Care Home: Four Acres

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What the care home does well The home has an up to date and informative Statement of Purpose and Service User Guide to assist people in making a choice about whether to move into the home or not. The majority of the surveys said that they had been given sufficient information to do this. Each of the three care files looked at included a pre-admission assessment that informed the home of whether they would be able to meet the person`s needs or not. Completed risk assessments were in place for the development of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area). Other risk assessments were in place for nutrition, moving and handling and individual risks. These would assist in minimising any risk in these areas. All the surveys returned to us answered "Always" or "Usually" when asked if they received the care and support needed. All people spoken with and who answered the surveys said that they enjoyed the meals at Four Acres. The `Focus on Mealtimes` project launched at the home showed that the provision of a nutritious choice of meals and meaningful mealtimes were important to the home. This was further evidenced in the varied menu. The people on the dementia unit were occupied and the atmosphere was lively and stimulating. Tactile, interesting and nostalgic items were displayed in the corridors to offer sensory information, points of interest and reminiscence. Visiting was at any reasonable time and comments made by residents spoken with and in the surveys showed that visitors were made welcome and their needs considered. All bedrooms looked at had been personalised by the occupants` belongings such as photos, pictures and ornaments and were able to bring in their own furniture and decorate and carpet their room at their own expense. The home was free of any offensive odour and all areas visited were clean. This was further confirmed in the surveys returned to us. The laundry was clean and well organised. Infection control measures were in place throughout the home. There were sufficient care staff provided to meet the needs of the people living and staying at the home. Comments made in the surveys about the staff were positive. Health and safety practice safeguards people living and working at the home. What has improved since the last inspection? Medication was audited at regular intervals and the medication system had generally improved, thus safeguarding the residents` health and welfare. There had been redecoration of some bedrooms and the replacement of some flooring. This and the removal of some clutter added to the comfort of the home for the people living and staying there. Residents now had better access to their money that was held by the home on their behalf and were encouraged to look after their own money where possible. What the care home could do better: One of the three pre-admission assessments looked at was not dated or signed by the assessor. All documents should be verified by signing and dating. Not all the care plans looked at reflected the current or specific needs of the individual as were shown in the reviews, in monitoring forms or as was known by staff. This information needs to be recorded on the care plans to ensure that needs are met. The home continued to wait for the medication policy being revised by the organisation although the manager advised us that this was about to be implemented. Not all eye drops had been dated on opening. This is necessary as the need to be discarded after 28 days. The manager should monitor that there are sufficient and appropriate activities provided for all the people living at the home as some comments in the surveys were in conflict with other evidence available. Some staff rotas did not show the employee`s name and/or designation. It is considered good practice to do so. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Four Acres Archer Close Studley Warwickshire B80 7HX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Beadsworth     Date: 1 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Four Acres Archer Close Studley Warwickshire B80 7HX 01527853766 01527853766 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Warwickshire County Council, Adult Health & Community Services care home 35 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Four Acres may also coare for a resident named in the care plan attached to the variaiton application dated 19th October 2005 Services users assessed as requiring dementia care to be admitted only to the dedicated unit identified as `Warwick`. The entrance and exit doors to the dementia unit must have a discreet alarm system fitted so staff are aware when service users leave the unit (1st January 2006) The garden to be used for the service users admitted to the dementia unit should be made safely accessible and stimulating for service users with dementia (July 31st 2006.) The total number of residents accommodated will be 35 to include up to 11 service Care Homes for Older People Page 4 of 30 Over 65 11 35 0 0 users assessed as requiring dementia care. Date of last inspection Brief description of the care home Four Acres is a Local Authority home for elderly people, with thirty-five beds. It provides permanent care, short stays and day care. The home is situated in the village of Studley, which has a variety of shops, churches, public houses, social clubs, a library and community centre. There is a regular bus service to Redditch town centre. The home provides accommodation on two floors. There are four units, one of which provides short stay or respite care, and one of which provides care specifically for people with dementia. Each unit has a lounge/diner with kitchenette, and there are additional communal areas, including two conservatories, on the ground floor. The home has a hairdressing salon. On each floor there are bathrooms and lavatories suitable for people with physical disabilities. The kitchen, laundry and staff offices are situated on the ground floor. There is a shaft lift to the first floor. At the time of the inspection the fees charged were in the range #98.60 - #388.87 per week. The fees do not include newspapers, toiletries, chiropody or hairdressing. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to Four Acres. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment, (AQAA), which is a self assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Ten surveys were sent to service users. Nine were completed and returned to us. Information contained within the AQAA, in surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting or observing them, talking to their families, (where possible), about their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents Care Homes for Older People Page 6 of 30 care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of some policies and procedures, discussions with the manager, staff and residents. The inspection visit took place between 12:15pm and 08:30pm. What the care home does well: What has improved since the last inspection? Medication was audited at regular intervals and the medication system had generally improved, thus safeguarding the residents health and welfare. There had been redecoration of some bedrooms and the replacement of some flooring. Care Homes for Older People Page 8 of 30 This and the removal of some clutter added to the comfort of the home for the people living and staying there. Residents now had better access to their money that was held by the home on their behalf and were encouraged to look after their own money where possible. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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. Information required to make a decision about choice of home is available when needed. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Evidence: The home had a Statement of Purpose and Service User Guide that had been updated for 2008/2009 and which contained the required information, including the fees for staying or living at the home. The documents were illustrated and included photographs of residents carrying out various activities. The AQAA told us that this documentation had been given to Warwickshire County Council social work team to ensure that they had accurate and up to date information about the services provided. Having this information would assist them in whether it was appropriate to refer a person to the home or not. Care Homes for Older People Page 11 of 30 Evidence: The majority of the responses in the surveys returned to us said that they had been given sufficient information before moving into the home, or that they had previous experience of the home. Referrals are made to the home by the social work team and no direct referrals are taken. An assessment is carried out by the social worker and following referral the senior staff of the home visits the person in their current location in order to carry out a pre-admission assessment in order to assess if the home could meet the persons needs prior to offering them a place at the home. Three care files were looked at as part of the case tracking process. Each had a preadmission assessment that had been all the appropriate heading and all medical conditions and needs were identified. There was sufficient detail to decide if the home could meet the persons needs or not. One of these assessments was not dated or signed by the assessor. A letter informing the person of the outcome of the pre-admission assessment was sent by the home and a copy of this was seen on their file. Care Homes for Older People Page 12 of 30 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. Care plans are detailed but with some omissions of information. Residents have access to health care professionals and are cared for in a respectful manner. Residents health and welfare are safeguarded by the homes medication procedures and practices. Evidence: The AQAA told us that the home had been working at improving the care plans by reducing the bulk of paperwork that had made it difficult to be able to extract information when needed. Discussion with the senior staff and observations showed that with the other Social Services care services they were continuing to review the care plans and were looking at alternative models. Three care files were looked as part of the case tracking process. These were easier to extract information than previously, partly due to the organisation and partly due to there being less repeated documentation. Care Homes for Older People Page 13 of 30 Evidence: The care plans included detailed information but two of them did not reflect the current or specific needs of that person. Reviews had been mainly carried out on a monthly basis but not all up to date information had been transferred to the care plan. One resident had been identified as having a pressure sore but the treatment for this or instructions regarding prevention of further sores developing were included in the care plan. However appropriate care, preventative measures and monitoring charts were in place. This person had also been seen by the GP for soreness that was considered appropriately recorded in the sensitive section of the care file but not on the care plan. Observations and discussion showed that a second person had become too frail to have a bath or shower and although the bathing records continued to state the person had a shower the daily records showed that they had a bedbath. This person had increased contact recordings in their room, which meant that each time a member of staff went into the room they recorded any observation or any care given. Records for falls, pressure areas, weight and bathing