Care Home: Framland

What the care home does well The service continues to provide the homely comfortable lifestyle that the residents wish for. Comments about the home included: "Its lovely." "I like it here, it`s my home." "I have only ever seen care and patience." There is a continual process of consultation with the people living and working in the home, through surveys, and resident and staff meetings. What has improved since the last inspection? They have listened to residents about the meals and menu planning to meet with personal choices and wishes of the people who live there. The main meal of the day is now served up in the dining area with the residents as to ensure that they obtain the size meals and support they require. They have employed another specific member of staff to co-ordinate and plan activities in the home. During the last twelve months they have carried out some redecoration and refurbishment including flooring in showers, toilets and sluices, and put a mechanical sluice in the downstairs wing. They continue to ensure that staff are trained and qualified for the role that they carry out. What the care home could do better: Continue improving the practices for record keeping to ensure that the information for care planning match what they actually provide. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Framland Naldertown Wantage Oxfordshire OX12 9DL     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: Ruth Lough     Date: 2 7 0 4 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 31 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 31 Information about the care home Name of care home: Address: Framland Naldertown Wantage Oxfordshire OX12 9DL 03003031470 03003031474 wantage@pilgrimhomes.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Pilgrim Homes care home 21 Number of places (if applicable): Under 65 Over 65 0 0 21 0 dementia learning disability old age, not falling within any other category physical disability Additional conditions: 21 1 0 1 The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Learning disability (LD) Physical disability (PD) Date of last inspection Brief description of the care home Framland is situated in a residential area of Wantage with easy access to the town centre. The home belongs to Pilgrim Homes, a registered Christian charity, and offers care for older people who share a Protestant Evangelical Christian faith. The house is a period property that was converted for its present purpose before it Care Homes for Older People Page 4 of 31 Brief description of the care home opened in 1986. It was sensitively adapted so as to retain some of the original period features and the original house contains the main dining room/lounge on the ground floor and there is a second lounge in the extension. The home has six single bedrooms on the ground floor and eleven single and two double bedrooms on the first floor. There is a passenger lift and stairs to the first floor. A hairdresser, chiropodist, dentist and optician are available at an additional cost by appointment at the home and local services in Wantage town can also be visited for these services. The home is registered to care for 21 elderly people who, for one reason or another are no longer able to live in their own homes. The staff cater for a range of needs, which have been assessed by the registered manager. The current range of fees is between £535.00 and £639.00 per week. Care Homes for Older People Page 5 of 31 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: This was an unannounced key inspection process generated from the good findings identified at the last assessment of the quality of the service by the commission in May 2007. This inspection process included reviewing information provided by the service before a one-day visit to the home. During the day the records for care planning, recruitment, and administration of the service were assessed. The people who use the service and the staff who provide the support were consulted during the day about their opinion of what is provided, and through surveys. Ten people who are in receipt of support that we contacted, we Care Homes for Older People Page 6 of 31 received ten responses at the time of writing this report. Five staff were also contacted through surveys, of which three responded. Two health care professionals who have been involved with visiting the service on a regular basis were also contacted. From this visit it was found that the home continues to focus on providing a comfortable homely atmosphere for the people they support to live in. No requirements were made from this inspection process but a small number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home have their needs assessed thoroughly before they are offered a place to live there. Evidence: Prospective users of the service are provided with copies of the Statement of Purpose and Service User Guide as to assist them with making a decision to live in the home. The current Statement of Purpose and Service User Guide were not reviewed during this inspection, but the manager was able to inform that minor amendments had been made recently to the information given. These were with reference to the named responsible individual and their contact details. Three residents care records were reviewed as to assess the quality of the processes to identify their needs before a decision is made to offer a place in the home. During previous inspections it was identified that the assessment of need process is thorough Care Homes for Older People Page 10 of 31 Evidence: and incorporates identifying that the specific ethos of the home, religious observances and beliefs, meets the needs of the person concerned. The records for the most recently admitted person showed that they continue to take detailed information from the prospective resident, their relatives and any health or social care professions as part of the process. The manager confirmed that a four-week trial of stay is offered as well as visiting the home before being admitted. Although brief records are kept of these day visits