Care Home: Foxes Moon

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What the care home does well A detailed pre-assessment of a person`s needs is carried out prior to their being offered a placement at the home. This procedure makes sure that should they be admitted to the home, their needs can be met. Residents` health care needs are met through the home`s care planning and risk assessment processes. Residents are treated with respect and dignity. Generally medicines are administered safely within the home by trained staff. The home provides a range of activities to meet the social and recreational needs of residents. Residents` spiritual needs are assessed and arrangements made to support them worship, should a person have any unmet needs. Friends and families can visit residents at the home at any time and are made welcome. The home provides a good standard of food and nutritional needs of residents are met. The home has a well-publicised complaints procedure and the home has all the relevant policies and procedures relating to the protection of vulnerable adults. All of the staff have been provided with the prevention of adult abuse training. The home is well maintained with furniture and fittings in good repair. There are ongoing plans to make the environment more user-friendly for people with dementia. The home has a longstanding staff team and there suitable members of staff to meet the needs of residents. The staff team is well-trained. The home was generally well managed and run in the interests of the residents. What has improved since the last inspection? We saw evidence at this inspection that residents` representatives had been involved in development of care plans on behalf of residents. We saw that the home had acted to meet a requirement to improve upon the risk assessment process where bed rails were used. We saw that skin-care and nutritional assessments now form part of the ongoing assessment process. We saw that the home now provides sufficient staff to meet the lunchtime needs of the residents. What the care home could do better: It was agreed that the home`s Service User Guide and a copy of the last inspection report would be kept at the front reception area to make these documents readily available to visitors to the home. It was agreed that the home would liaise with their pharmacist concerning information on the medication administration records, to make it clearer as to whether medications were no longer prescribed or had not been supplied owing to adequate stock levels. Where hand entries have to be made onto medication administration records, a second person should check and sign that the entries have been made correctly. Wardrobes in the home should be risk assessed as to their likelihood of being toppled and action taken where such a risk is identified. The management of staff recruitment needs to be improved to make sure that new staff subject all the required recruitment checks. Key inspection report Care homes for older people Name: Address: Foxes Moon 40 Ringwood Road St Ives Ringwood Dorset BH24 2NY     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: Martin Bayne     Date: 2 6 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: Foxes Moon 40 Ringwood Road St Ives Ringwood Dorset BH24 2NY 01425474347 01425474347 foxesmoon@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Jean Lubbock,Mrs Christine Ramsey care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 31. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Dementia (Code DE) Date of last inspection Brief description of the care home The house is a detached older style property, which is situated in a residential area off the main A31 road between Ferndown and Ringwood towns. The home is about a mile and a half from Ringwood town centre. There is a large secure garden to the rear of the property, with car parking and shrubbery/trees to the front. The rear garden provides a safe and stimulating environment for residents, along with ample seating. Accommodation comprises 31 bedrooms, most with en-suite facilities, over the ground and first floor of the home. Care Homes for Older People Page 4 of 28 Over 65 0 31 2 0 0 1 2 0 0 9 Brief description of the care home There are five communal bathrooms, two of which are walk in wet rooms. There is a main lounge/dining area, as well as a small lounge area. The home has one room that is used for people visiting the home for respite care. 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: We, the Commission, carried out a key inspection of Foxes Moon between 9:15 a.m. and 4:15 p.m.. The inspection was carried out by one inspector, but throughout the report the term we is used, to show that the report is the view of the Care Quality Commission. The aim of the inspection was to evaluate the home against key National Minimum Standards for older persons, and to follow up on five requirements and one recommendation made at the last key inspection of the home in January 2009. We were assisted throughout the inspection by Mrs Ramsay, the person responsible for the management of the home. During the inspection we spoke with one relative, a visiting district nurse and with some of the residents; although on account of the mental frailty of the residents, they were unable to give much of an account of what it was like to live at the home. We used a sample of three residents files to track the records and paperwork that the home is required to keep up to date under the Care Homes Regulations 2001. Throughout most of the inspection we sat in the main Care Homes for Older People Page 6 of 28 lounge/dining area, so that we could observe the residents and interactions with the staff. At the time of our inspection there were 29 residents accommodated at the home. Additional information that helped form the judgements contained within this report was obtained from the Annual Quality Assurance Assessment document AQAA completed by the home. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? We saw evidence at this inspection that residents representatives had been involved in development of care plans on behalf of residents. We saw that the home had acted to meet a requirement to improve upon the risk assessment process where bed rails were used. We saw that skin-care and nutritional assessments now form part of the ongoing assessment process. We saw that the home now provides sufficient staff to meet the lunchtime needs of the Care Homes for Older People Page 8 of 28 residents. 