Care Home: Forest Manor Nursing Home

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What the care home does well Specific people at the home have had a review of their pre-assessment information as requested by the Commission, this is to ensure that the staff will be able to meet their needs. People are provided with the care support that they need through the provision of specialist equipment to support people`s physical needs. Nurses and care staff are provided to meet peoples assessed needs to cover a twenty four hour period of care. A review of the rota has taken place to ensure the skill mix and number of staff at the care home to meet people`s assessed needs. A complaints procedure is in place and available through out the home. Concerns and complaints are taken seriously and staff are aware of the procedures for this. A process of redecoration and modernising of the home has taken place. People are encouraged to personalise their rooms and a safe working space for staff to work in is provided. Comments on care from people at the home included: ` The home is kept clean and fresh` and that they `liked their bedroom`. Relatives comments included: `Staff have patience with each individual.` `Staff are very approachable.` `It is a nice place, with lovely bedrooms.` What has improved since the last inspection? A review of the care plans has taken place to show that the person or their representative has been involved. In the improvement plan returned by the provider we are told that a new hoist and three additional slings to ensure sufficient equipment is available to meet the needs of the people at the home has been provided. In the improvement plan we are also told that : `Medication training has been provided for senior care staff so that they can administer medicines to people in the residential category and that competency assessments were carried out prior to them undertaking administration of medicines. A weekly medication audit is undertaken by the project manager. This also includes checking that medications will not run out of stock.`Senior managers have been observing care practises to ensure that personal care is delivered with dignity and that no further episodes of personal care is delivered in a communal area. The inclusion of more one to one activities for anyone who needs this. Pre-booked entertainments are encouraged to provide entertainment within the home for people who are unable or prefer to remain within the home. There is now greater involvement by the Cook to ensure that specialist dietary needs are met. A review of meal times has taken place to ensure that meal times are better spaced out with snacks between meals such as fruit being better promoted as part of this choice. Training for staff has been revised and implemented in Moving and handling, Protection of Vulnerable Adults, bed rail management, wound care management with one nurse to become the nurse that attends meetings and acts as a link person between the home and the Tissue Viability Nurse specialist in the community. Staffing levels have been reviewed to meet the assessed needs and when greater occupancy to be a minimum of two Registered nurses, one senior carer and three care staff between eight in the morning to eight in the evening. At night there will be one nurse and three care staff.` There has been an appointment of a new acting manager who has held a similar position with the Commission in a different care home. It is expected that he will apply to become the registered manager for this care home. What the care home could do better: The acting manager should seek registration approval with the Commission. This will help to maintain the growing confidence in the service. Key inspection report Care homes for older people Name: Address: Forest Manor Nursing Home Mansfield Road Sutton In Ashfield Nottinghamshire NG17 4HG     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: Lesley Allison-White     Date: 0 9 1 1 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 29 Information about the care home Name of care home: Address: Forest Manor Nursing Home Mansfield Road Sutton In Ashfield Nottinghamshire NG17 4HG 01623442999 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hallmark Healthcare (Sutton in Ashfield) Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 40 The Registered Persons may provide the following categories of service only: Care Home with Nursing - Code N to service users of the folowing gender: Either whose primary care needs on admission are within the following categories: Old Age, not falling within any other categoriy - Code OP Dementia - Code DE Physical Disability Code PD Date of last inspection Brief description of the care home Forest Manor Nursing Home provides personal and nursing care to older people, people with a physical disability and people with dementia. The home is situated between the town centres of Mansfield and Sutton in Ashfield. Care Homes for Older People Page 4 of 29 Over 65 0 40 0 40 0 40 1 1 0 5 2 0 0 9 Brief description of the care home The home has a well-maintained patio and garden area and car parking space. There are three lounges and a spacious dining room. The home has 36 single bedrooms and 2 shared bedrooms. None of the bedrooms have en-suite facilities. People who need wheelchairs to get around can access all areas within Forest Manor. Mobility aids are available such as hoists, transfer belts and strategically placed handrails. A wheelchair accessible shower and bath area is available. A vertical lift is also available to allow easy access to the first floor of the home. Information about the home, including the Care Quality Commission (previously known as CSCI) inspection reports, is available in the main entrance area of the home, or from the acting manager. The fees currently charged range from £294 to £594 per week. There is an extra charge for hairdressing and podiatry services. 