was a little distressing for the resident. Electric hoists allow much smoother transfers and should be less distressing and considered as a purchase for this home. 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. The staffing levels have improved and residents are now cared for by an adequate staff compliment. Staff are recruited correctly by suitable policies and procedures to ensure that residents are cared for by suitable people. The training for staff could be improved to ensure staff are fully up to date with their knowledge and competencies. Evidence: On the day of this inspection there were 7 staff on duty. One Deputy and 6 carers. Throughout the visit no one appeared rushed, residents appeared calmer and presented well. The kitchen is now fully staffed and improving the meal provision.The domestic team are in place and able to do there job more thoroughly. There is an Activities Organiser working full time in this role and residents have the opportunity to participate in activities more often than in the past. The Deputy Manager informed us that the home will not let gaps in the rota happen and that all A/L and sickness is covered by the homes staff or agency. The two staff spoken to in private both said that the staffing level and morale was much improved and that the team were now getting some job satisfaction from their role which up Care Homes for Older People Page 21 of 28 Evidence: until a few months ago was not happening. The Deputy informed us that she will not let the levels of staffing fall and it was discussed that if the numbers of residents does increase then the staffing numbers will also need to increase. Although the NVQ certificates were not seen, the two staff spoken to told us of their qualifications gained. The training matrix of the 2nd October 2009 shows 8 staff have obtained their NVQ 2 award. 3 staff are in the process of gaining the qualification. 1 person has an NVQ 3 and another has just started. The home does need to increase the numbers of staff qualified as 8 is only a third of the care team with this recognised qualification to date. Recruitment procedures are robust and are carried out fully. The Manager was contacted after this visit to discuss the procedure fully. Two new staff who had been recruited recently do have POVA checks and CRBs with two suitable references held on their personnel file. This was also confirmed by the homes Administrator. The training statistics on the homes training matrix is a little behind in ensuring the annual training is up to date. The Fire Safety training shows only 39 of staff are up to date with this topic. Overall, on looking at the statistics, over the nine subjects covered for all staff 144 dates were current, 39 dates were due before the end of the year and 80 dates were already overdue. The training matrix makes the overdue dates easy to see as it highlights in red. A concentrated effort now needs to be in place to bring the training for all staff up to date. The home has been developing the Yesterday, Today and Tomorrow training with only a very small number left to finish, with plans to take the remaining staff to another home within the company to complete the course in the next few weeks. Some Senior staff are also taking part in further training at Otley College to increase their knowledge further on caring for people with dementia. 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 management of the home is improving but to ensure continuity of these improvements and to gather further information about the quality of the service from people involved in the service, more time is needed to see ensure positive outcomes continue. The health and safety of residents and staff is promoted and protected. Evidence: The new Manager has only been in post for a few weeks and has already made an improvement within the home. It is very early days to prove the ability of this person but already it shows a positive and better outcome for residents. This person does have a lot of management experience and although holds a Diploma in Health care Management is also about to undertake the NVQ 4 in care management. The application for registering as the Manager with the Commission has already been submitted and staff are saying that morale has improved and that they are able to talk Care Homes for Older People Page 23 of 28 Evidence: to the new manager and are listened to. To date there is limited information on the quality of the service in the home and more effort is required to gather, collate and develop the service to improve the outcomes for residents. A few surveys regarding the quality have been returned and the Deputy Manager has asked families to give some written feedback on the service. As the home has been through three changes of management in the last two years time is required to see the development and improvement. The Manager and Administrator were both absent during this inspection so the residents financial records were not seen on this occasion. In the past all records have been audited by a Southern Cross Manager and financial procedures have been noted to be followed and there have been no concerns about records kept or money held in safe keeping for the residents. Records of dates and notes from meetings are beginning to be kept of staff supervision sessions. The two staff spoken to told me that the meetings are minuted and also confirmed that training development discussed had been listened to and actioned. The home has procedures in place to ensure the home is working safely. Records of training under health and safety such as infection control, fire safety, food hygiene and first aid are carried out by staff but some do need to be updated. The home has a good star rating from the Environmental Officer which the kitchen staff hope to maintain. Areas in the kitchen are being covered with a surface that is wiped easily, within the week following the inspection, to maintain hygienic practices. The domestic staff have access to all the safety data sheets of the cleaning chemicals used in the home and all chemicals are stored in a locked cupboard. Water temperatures were checked in three different areas around the home and were running at a suitable temperature. Although the home is without a Maintenance Officer at present, two days a week is covered by a trained Officer from another home and records are made of maintenance checks throughout the home. Some servicing of equipment information could not be found as the home is in the middle of moving all the offices to other rooms in the home and with the Manager and Administrator away these were not seen on this occasion but have been seen and were up to date at previous inspections. Care Homes for Older People Page 24 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 25 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 1 9 13 The staff must ensure that fridge temperatures that store medication, although improved are recorded daily Residents must have medication stored on their behalf at a safe temperature. 01/11/2009 2 30 18 The home should ensure that the training according to homes matrix is met in the timescales expected. To ensure that staff competencies and skills are up to date as dictated by the companies procedures. 01/01/2010 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 22 The home should consider purchasing a more up to date electric hoist to ensure the transferring of residents is Care Homes for Older People Page 26 of 28 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 carried out as smoothly as possible. 2 3 28 31 It is recommended that the NVQ qualifications of staff are increased now a larger staff team is in the home. The resources, environment and support needs to continue to improve, to ensure the quality can not only be provided in the short term but also maintained. 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. 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