nail checks were in place within the files looked at. Completed risk assessments for tissue viability in relation to the development of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area), manual handling nutrition and nutritional screening were also in place. These would help to minimise any risk in these areas. Individual risks were also assessed and records in place. Risk assessments had been reviewed monthly. These would help to minimise any risk in these areas. Preventative measures such as pressure relieving mattresses and cushions were in use for those people at risk of developing pressure sores. All responses in the surveys were Always or Usually, or did not tick any of the responses, to the question, Do you receive the care and support you need?. The following comments were added, I have all the care I need. When I ask for help they give it. I have had my room adapted and a hoist put in. One person who did not answer the question but in a comment said, Its not as good as it could be. Sometimes the meals are late and the tea (to drink) is not hot. Another person who answered Usually also added, Care Homes for Older People Page 14 of 30 Evidence: To a certain extent but there are gaps, quite big ones but by and large, yes. Neither of these people wanted to speak to an inspector and therefore the comments could not be pursued with them. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician and chiropodist being identified in the care files looked at. Residents spoken to confirmed that they could see the doctor if they wished and that they had visits from the chiropodist, optician, district nurses and other health care professionals when necessary. When asked in the surveys if they received the medical support that they need everyone answered, Always to Usually and some comments were added to further confirm this. One person was less sure and said that they felt there should be a set time when a doctor was available if needed. The medication system was inspected. The AQAA had informed us that medication reviews had been held since the last inspection, which had resulted in a reduction in the amount of medication used in the home. It also told us that the home had introduced monitoring of the medication administration process. The medication system was inspected. The home had recently changed pharmacists. Most of the medicines were supplied in a monitored dosage system where each medicine is dispensed in a blister pack from which to administer on a daily basis and stored appropriately and safely in a trolley and medicine cupboard on each of the four units. The home had a medication policy but was still waiting for the version being revised by the organisation for over a year. However the manager said this was about to be implemented. Medication Administration Record Sheets (MARS) were inspected. Records and discussion showed that these were checked at each handover by senior staff to ensure that there were no inappropriate gaps or codes used. An audit on the number of tablets remaining in original packaging was also carried out at intervals during the day. An audit of medication in original packaging was carried out and all tablets remaining balanced with the records. Not all eye drops had been dated on opening. This is Care Homes for Older People Page 15 of 30 Evidence: necessary as they need to be discarded after 28 days when they can become unstable. All staff responsible for medication had undertaken medication training. Evidence of further in house training on the use of MARS was seen on flip charts left out following a recent session. A member of staff spoken with regarding the medication showed a good awareness and knowledge of medicines. Care Homes for Older People Page 16 of 30 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. Stimulating activity was available for the people staying at the home. Visitors were made welcome and their needs considered. Residents had choices and control, over their daily lives. Residents enjoyed the nutritious and varied meals provided. Evidence: The home had a designated activity organiser. The AQAA gave a list of some of the planned activities provided in the home and photos and other evidence were on display in the home showing some of these, such as the Four Acres Olympics (where the residents and staff had their own version of the Games and of which a DVD had been made to share with relatives and friends that had not been there), arts and craft, baking sessions and tea parties. The manager also told us about the butterfly training that staff had undertaken which would give them the skills to be able to interact with residents in a meaningful way and that offers residents with dementia frequent and regular brief episodes of occupation with the aim to improve their quality of life. Trips out also took place and residents had recently been on a trip to see the Christmas lights. The people on the dementia unit on the ground floor were occupied and there was an active and stimulating atmosphere. Tactile and interesting objects were displayed on the walls to give interest and sensory information to the people living on that unit. Care Homes for Older People Page 17 of 30 Evidence: Observation and discussion showed staff interaction with residents to be good and took place not just to meet personal care, but also to meet a social or recreational need. Only one person said that there was Always activities arranged by the home that they could take part in, with the remainder answering, Usually, Sometimes or Never. The person who answered Never also added that they were bedridden. It is necessary for activity or occupation to be available to people in bed. Other comments added in the response to this question were, play dominoes and theres a dart board. Dont do them on a regular basis, I suppose I join in when they have