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: This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people using the service and their views on the service provided. The last key unannounced inspection was 11th May 2009. Prior to the visit an analysis of the care home was undertaken from information gathered including information from the Annual Quality Assessment completed by the provider. Surveys were not sent out. Other information was also used as part of the evidence gathered. The process considers the providers capacity to meet regulatory Care Homes for Older People Page 6 of 29 requirements, minimum standards of practise; and focuses on aspects of service provision that need further development. The site visit lasted 5 hours and the main method of inspection used was case tracking which involved looking at the records of two people in detail and tracking the care they received by checking their records and discussing this with them where possible. There was a total of nine people living at the care home. One person was on on holiday with their family and there were two younger adults in the home at this inspection with primary need of Physical Disability under 65 years of age. We spoke with four other people who either received care or were relatives or visitors of people who receive care at the home. We spoke with the acting manager and five staff members as part of this visit. We observed care practises to see how staff interacted with people at the home and triangulated other evidence to help us make judgements about how well the service is meeting peoples individual needs. The premises was not inspected in detail but there was evidence of security to ensure that confidential information is protected and that people at the home are made safe. The Employers liability certificate and the Registration certificate was seen and satisfactory. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? A review of the care plans has taken place to show that the person or their representative has been involved. In the improvement plan returned by the provider we are told that a new hoist and three additional slings to ensure sufficient equipment is available to meet the needs of the people at the home has been provided. In the improvement plan we are also told that : Medication training has been provided for senior care staff so that they can administer medicines to people in the residential category and that competency assessments were carried out prior to them undertaking administration of medicines. A weekly medication audit is undertaken by the project manager. This also includes checking that medications will not run out of stock. Care Homes for Older People Page 8 of 29 Senior managers have been observing care practises to ensure that personal care is delivered with dignity and that no further episodes of personal care is delivered in a communal area. The inclusion of more one to one activities for anyone who needs this. Pre-booked entertainments are encouraged to provide entertainment within the home for people who are unable or prefer to remain within the home. There is now greater involvement by the Cook to ensure that specialist dietary needs are met. A review of meal times has taken place to ensure that meal times are better spaced out with snacks between meals such as fruit being better promoted as part of this choice. Training for staff has been revised and implemented in Moving and handling, Protection of Vulnerable Adults, bed rail management, wound care management with one nurse to become the nurse that attends meetings and acts as a link person between the home and the Tissue Viability Nurse specialist in the community. Staffing levels have been reviewed to meet the assessed needs and when greater occupancy to be a minimum of two Registered nurses, one senior carer and three care staff between eight in the morning to eight in the evening. At night there will be one nurse and three care staff. There has been an appointment of a new acting manager who has held a similar position with the Commission in a different care home. It is expected that he will apply to become the registered manager for this care home. 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 9 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 10 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. People have an assessment made prior to being admitted to the care home. Assessments are now completed and followed up by the staff to ensure that they can meet peoples needs. Evidence: There is a new acting manager who works with the guidance of other health care services to improve the well being of people at the home. The Service User Guide and Statement Of Purpose is available in the main entrance to the home and in individual bedrooms. It contains information about the home and what people can expect from services at the home. We case tracked the care of two people. We saw that pre-assessment information about them was present and that Social Services had completed their assessments. Records show that a needs assessment is preformed prior to people moving into the Care Homes for Older People Page 11 of 29 Evidence: home and that their physical, psychological, social and cultural needs and preferences are identified. We also noted that there were improvements in the way that the home went about providing and completing follow up to the assessments so that the home can meet peoples needs. Intermediate cares services are not offered at Forest Manor. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs met as care is delivered to them in an appropriate manner and their privacy and dignity is maintained throughout. Evidence: Care plans were developed from pre-assessment information and risk assessments were in place to support individuals needs such as nutrition, continence, hygiene, use of bed rails, moving and handling, pressure area care or the prevention of it. We saw that care plans were revised to include the opinions of the people wherever possible and that of their families and visitors were recorded in the individual care plan. We saw that there was greater involvement by the home with other agencies such as the continence adviser or the dietitian. We case tracked two people with different care needs. One person was in bed permanently and the other person frequently. Both were in bed but one person was to be sat out of bed during the afternoon in their arm chair. Care Homes for Older People Page 13 of 29 Evidence: One person on bed rest had a catheter and oxygen. The contact details for the oxygen supplied was clearly identified on the container so that it would be easy to find and use in an emergency. This person had a catheter leg bag which was emptied at regular intervals and recorded by staff for example at 12 mid day 500 mils urine. Oral care was given using orange squash. Staff explained that this person does not like water but will take very diluted orange juice on a swab easily this helps to keep their mouth from becoming dry. Drinks provided now state how much each container holds. There was a separate bowel movement chart kept in the room. Recordings were made of the type of bowel movements and amount was recorded so that the care staff could alert the nurse to monitor this aspect of care and well being and reduce the risk of constipation. Fluid balance charts were added up or at least a note was made on the chart. The care plan would identify when not enough fluid has been taken in a 24 hour time period this would alert a nurse to respond as appropriate. There was evidence of the kitchen staff being involved in the welfare of this person when they sent fork mashed food to the room a care staff member would record if the food was eaten and the Cook would make a note in the kitchen if food was not eaten by this person because of the importance attached to food and the need to monitor diet and nutrition and to prevent any further weight loss. Staff seem to be working together to achieve this goal. We spoke with this persons key worker who had identified that they needed something to look at when their position was changed in bed. (A key worker is a member of staff who takes a special interest in a person living at the home. One of their roles is to provide extra friendship to the person and to get to know them better and complete small tasks on behalf of the person). A large colourful item was bought for this person to look at in the room. The next day staff asked what they thought about it they replied its cute. This person did not talk very often but was able to express some of their feelings through their facial expressions. The care records explained that they slept a great deal but that staff should be encouraged to visit them and check on them at no less than 2 hourly intervals. Details about this person was being recorded so that anyone providing care could follow the care plan and meet their needs. The recording of details has improved and the newer care plans also includes an evacuation plan that can be used for emergencies such as fire. Care Homes for Older People Page 14 of 29 Evidence: On the doors where oxygen is used the doors state: caution medical oxygen in here. This tells anyone entering the room that there is an increased risk of fire due to the presence of an Oxygen cylinder. When people on charts are up and about and are assessed to have needs such as the need to monitor fluid intake and output each day care staff now keep the fluid balance chart/ food charts with the individual on back of the wheel chair or near to the persons seat when in the lounge or in the persons bedroom and it moves around with person receiving care and support. We saw body mapping charts that were completed correctly to describe marked areas of the body and where special daily attention was needed. For one person in bed staff recorded that they did not eat well. Staff were aware of their likes and dislikes and had conveyed this to the cook who prepared home made soup most days as they often refused the main meals. The Cook prepared bacon sandwiches which they enjoyed between meals and the care staff assisted them to have them. We saw that people were now referred to the dietitian who visited the home every 6 weeks. Information conveyed by the dietitian was recorded by the staff and acted on. Carers were more involved in writing down peoples needs when they identified them as well as informing the nurse to let them know. We saw that a nutritional assessment as completed, and kitchen input on how food is to be given to this person was recorded in their care record and also on the sheet kept by the staff in the kitchen. This person had fork mashed food, thick and easy added to drinks and nutritional supplements that once opened were refrigerated and staff kept a record when it was given. We saw that the care records for the person in bed explained that they had experienced weight loss sufficient to warrant action to be taken by staff to prevent any further deterioration in this area of their care. This was addressed by various means this included weekly observations and recordings by a Nurse who attended to them each day. Nurses were involved in their daily care and assisted care staff with the moving and handling of this person to ensure that they were handled correctly and repositioned in bed correctly each time. In this way the integrity of the skin was checked each time the person was moved in bed. Food was carefully monitored and supplements were offered in between to ensure that this person had a reasonable nutritional input at each meal time and in between. For people in bed staff now recorded when they visited them including just stopping by for a chat. Care Homes for Older People Page 15 of 29 Evidence: Medicine sheets had photographs of the person on them. This will help staff to identify an individual. This is particularly helpful for new staff working at the home. Allergies were recorded. A Controlled Drug was checked and satisfactory. Controlled drugs are identified by the Government to need special treatment when used. We observed staff at work they were caring and considerate when providing care to the people at the home. They concentrated on the task in hand and spoke with the person that they provided care for. In this way they were seen to demonstrate their understanding of the need to respect the person being cared for at each interaction with them. Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle and experiences of people at the home varies this allows them to be involved in activities inside and outside the homes environment. Staff are available to help individuals who need assistance with eating and make the meal time experience a pleasant occasion for everyone. Evidence: We saw people doing activities that they enjoyed some were painting a picture some people sat making conversation together, others were listening to the activities coordinator read a news paper to them, some people were having their nails painted, someone else was visiting the hairdresser who came to the home. We saw records of the daily activities in the individuals records. People at the home told us that religious ministers visit to conduct services in the home. We saw that staff had documented this in a few care plans. This allows their diversity needs to be met. People told us that they made a choice as to when they decided to go to bed or if they preferred a bath or a shower or what they wanted to wear. For one person their Care Homes for Older People Page 17 of 29 Evidence: choices were shown as to take part in an activity, to sit out or to stay in bed. Different people told us that family and friends were made welcome when they visited. We spoke with the Cook and saw that she had a good understanding of her role. She told us that she felt more involved in the diets of people at the home. We expressed concern that when the home started to have larger numbers of people that she would need help in the kitchen to cope with the special diets she said that she would ask the manager to assist her with any staffing issues. We saw that the food was well presented. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are happy to be at the home. They will go to the staff if they have any concerns and staff have been given appropriate training to help them. There is a complaints procedure and it is easily accessible to people at the home and their representatives. Complaints are dealt with by the home in a satisfactory manner. Evidence: People who spoke with us said that they were happy to be at the home and that they would go to the staff if they had any concerns. The AQAA tells us that a : Have your say representative is allocated to each person receiving care who may ask for representation at resident meetings because they may not be able to attend. A key worker and a nurse is allocated to provide care for a specific person at the home. There is a complaints procedure and it is displayed in the foyer of the home and people at the home and their representatives are given the complaints procedure Care Homes for Older People Page 19 of 29 Evidence: within the Service User Guide. Records show that complaints are dealt with by the home in a satisfactory manner. We spoke with a person living at the home and a visitor to the home who confirmed that they were aware of the complaints procedure and that the procedure had been made available to them within the Service Users Guide. One of the people case tracked said that they felt safe within the home, and should they have any concerns or complaints they would feel confident in discussing them with any member of staff. A visitor to the home also said that they felt confident that should they have a complaint or concern it would be addressed effectively and would go to the acting manager. The Care Quality Commission has not received any further complaints since the last report of 11 May 2009. We looked at training records to see if staff have had recent training in relation to Safeguarding Adults they had, and then spoke with staff who were able to confirm this. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe and hygienic environment that meets their needs. Evidence: We saw that the home had been decorated and was clean, hygienic and tidy and well maintained when we visited. Lift access is available to all floors and a range of mobility aids are available such as handrails, walking frames and hoists. Window restrictors and radiator protectors are evident, together with nurse call alarm systems to ensure that staff can attend to peoples needs over a 24 hour period. People at the home told us: the home is kept clean and fresh and that they liked their bedroom. 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. The skill mix and numbers of staff is meeting the needs of the people who live at the home. In this way individuals are no longer being put at risk. Evidence: We observed staff having a handover report at the change of shift for staff. This ensures that information about individuals at the home is passed on to the next staff team. Important information can then be conveyed in this direct way. We looked at the rota and saw that there was one Nurse per shift and two care assistants plus the activities coordinator, a cook, a domestic, maintenance person and manager. At night there was one nurse and one care staff. We spoke with a visiting health care professional (giving a flu injection to someone at the home, who said that the carer that assisted her was both helpful and knowledgeable and that she was happy give her care instructions when necessary and that staff at the home would carry them out if required to do so. We saw care records that identified an allocated named nurse