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 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 10 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. Residents benefit from having their needs assessed prior to being offered a placement at the home with this procedure ensuring that the home only admits residents whose needs can be met at the home. Evidence: We were told that the homes deputy manager carries out the pre-admission assessment of need for all people referred to Foxes Moon. The deputy manager is qualified to carry out such assessments, as she has achieved qualifications of NVQ level 4 and the Registered Managers Award. Where residents are admitted through care management arrangements, we saw that the home obtains a copy of the care management assessment. Throughout the inspection we tracked a sample of three residents care files, one of whom had been admitted to the home after the last key inspection in January 2009. We saw that a detailed pre-admission assessment of their needs had been carried out Care Homes for Older People Page 11 of 28 Evidence: and recorded. The assessment covered all the topics detailed within the National Minimum Standards for older persons. We saw evidence of good practice; for example, one persons pre-admission assessment of need identified that they needed a door alarm on their bedroom door to maintain their safety and an alarm had been purchased prior to their moving into the home to meet this assessed need. At the front reception area of the home we saw a range of informative literature, such as details about the Mental Capacity Act 2005. It was discussed and agreed with Mrs Ramsay that the homes Service User Guide and a copy of the last inspection report be provided to make these documents readily available to visitors of the home. This will be followed up next inspection. The home does not provide an intermediate care service. Care Homes for Older People Page 12 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. Residents benefit by their health care needs being met through the homes care planning and risk assessment processes, through being treated with respect and dignity and from having their medication administered safely. Evidence: At the last key inspection three requirements were made concerning care planning. Firstly, that residents or their representative be involved in their development of the care plan. Secondly, that where bed rails were used, a risk assessment involving relatives and health professionals be put in place, as bed rails restrict residents freedom; and thirdly that skin-care assessments and nutritional assessments be put in place where there were risks to residents in terms of development of pressure sores or loss in weight. At this inspection we looked at the care plans for the three residents we tracked through the inspection. Owing to their mental frailty, the residents concerned were not able to be involved in the development of their care plans. We saw, however, that their relatives or representatives had been involved in development of care plans with their signing the plan. Concerning the use of bed rails we saw that risk assessments had been carried out involving a relative or the residents representative Care Homes for Older People Page 13 of 28 Evidence: but not health professionals. Mrs Ramsay explained that she had sought involvement from GPs and district nurses and had even written to the PCT concerning this matter. She showed us a letter from the PCT declining to be involved in these assessments, as it was their view that a risk assessment should be carried out each day and therefore it was not practicable for them to be involved. At the time of our visit there was one resident being cared for in bed and bed rails were in place to prevent this person from falling from their bed. We saw that Mrs Ramsay had instigated staff completing a daily risk assessment for the use of bed rails. We agreed that the risk assessment did not need to be completed each day but should be reviewed each month to make sure that it was still valid and current. We therefore acknowledged that Mrs Ramsay had done all that she could to meet the requirement. Concerning the third requirement, we saw that as detailed within this persons care plan, staff were turning this resident every two hours in order to look after their skin with a turning chart being completed by staff. We also saw that skin-care assessments and nutritional assessments were now in place and form part of the assessment and care planning procedures. Concerning another resident, we found that a nutritional assessment that identified a trend of weight loss had resulted in referrals been made to their GP. We also saw that the record of falls concerning one resident had led to a referral to the falls clinic. The district nurse with whom we spoke, told us that the home referred residents appropriately and there was good communication with the home. We were therefore satisfied that residents health care needs were being responded to appropriately. As detailed at the last inspection the home has introduced a computer-based care planning system. The system generates a standardised format of care plan that is comprehensive, detailed and person centred, providing details of residents likes and dislikes, their spiritual needs and a brief social history. Throughout the inspection we observed interactions between staff and residents. On the morning of our visit a group of residents were being supported by an outside activities volunteer and the staff at the home were seen to assist and reassure the other residents. The relative with whom we spoke told us that she found the staff were kind and courteous to residents. Throughout the inspection we saw that staff were respectful and supportive with residents. The senior carer on duty responsible for administering medication that day showed us how medications were stored and administered in the home. At the last inspection a requirement was made concerning recording of controlled drugs administered. At this inspection no resident had been prescribed controlled drugs but we saw that a controlled drugs register was available and entries had been made correctly. We looked at the medication administration records for all of the residents on one floor of Care Homes for Older People Page 14 of 28 Evidence: the home. We saw good practice of a photograph of the person concerned being provided at the front of their administration records, together with information about any allergies suffered by that person. Generally we found that medication administration records were being completed correctly with no gaps within the record. We found however that there was confusion in some of the records as to whether the prescription had been stopped by the GP, or whether the home had surplus stock of medicines with these not being provided by the pharmacist that particular month. We recommend and it was agreed that the manager would liaise with the pharmacist as to how to make these records clearer. We also found some examples where hand entries had been made to the