them. Activities in the lounge. Depends who is on duty. Yes, not many but some. Prefer to stay in room, own company and a book. A notice was displayed on the notice board to inform residents and their visitors of forthcoming events. Visiting was at any reasonable time and residents said that their visitors were made welcome. One of the residents commented in a survey, Very accommodating to visitors, providing meals for them and cups of tea. Observations made and discussion with residents showed that people living and staying at the home had the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat and where to spend their time. The manager told us in the AQAA and in discussion about the recent Focus on Mealtimes project which had been launched in order to give the people living at the home more meaningful mealtimes and a balanced and nutritious choice of meals. It was evidenced from this that the home is giving positive mealtime experiences a high profile. The home had a menu that offered a choice of varied and nutritious meals. Staff asked Care Homes for Older People Page 18 of 30 Evidence: residents at breakfast what their choices of meals were. Any sandwiches at tea time were made by the care staff and assisted by residents in order to give them some independence and self esteem. Everyone answered in the surveys that they Always or Usually liked the meals at the home and the following comments were made, Pretty good, always a choice. I enjoy the meals. Care Homes for Older People Page 19 of 30 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. The home has appropriate practices in addressing complaints and policies and procedures to safeguard residents. Appropriate training has been undertaken by staff. Evidence: A copy of the complaints procedure was displayed in the reception area. A box was also in the reception so that anonymous complaints, compliments or suggestions could be made. People spoken with said that they knew who to talk to if they had any concerns. One person answering the question in a survey, Do you know who to speak to if you are not happy. said, Not always. Not really because the carers are not high enough, though there is usually someone in the office, but it is difficult. I would like one or two more in authority to speak to. Other more positive comments included, Yes, get on well with keyworker but its not often I see her. Yes, Id speak to (care officer). Id speak to any of the carers or keyworker. Care Homes for Older People Page 20 of 30 Evidence: Depends if people are busy, then theyll say come and see me later for a chat. However all survey respondents answered, Yes to whether they knew how to make a complaint. A complaints log was maintained as in line with the organisations procedure. There had been four complaints made to the home since the previous inspection and each had been addressed appropriately, showing that complaints were taken seriously and people were listened to. The AQAA and records looked at told us that staff have undertaken training related to safeguarding (protecting against abuse). The training provided by the organisation is relevant to the role of the employee and what part they would play in the action taken if abuse was suspected or witnessed in the home. These systems indicated that the people living at the home were safeguarded from abuse. As a Social Services home the Local Authoritys safeguarding policy and procedure were in use in the home. The manager and other people spoken with had an understanding of the types of adult abuse and what to do if they suspected or witnessed abuse. Information about adult abuse was displayed in the reception area. Recruitment procedure and practice protected residents from the employment of unsuitable people. The financial procedures viewed safeguarded the financial interests of the residents. Care Homes for Older People Page 21 of 30 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. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour and safe and well maintained. Infection control is maintained. Evidence: Four Acres is located in a quiet cul-de-sac. It has gardens at the sides and rear of the building, with a secluded area at the back that can be accessed by everyone using the service. All areas of the building can be accessed by means of a passenger lift. The home offers accommodation over two floors and is divided into four units each offering a small group living area. One of these units is a specialised dementia unit based on the ground floor. A second unit on the ground floor caters for four short stay service users. The other two units are on the first floor and caters for nineteen permanent residents.The lounges and dining areas were decorated and furnished to a good standard and looked comfortable and homely. As was said in the AQAA it was evident that the home had disposed of clutter making the surrounding more comfortable. Some flooring had been replaced and some bedrooms redecorated. There is a large conservatory that is currently used by staff. There is also a day care centre on the ground floor, which is not registered with us and therefore did not form part of the inspection visit. Care Homes for Older People Page 22 of 30 Evidence: All bedrooms are single and have en-suite facilities. All those viewed had been personalised with the occupants belongings such as photos, pictures and ornaments and were comfortable in appearance. The Statement of Purpose also told prospective residents that they could bring in their own furniture, within the limits health and safety, and are able to decorate and carpet their room to their own choice at their own cost. In the surveys everyone answered, Always or Usually when asked if the home was fresh and clean and this was confirmed with all areas viewed. The laundry was visited and was clean and organised. Laundry equipment meets the