to the home, the information could be expanded to give greater indication of how the home could meet the needs of the person concerned. This then would be helpful in the final decision that the service is the right place for the individual. A good number of residents have enjoyed the use a respite stay in the home as part of this process. All respondents to the service users survey confirmed that they had received sufficient information about the service before the came to live at the home. One person added, Its lovely. Care Homes for Older People Page 11 of 31 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. That individuals needs are identified and care is provided to meet their them. Medical health consultation and treatment is sought quickly and appropriately when concerns are raised. Evidence: The care planning records reviewed confirmed what was previously identified during the last inspection process that the information is provided in a clear and concise way ensuring that staff generally, have a good set of instructions of how to meet the needs of the person concerned. Of the three records examined it was evident that staff have identified areas of need and had put action in place to meet them, according to the daily records. This was particularly relevant to one person in regard to changed health needs, such as seeking professional medical advice and treatment and the extra equipment to provide support. There were some areas that could be improved as to provide better detail and ensuring that the care planning records are ammended as soon as possible to outline Care Homes for Older People Page 12 of 31 Evidence: their current needs. From other the sampled care plans show that this is an area of where improvement is required, as each area of identified need is documented as evaluated regularly, changes noted in the evaluation record, but the documented care plan not updated to reflect this. In parts the staff write well in the records showing the daily outcomes for individuals but from one of the sampled records it shows that gaps have occurred and these do not provide sufficient information about the individual over the twenty-four hour period. The sampled risk assessments show that they provided staff with good information about general risks to the individual and those more specific to the need of the person concerned. The majority of them seen had a programme of review, update, and amendment as the persons needs changed. Seven of the people who use the service gave a response in the surveys that they thought they always got the care and support they needed, of the three others two put usually, one put sometimes. One person put, Its good. In the returned surveys only two people commented that they usually obtained the medical support they needed, the others expressed that they always had the assistance they required. This was supported by the information in the care records that were reviewed as each showed the visits made by individuals GPs, District Nurses, and any other health professionals. The two health care professionals who responded to the commissions surveys did confirm that they thought the homes staff sought appropriate advice and support from them quickly when required. Also any recommendations made are swiftly acted upon with staff including relatives to achieve what is required for the individual concerned. General comments from the healthcare professionals included: I have only ever seen care and patience. Provides a caring resident focussed environment Appropriate GP contacts. Appears to respond quickly to the needs of the residents. Some of the processes, the storage, and record keeping for the administration of Care Homes for Older People Page 13 of 31 Evidence: medications in the home were reviewed. From the sampled records it was apparent that safe practices are carried out, and items recorded appropriately. Detailed risk assessments are in place for residents who self medicate and they are provided with suitable facilities in their rooms to store them safely. One area that needs to be developed is the recording and monitoring of prescribed creams, ointments, or nutritional supplements that are not given during the routine medication rounds. Care staff are reporting back to the senior staff when they have been carrying this out and this is partially supported in the recorded daily care records. However, for one person, a change to using prescribed creams during personal care had not been reflected in the care records and therefore there is no certainty that the creams are being used as prescribed. The staff consult with residents about some of their personal choices for support at the end of lives. They have been looking to develop this area of their care practices and have commenced in seeking professional assistance as to provide continuing care within the home and prevent admission to hospital. Care Homes for Older People Page 14 of 31 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 people who use the service are given the opportunity to exercise choice over their lives and be able to maintain their interests. Meals and menu planning meet their health needs and personal choices with appropriate support given when required. Evidence: During the assessment of an individuals needs, personal choices about interests, hobbies, and how they wish to live is obtained from the person concerned and their relatives or supporters. The staff routinely spend time with individuals and their families following admission to obtain a life history that will help staff understand and meet their needs. The organisation has implemented a document tool to record information that can be used in the general care planning. The sampled records showed that there was a variable quality of information obtained, the most recently completed records seen giving a good picture of the person and their family which will enable staff to have a very good knowledge of their personality and individuality. The service is provided to specific group of people, Protestant Christians. To meet their needs there is a regular