for each person who needed nursing care. This nurse is responsible for ensuring care plans are kept up to date, to liaise with family members about the care provided and to inform family members when other health care professionals such as the Doctor or specialist nurse appointments and visits have taken place. Care Homes for Older People Page 22 of 29 Evidence: Each person also has a key worker who is responsible for ensuring that documents are kept up to date and that toiletries do not run out and to help keep personal belongings tidy. Staff told us that they have received a lot of training in different areas of care and the privacy and dignity training emphasised. They have been reminded to knock and wait at a door before entering, addressing people by their preferred name, providing care with respect and attention and providing privacy at all times. We saw records of training in many areas including privacy and dignity. We saw that the new manager has completed his checks of the Personal Identification Numbers (PIN)on each of the nurses at the home and keeps a list as a reminder for when the yearly updates for PINs are required. Each nurse works under a specific number that is held on a register by the registering authority for nurses called the Nursing and Midwifery Council (NMC). Since the last inspection in May 2009 the following training has been provided for staff. This includes a refresher training in gastric feeds management, care documentation, medication training, bed rail management, Vulnerable Adults, Moving and handling, wound care management with one nurse to become the nurse that attends meetings and acts as a link person between the home and the tissue viability nurse specialist in the community. In the improvement plan we are told that : Medicaton training has been provided for senior care staff so that they can administer medicines to people in the residential category and that competency assessments were carried out prior to them undertaking administration of medicines. A weekly medication audit is undertaken by the project manager.This also includes checking that medications will not run out of stock. Senior managers have been observing care practises to ensure that personal care is delivered with dignity and that no further episodes of personal care is delivered in a communal area. The inclusion of more one to one activities for anyone who needs this. Pre-booked entertainments are encouraged to provide entertainment within the home for people who are unable or prefer to remain within the home. Greater involvement by the Cook to ensure that specialist dietary needs are met and a Care Homes for Older People Page 23 of 29 Evidence: white board has been provided to act as a reminder of the diets for all staff to see. A review of meal times has taken place to ensure wider choices of snacks between meal times. Snacks between meals includes the promotion of fruit as part of this choice. Further training for staff has been revised and implemented. We spoke with staff who were able to explain their induction process and had records of this. We spoke with the new manager and the details for his recruitment was available we saw that he had a full and enhanced Criminal Records Bureau (CRB) check and it was satisfactory. The senior managers were able to confirm that other aspects of the recruitment and appointment of the new manager had been followed. Visitors comments included: Staff have patience with each individual. Staff are very approachable. It is a nice place, with lovely bedrooms. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements within the management of the home allows people to live in a happy and safe environment. Confidence in the service will be sustainable once the acting manager is registered with the Commission. Evidence: Visitors comments included: It is a nice place, with lovely bedrooms. Residents comments included: the home is kept clean and fresh I like my bedroom Peoples monies and valuables held in the home is it kept secure with appropriate records of transactions maintained Regional audit checks are also carried out. We saw that fire checks had been recorded and that staff had been involved in a fire drill recently. Although there were nine names on the fire drill list none of the staff Care Homes for Older People Page 25 of 29 Evidence: were night staff. It is important that the night staff receive fire instruction at regular intervals. Staff said that they knew where the polices were kept and had access to them when needed by them. Opportunities are available for people to give their views and opinions about how the home is run. The Annual Quality Assurance assessment informs us that: Quality assurance systems are in place and the findings are used to inform the annual business plans. We would expect that the acting manager becomes the Registered Manager for this service to improve confidence in the service. Regulation 26 visits (these are visits by the provider to the home to check that standards are being adhered to). We saw copies of Regulation 26 visits by the provider where Regional managers made unannounced observations of care practise at the service. These are a legal requirement for the provider to visit and make records of the home to ensure that standards are being adhered to. The improvement plan was returned when we asked for it and was available at inspection also. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 9 The acting manager should apply to become the registered manager. This will ensure that confidence in the service is maintained. 31/05/2010 2 38 13 All staff must receive regular 26/02/2010 instruction in fire safety. This will ensure that all staff will know what to do in the event of an emergency such as fire. 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 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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