required standards to maintain infection control. Protective clothing was available for staff in the form of disposable gloves and aprons; soap dispensers and disposable hand towels were provided in all communal areas where staff and residents can be expected to wash their hands, in order to prevent cross infection. However disposable towels were discarded in waste bins without lids, which could impact on infection control. To further maintain infection control the bins should have hands free opening and closing. Care Homes for Older People Page 23 of 30 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. There are sufficient care staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. Evidence: The manager told us both in discussion and in the AQAA that the normal staffing was seven care staff in the morning and evening, six in the afternoon and three waking care staff during the night. Ancillary staff consist of two cooks who work 8.30am to 4pm, four domestic staff, three working the morning shift and one working the afternoon and a laundry assistant who works thirty hours a week. This related to the staff on duty at the time of the visit and the rotas that were made available. Not all rotas included the full name and/or designation of each employee, which is considered good practice. In surveys and in discussion residents, or their representatives, spoke positively about the staff at the home. Comments made in surveys included, My (relative) is very happy at the home and likes all of the staff currently attending her. The staff at Four Acres do a very good job. Care Homes for Older People Page 24 of 30 Evidence: In the AQAA the manager spoke of the low turnover of staff and the reduction in sickness levels in the previous year, providing continuity of care to the residents.. Sixty per cent of the care staff had achieved National Vocational Qualification in Care Level 2, which means that the home had exceeded the required ratio. This qualification shows that staff are competent in their role. Three staff files were looked at. All staff files contained the appropriate Criminal Records Bureau disclosures, Protection of Vulnerable Adults clearance, two written references and an employment history. The recruitment procedure safeguarded residents from the employment of unsuitable people. All new staff undertake induction training as implemented by the Local Authority. This was evidenced in staff records and in the AQAA. Training records and staff files showed that staff had undertaken mandatory training and also training in Parkinsons Disease, Strokes and Dementia in order to meet the specialist needs of people with these conditions. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person with the appropriate qualification and previous management experience manages the home. Monitoring and auditing of the service and practices takes place to ensure that all services operate in the best interests of residents. Evidence: The manager is registered with us and had been at the home for more than a year, giving the home some stability in leadership that had previously been missing. She has achieved the Registered Managers Award, the Diploma in Welfare Studies, an HNC in Care and a qualification in Counselling. The manager is supported by an assistant manager and four care officers, who are responsible for the day to day running of the home in her absence. The home uses the organisations Quality Management System, which using feedback from residents and monitoring the service by the management of the home, the Care Homes for Older People Page 26 of 30 Evidence: organisations managers and by monthly visits by the Responsible Individuals representative. Surveys are also carried out by an independent source with regard to the residents opinions of the service they receive. The responses are correlated and an action plan developed on the outcome. Copies of these were made available for us to look at. These systems indicate that the home is monitoring the service in order to enable growth and improvement and to ensure it is acting in the residents best interests. The home looks after some money for some residents, although the manager told us that residents were encouraged to look after their own money if they were able and wished to do so. The persons representatives were encouraged to support them with their financial affairs if necessary or advocacy is sought for those people who do not have family or friends to do this. This was also included in the homes Statement of Purpose. The home uses the Local Authoritys system of looking after residents finances. There were appropriate records of transactions, and cash and bank statements that balanced against these records, for any money held on behalf of residents. Residents access to this money had improved. Residents financial interests were safeguarded by this system. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. Care Homes for Older People Page 27 of 30 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 28 of 30 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 1 2 3 4 5 6 7 3 7 7 12 12 26 27 Assessment records should be dated and signed by the person carrying out the assessment. Staff should not rely on verbal communication to pass on care instructions. Up to date information should be transferred from review records to the care plans. People cared for in bed should be offered activity and occupation to meet their wishes and needs. The manager should monitor that there are sufficient apropriate and stimulating activities available. Bins used for the disposal of used towels should have lids and have hands free opening and closing. Staff rotas should include each employees full name and the capacity in which they work. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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