medication administration records and these had not been checked and signed by a second member of staff, which is the recommended good practice. The home has two medication trolleys, one from each floor of the home. The home also has a controlled drugs cabinet that meets new regulatory requirements. We saw that all of the staff who administer medication to residents had received training in safe administration of medicines. Care Homes for Older People Page 15 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. Residents benefit from their social and recreational needs being met with a range of activities, from being able to receive visitors at any time and from being provided with a good standard of food. Evidence: On the day of our visit to the home an activities coordinator from a voluntary agency was holding a reminiscence session to a group of residents in the main lounge. We also saw that the care staff took time to reassure and speak with residents throughout the morning. Mrs Ramsay told us that there was no formal programme of activities with the exception of the activities coordinator visiting on the Monday morning and a music and entertainer visiting the home on a Tuesday and Friday afternoon. Mrs Ramsay told us that there was an expectation that the care staff engage with residents when not providing personal care and a range of craft materials, boardgames was available, as well as memory boxes supplied by both the library and a voluntary organisation. Mrs Ramsay told us that she had tried to recruit an activities coordinator, but there had been no successful applicant. We were told that the home holds a Christmas party and also a summer party to which relatives and friends of residents are invited. The home has a well maintained, enclosed garden with level access paths and separate areas of interest that residents can access in good weather. Care Homes for Older People Page 16 of 28 Evidence: We saw that residents spiritual and cultural needs formed part of the pre-admission assessment. Mrs Ramsay told us that she had contact with local churches should any resident have any unmet spiritual needs. We were told that two residents are taken out by their relatives to attend church services each Sunday. The relative we spoke with told that she could visit unannounced at any time and that she was was made welcome at the home. She also told us that she had peace of mind when leaving the home that her mother was being well cared for. At the last inspection it was recommended that the manager review the availability of staff during the lunchtime period to make sure that residents were appropriately supported. We sat in the lounge throughout the lunchtime period and saw that there were sufficient staff to assist the residents. We saw that the three residents who needed assistance with feeding were patiently assisted by individual members of staff and that there were sufficient other staff to assist the other residents. We looked at the records of food provided and these informed that a varied and wholesome diet was being provided. We also saw that those residents whose care plans identified that they needed soft or pureed diets were being provided for appropriately. Mrs Ramsay told us that the home had tried using picture menus, however they had a problem as the one resident pulled these down from the walls and so currently the home was using a whiteboard to inform of the menu for the day. We spoke with the cook who told us that she knew the residents likes and dislikes and that alternative meals would be provided for residents should the main meal not be to their liking. Salads were also available as an option each day. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well-publicised complaints procedure, by the staff being trained in the protection of vulnerable adults and the home having policies and procedures dealing with adult abuse. Evidence: The home has a well-publicised complaints procedure this being detailed at the front reception of the home, informing relatives of how to make a formal complaint. It was noted that the address for the Commission has changed and it was agreed that the new address would be substituted. Since the last key inspection there has been one concern that was investigated by the local authority under local safeguarding protocols. The results of this investigation were inconclusive and the case is closed. Since the last inspection one formal complaint has been raised with the home and this was also brought to the attention of the Commission. We saw that all staff had had been provided with training in the protection of vulnerable adults and as found at the last key inspection the home has all the necessary policies and procedures relating to the protection of vulnerable adults. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well maintained and clean environment. Evidence: As part of the inspection we conducted a tour of the premises. On the day of our visit the home was found to be clean with no unpleasant odours. The relatives we spoke with told us that the home was always clean when they visited. The home is not carpeted and provides vinyl floor surfaces on account of the high continence needs of the majority of the residents accommodated. Though this may not provide such a homely feel to the home, a higher standard of hygiene can be maintained. Mrs Ramsay informed of her intention to make the environment more user-friendly and homely for residents by providing themed corridors to make them more individual and more recognizable for residents suffering with dementia. We saw the new signs that had been purchased. We also saw that new signage, designed the people with dementia had been purchased that would better inform residents of where toilets and bathrooms were located. We saw that residents names had been put on their doors with a personalise picture to help residents identify their rooms. We saw that residents could personalise their bedrooms with their own furniture and possessions. We saw that wardrobes had not been attached to the wall and we recommend that a risk assessment of all wardrobes be carried out to assess the risk of these being toppled. Where any such risk is identified, the wardrobe should be attached to the wall. We saw that all radiators in the home had been fitted with covers or were of a low surface Care Homes for Older People Page 19 of 28 Evidence: temperature type to protect residents from the risks of receiving burns from hot surfaces. We were told that all of the windows above ground floor level had window restrictors fitted to prevent accidents. All bedrooms within the home are for single occupancy, with 24 of these having ensuite facilities. The home has two assisted bathrooms and two wet rooms, one of each provided on the first and ground floor of the home. We saw that within these communal bathrooms liquid soap, paper towels and waste bins were provided to promote good infection control. We were told that thermostatic mixer valves were fitted to hot water outlets of baths and showers in order to protect residents from scalding water. The home has a dedicated laundry room that is equipped with commercial machines sufficient to meet the laundry needs of the home. Walls and floor surfaces were sealed and easily cleanable. We saw that hand washing facilities are provided in the adjacent sluice room. We were told that the laundry room is kept locked when not in use to maintain safety of residents. We were told that alginate bags were used for soiled laundry, which is good practice. All the staff have received training in infection control. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from adequate staffing levels being provided and through the staff receiving suitable training. However, failure to ensure that new members of staff have been subject all the recruitment checks of the Regulations could mean that residents are at risk from unsuitable members of staff. Evidence: Mrs Ramsay told us that the home provided the following staffing levels: 8am to 9am, five care staff. 9am to 1pm, six care staff. 1pm to 2pm, five care staff. 2pm to 7:30pm, four care staff. Between 8pm and 8pm three care staff on an awake night duty. We saw duty rosters that reflected the above staffing levels. In addition, the home employs a deputy manager who works in the home office hours each week as well as the manager. The home has two administrators, a chef and kitchen assistance and two domestic staff who provide cleaning seven days a week. A handyman is also employed and works two days a week. The relatives and the staff with whom we spoke told us that the above levels of staffing were adequate in meeting the needs of the residents. Since the last key inspection in January 2009 no new care staff have been employed. A kitchen assistant was employed in July 2009 and we therefore looked at their Care Homes for Older People Page 21 of 28 Evidence: recruitment records. The kitchen assistant works solely in the kitchen area and has no contact with residents. Mrs Ramsay told us that the deputy manager was responsible for processing the recruitment of new members of staff. Some of the recruitment checks as detailed within Schedule 2 of the Care Homes Regulations 2001 had been complied with, such as evidence of proof of identity, a full employment history, a health declaration and the taking up of two references and a criminal record bureau check. However there were shortfalls. There was no photograph of this member of staff and the staff member had started work prior to the return of the CRB check and written references. Following the inspection Mrs Ramsay looked into this matter and found that the umbrella organisation had failed to request a check against the register of adults deemed unsuitable to work with vulnerable adults. The home must review recruitment practices and make sure that all of the checks detailed within Schedule 2 of the regulations are complied with before members of staff start work in the care home. We looked at the training provided to the care staff team. We saw that there were systems in place to make sure that all of the staff had received core training in areas such as; health and safety, first aid, infection control, fire safety, adult protection and basic food hygiene. We also saw that staff had received specialist training such as caring for people with dementia. The AQAA informed us that 16 of the care staff team of 17 had been trained to NVQ level 2 or above. All new members of staff receive a six-day induction. 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 home is generally well managed and run in the interests of residents. Evidence: Mrs Ramsay is a trained mental health nurse and has many years experience in both nursing and management. She has also achieved relevant qualifications in respect of being a registered manager. The poor recruitment practices identified in the last section of this report are reflected in the rating for this section. Although we found that the last member of staff had not been recruited in line with the regulations, since that time management has taken action to ensure better recruitment practices in the future and there has been good communication between them and the Commission. The home carries out annual quality assurance surveys with relatives and professionals who have contact with the home. We saw that there were positive results and feedback from the last survey. The staff we spoke with during the Care Homes for Older People Page 23 of 28 Evidence: inspection told us that managers were approachable. The home has a long standing staff team and there was a good staff morale. We were told that the home does not look after any monies on the half of residents. As part of the inspection we looked at the fire logbook and found that tests and inspections of the fire safety system were taking place to the required timescales. Apart from the recommendation to risk assessed wardrobes, there were no other health and safety matters identified during this inspection. We saw that accidents were being recorded properly and that there was an audit of accidents to identify trends and action that may be taken to reduce the frequency. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 29 19 The manager must make sure that they do not allow an individual to work in the care home unless information specified in Schedule 2 have been obtained. This is to make sure that suitable people are employed. 24/02/2009 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 29 19 You are required to ensure that new members of staff recruited to the home must have been subject to all the recruitment checks detailed within Schedule 2 of the Regulations before they start work in the home. In order to protect residents from being cared for by unsuitable staff. 07/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 We recommend that: Where hand entries have to be made to medication administration records, a second person should check and sign that the entries have been made correctly. The home should liaise with the pharmacist about making medication administration records clearer as to whether medication was no longer prescribed or had not been supplied that particular month. We recommend that wardrobes are risk assessed as to Page 26 of 28 2 19 Care Homes for Older People 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 their likelihood of being toppled over, and where such risk is identified these wardrobes be attached to the wall. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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