programme of daily devotions, bible reading, and regular acts of worship. There are also other planned activities such armchair exercises, games, Care Homes for Older People Page 15 of 31 Evidence: crafts, cooking and reminiscence that are also provided. Staff have taken time to support individuals with personal photograph albums which they can share with their relatives when they visit and be used as reminiscence aids when required. They have also increased the number of staff employed specifically for activities to two, since the last inspection visit to develop activities in the home. During the day of the inspection a musical entertainment group visited the home in the afternoon. From what could be observed all the residents appeared to be participating and enjoying the experience. The manager confirmed that they are focussing on making the care planning person centred and this could be seen in the majority of the detailed care records reviewed. An area that they are aware they need to improve with documentary evidence, is within achieving providing support to meet the individuals personal interests, activities, and choices for daily living. Seven of the ten respondents to the survey expressed that there were always activities arranged by the home that they could join in with. Three put usually. From information given in the Annual Quality Assurance Assessment, self-assessment document there has been a review of the meals and menu planning for the home since the last inspection visit. Time was spent with the cook during this inspection visit to find out what processes they have in place to identify the dietary choices and needs that residents may have. During the initial admission process to the home they are consulted about their preferences and dietary needs and this information is given to the cook to use within the menu planning. From reviewing some of these documents and through discussion it was apparent that the cook had responded to new information about individuals needs that had not been reflected sufficiently in the records held. The current menu plans, which are on a four weekly rotation, had been recently updated. The cook has spent time investigating new meals to appeal to the people they support and as yet needs to expand the information a little further as to give greater detail about what is on offer and a variety of meat choices. Information about the main meal of the day is put on display in the central communal area for residents and visitors to see. Residents are consulted on a daily basis about their preferences for the meals and it was evident that if there were any changes, these were accommodated swiftly by Care Homes for Older People Page 16 of 31 Evidence: staff. The cook was able to give examples of what alternatives were on offer. Residents are encouraged to participate in the main meal of the day in the dining areas of the home. During this inspection it could be seen that the usual practices were not in place as there was redecoration being carried out of one of the main communal areas. Therefore alternatives had been put in place for the interim period. This did not appear to adversely affect the residents. A small number of people living in the home need assistance or prompting with their meals and staff could be seen to be engaging the residents in conversation whist this was going on, making it a more sociable occasion for them. Meals are now served in the dining room and not in the kitchen, giving the staff the opportunity to provide the quantity of food that residents wish for. Residents had previously highlighted in a survey and commented at the last inspection process that sometimes their meals were too large. The home has altered its practices accordingly to ensure that they are now not overwhelmed, by being offered too large portions. Of those who completed the surveys sent to them, five stated they always liked the meals, four gave a response that they usually liked the meals, one noted, sometimes. An added comment was, Not always to my taste, they seem to have some funny ideas. I dont like thin soups. From the most recent Residents Questionnaire carried out in November 2008 by the home, one person put, There is more food variety. Care Homes for Older People Page 17 of 31 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 people who use the service can be confident that their concerns or complaints will be listened to and acted upon. The service has systems in place to protect the people living in the home from possible abuse or harm. Evidence: The home provides residents with a copy of the complaints procedure in the Statement of Purpose and Service User Guide and is also on display in the home for all to read. The manager provided information in the Annual Quality Assurance Assessment that the service has not been in receipt of any complaints over the last twelve months. The commission has also not been in receipt of any concerns or complaints about the home during this period either. The processes for recording complaints, concerns, or compliments were reviewed to see what the home has in place to monitor residents and others comments. The manager has implemented a comment book and compliment record for residents and others to use in the lobby of the home. From what could be seen the manager currently only logs any formal complaints made centrally and that minor concerns expressed are recorded in individuals care records. They were advised to look at developing this for quality assurance processes as to monitoring trends of minor concerns that staff usually take action on immediately as to assist with further Care Homes for Older People Page 18 of 31 Evidence: development of the service. From information given in the returned surveys all residents expressed that they knew how to raise any concerns or complaints if they should have them. The policies and procedures for safeguarding and protecting the people living in the home from possible abuse or harm are made readily available to staff should they need to act upon any concerns. These could be seen to have been used appropriately recently, when concerns were raised and from information given by the manager, the necessary action has been taken. The outcome from this one investigation had not been concluded at the time of the inspection visit or the completion of this report. The records for training show that the majority of the staff are provided with regular training in regard to safeguarding and protection. However, one member of the ancillary staff could not provide evidence that they had had any training in this area for at least nine years. This information was passed back to the manager who confirmed that this individual would be in receipt of training soon. Care Homes for Older People Page 19 of 31 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 is maintained well and meets the needs of the people who live there. Evidence: The premises is an adapted property that retains some of the period features and provides a purpose built wing of the home. The majority of the bedrooms do not offer en suite facilities and were not designed to meet the National Minimum Standards(2002) for room sizes for shared accommodation or the provision of furnishings. The facilities suit the current needs of the people living there, giving them a homely, comfortable environment to live in. Residents are supported to furnish their rooms with their personal property where able within the limitations of space. The two, shared bedrooms, are provided with a full-length curtain between beds for screening as to assist with privacy. Likewise another is placed in front of the hand washbasin. The home appears to be generally maintained well. During the last twelve months they have carried out some redecoration and refurbishment including flooring in showers, toilets and sluices, and put a mechanical sluice in the downstairs wing. Care Homes for Older People Page 20 of 31 Evidence: Some of the bedrooms decoration and fitments are looking tired and the manager confirmed that the rolling programme was in hand to improve them. Residents are provided with a variety of communal spaces to use, areas where they can join in with others and quieter spaces to meet family or visitors in privacy. The home has pleasant secure gardens that residents can enjoy in the warmer months. They and their relatives can be confident that the added security gates to the front of the property will ensure that there is added protection from unwanted visitors to the grounds. Storage space in the home is minimal for the necessary equipment to provide support and care. As previously stated the home was developed before the National Minimum Standards (2002) and staff, struggle to fit the required seating in some of the bedrooms, plus any commodes or special equipment (wheelchairs) individuals may need. Overspill of these means that at times the corridors are partially blocked to accommodate them causing a possible risk for fire safety and residents walking around the home. The manager was advised to look at developing strategies for storage of equipment and spare furnishings. From what was observed the home is kept clean, tidy and fresh for the people who live there. There were a few areas that will need to improve to maintain safe hygiene. This was to ensure that all areas that staff carry out personal care are provided with liquid soap and paper towels, and in the shared accommodation improved facilities to separate the toiletries to prevent accidental cross infection. Only one bedroom had a slight odour when reviewed, the manager was made aware of this during the inspection and the concern was dealt with at the time. The majority of the residents who responded to the survey thought that the home was always and usually kept fresh and clean. One person commented about the freshness of the home by stating, Lacks fresh air and windows open and added, Have not seen a thermostat, so central heating is irregular and wasteful. During the day of the visit the home in the areas that were seen to be kept warm and draft free. Care Homes for Older People Page 21 of 31 Care Homes for Older People Page 22 of 31 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 homes staffing levels meet the needs of the people who use the service and they have been given the necessary training they may require. The recruitment process is carried out appropriately and protects the people the staff support. Evidence: Prior to and during the last inspection process some concerns were raised about the home having sufficient numbers of staff. From information available this appears to have been generally resolved with the occasional use of agency staff and the recruitment of new permanent staff. One comment in a returned survey from a relative on a residents behalf was, Sometimes Agency staff are used to fill in which isnt always completely successful. The addition of dedicated staff time for activities has also improved the outcomes for residents. Although one staff member put, The staff having a little more time to spend with the residents, for a suggestion for the home to do better. What was evident was the overall policy and provision of training, parallel with the consistent programme of formal supervision and appraisal of staff has given staff confidence in the roles that they perform in the home. This was reflected in some of Care Homes for Older People Page 23 of 31 Evidence: the comments made by staff in the surveys returned. Information provided by the manager before the inspection visit did support that of the eighteen staff, eight had attained the minimum of an NVQ 2 in care. Information was also provided that at least nine permanent staff had left within the last twelve months and that new staff had been employed and had registered but not yet completed NVQ training. From what also could be seen was that good records are kept of any training undertaken by staff including the ancillary staff for most of the necessary health and safety training. Any gaps were identified, and have been planned to be met, within the training programme. Staff expressed confidence that they were provided with the most up to date information to carry out their roles. This included the regular programme of revisiting key policies and procedures, meeting with the manager, staff meetings, and the training for topics relevant to their roles. Some staff have, had additional training for dementia, the majority more recently, on the Mental Capacity Act. The recruitment and employment records for three staff were reviewed as to see if the process is robust enough and protects the vulnerable group of people they support from inappropriate staff providing their care. Two of whom had been employed during the last seven months, the third had transferred roles within the home. The two records for the newly employed staff reviewed supported that the necessary information is obtained about the individual before they commence working in the home. The organisation use a check-list to identify that required information has been obtained, although the two sampled had not been used as effectively as possible. The manager could not access information to evidence that a Pova First had been carried out on one new member of staff as a copy of the check had not been provided to the home from the central organisation. Likewise, the documented checks carried out on the registered nurse, Nursing and Midwifery Council registration, who is working as a senior carer in the home had not been provided. Since the inspection the manager has confirmed that the service now has the necessary evidence that the required checks have been carried out. All three supported that Criminal Records Bureau checks had occurred and that references had been sought. One area they could improve is to note in better detail the decision for a change in Care Homes for Older People Page 24 of 31 Evidence: occupational roles in the home for staff. This is in particular to the carer now in the position of an activities organiser. Better information should be in place to support that they have identified that the individual is suitable to the role. Care Homes for Older People Page 25 of 31 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. The service is run in the best interests of the people living there, and is managed effectively by a knowledgeable manager and provider. Evidence: There have been no changes in the management structure or the home since the last inspection process. From information provided the Registered Manager has already attained RMA(Registered Managers Award) and continues to attend regular training provided by the organisation. Some of the training during the last twelve months has included updated for the practical safe working practices that should be in the home and those around developing and maintaining her management skills. The home has some good processes in place for quality assurance monitoring and for consulting with the people who use, come in contact with, and work within the service. As previously identified that they have several formal and informal recorded processes for seeking residents opinion of the services provided including the reviews of care, Care Homes for Older People Page 26 of 31 Evidence: comment books, and the regular quarterly meetings. From the records available there appears to be a wide variety of topics discussed and again this is reflected in the similar staff meetings. What was apparent was that they have a very good programme of meetings in place including specific ones for the night staff, domestic and a general all staff meetings where the focus according to the dialog seen is on improving the outcomes for the people who live in the home. There are also regular six monthly surveys sent out to residents, staff and relatives where they are asked key questions about the environment, the care received and about living in the home. One person commented in one survey, I like it here- its my home. Additional good lines of communication are through the handover at every shift and the notebooks that are used to log key information for the day for staff. A representative of the provider organisation regularly visits the home to check on the service under their responsibilities of Regulation 26. There is a focus on staff continually reading and revisiting policies and procedures in the home as to assure that they have a good understanding of the key topics. The three staff who returned surveys to the commission thought that the communication between all staff and the manager was good and a positive experience. One member of staff wrote, In our home, each member of staff is encouraged to freely meet with the manager to personally receive the right support in our jobs. A sample of the administration of monies handled in the home on residents behalf were reviewed to see if good practices were in place. From what could be seen the records provide sufficient information and we were informed that these are regularly managed weekly by an administrator in the home and audited by the provider organisation. The home was found to have generally good practices and procedures in place at the last inspection process for protecting the health, safety, and welfare of the people living and working in the home. Through discussion with staff it was apparent that one person takes the lead in safe working practices and is involved with some of the induction and training for staff and the key safety checks in the home. Care Homes for Older People Page 27 of 31 Evidence: Evidence was available to support that any identified risks or improvements made by any regulatory body, such as Environmental Health, are acted upon and rectified. Other comments made about the service in surveys and during the day visit to the service: From a visiting health professional, I always enjoy working at Framlands. Its a very kind and caring place. All but a few who suffer dementia are content and those who occasionally become distressed are comforted. A resident stated that they liked living there and it was very pleasant and comfortable. Care Homes for Older People Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 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 31 of 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!