Care Home: Freestones Residential Care Home

What the care home does well Freestones Residential Care Home is an established care home and has cared for people, new and those using the service for a number of years. There is a welcoming and homely atmosphere in the home, whereby staff greet people and make the experience at the home pleasant. People are encouraged to relax, socialise and conversation is promoted by the layout of the lounges and the dining area. People are encouraged to continue making decisions about their daily routines and lifestyle. People are involved in their care arrangements to ensure individual choices are respected. There is a positive focus on providing `personalised and tailored care`, which promotes people`s well-being. People have good access to health care support on a regular basis and when required. People are encouraged to maintain contact with family, friends, the local community and can choose to participate in social events. Visitors are welcome at any time. People are supported to continue observing and practicing their religious or spiritual beliefs. People are offered a good choice of home-cooked meals. Menus and mealtimes are flexible and suitable for individual needs. There is a good complaint procedure and people are encouraged to express any concerns or complaints that they may have, which are addressed quickly. People are encouraged to participate and be involved in discussions that may influence the day-today running of the service. The home welcomes comments and suggestions and sees this as beneficial to improving the quality of the service people receive. There is an established and stable staff team, who have clear roles and responsibilities. Staff skills are maintained through regular training, updates and supervision. The comments we received from the surveys that were returned together with comments made directly to us during the site visit to the home included: "I am very happy living here and have made lots of good friends" "My dad is very well looked after. The staff seem to really like him and make a big fuss of him" "Usually, a very high standard of care" "My wife and myself would like to say we are pleased with the way ... is being looked after and attends to her needs. She is always immaculately dressed and very clean. Credit must be given to all the staff and carers for their dedication" "We visit regularly and we have no complaints, staff and the manager are very easy to get on with, informative and know the residents here""The care is excellent, the staff are caring and very kind and attentive" "Mum is definitely happy here, she has her friends and joins in with activities. We often sit away from her as she enjoys her singing" "We hold different activities for the service users and people from the community also come in and get the service users involved in singing, arts and crafts, exercise, games and hymns" "Encourage individuality, choice, respect all individuals religion and faith" "We`re mates, we talk and laugh alot, there`s always something that makes us laugh" "Food is well balanced and prepared in line with the government`s healthy eating requirements" "It`s always clean, tidy and a pleasant home to visit" "The staff, manager and the owner are approachable and willing to listen to make things better for the residents" "There are enough staff for us to meet the individual needs, we try to spend one-toone time with service users" "We have competent team leaders who make sure the way information is passed onto staff works well. The manager and team leaders are well qualified and pass down their knowledge to the less experienced staff. We are sent on training courses, which help, e.g. manual handling, etc" What has improved since the last inspection? Since the last inspection of Freestones Residential Care Home, Mrs Claire Davidson is the Registered Manager of the service. The assessment and care planning is person centred, holistic and considers the care needs and lifestyle of the individual. The key worker systems promotes better person centred care and staff take responsibility to providing a quality service and lifestyle that promotes people`s well-being. There have been a number of improvements made to the home environment. These include the decoration of some bedrooms, the lounges and the refurbishment of the bathrooms. The layout of the lounges and dining area has been changed to encourage people to talk mingle with each other and promote participation in organised activities. New furniture for the lounge and bedrooms has been purchased such as bed linen and curtains. Staff have received regular updates in training and accessed new training with regards to Deprivation of Liberty, Palliative Care, Dementia and Parkinson`s Awareness. We were informed that there are plans to develop a sensory garden and work has begun with the appointment of a gardener and the purchase of garden furniture. A number of sensory items have been purchased such as the `magic light ball` and `lava lamps`, to stimulate people who may have dementia or poor eye-sight. What the care home could do better: This was a positive inspection of Freestones Residential Care Home. The information we received in the self-assessment tool completed by the Registered Manager and the evidence we found on the day demonstrated that there is a continuous programme of improvements being made at the home to benefit the people using the service. The Registered Manager demonstrated a high degree of responsibility by acting promptly when we identified issues. For example, we received the updated `Statement of Purpose` and `Service User Guide` following the site visit. This showed she is keen to make sure the home maintains a high standard of care together with a high quality of service. We have made some good practice recommendations, that should be considered. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Freestones Residential Care Home 85 Finedon Road Irthlingborough Northants NN9 5TY     The quality rating for this care home is:   three star excellent 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: Rajshree Mistry     Date: 0 1 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 41 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 41 Information about the care home Name of care home: Address: Freestones Residential Care Home 85 Finedon Road Irthlingborough Northants NN9 5TY 01933650430 01933651189 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Caroline Davidson,Christopher Mole Name of registered manager (if applicable) Mrs Claire Davidson Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical Disability Code PD Date of last inspection Care Homes for Older People Page 4 of 41 Over 65 0 19 0 19 0 19 Brief description of the care home Freestones Residential Care Home is an established residential care home since 1989. It is registered to accommodate up to 19 older people who may also have associated condition of dementia and physical disability. Freestones Residential Care Home is situated in the small town of Irthlingborough, with local amenities such as a post office, shops and a library. There is a local bus service, with a bus stop close to the home, providing access to the town and surrounding villages. The home is within a short travelling distance to Wellingborough, Northampton and Kettering. Freestones Residential Care Home has two lounges with a dining area in between. The majority of the bedrooms are single and there are two double rooms. Many of the rooms have en-suite facilitie with additional bathrooms and toilets on the ground and first floor. There is a stair lift to the first floor. There is a large established garden to the rear that people can use. The Registered Manager provided us with the range of fees, which are £362.00 to £450.00 per week. There are additional charges for personal expenditure such as hairdressing and personal toiletries. People considering using Freestones Residential Care Home should contact the Registered Manager to discuss individual needs and requirements. The full details of the home and any specific requirements can be obtained from the home in the form of the Service User Guide and Statement of Purpose. Alternatively, information about service is available on the website: www.freestonesrch.co.uk The latest inspection report from the Care Quality Commission is available at the home. Care Homes for Older People Page 5 of 41 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: three star excellent 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 quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We as it appears throughout this Inspection Report refers to The Care Quality Commission (CQC). Any references to The Commission for Social Care Inspection (CSCI) should be taken as CQC, who now hold the legal responsibilities previously held by the CSCI, as of the 1st April 2009. This key inspection started with the review of the last key inspection report dated 9th April 2008. We looked at the information we had about the management of Freestones Residential Care Home and the events that affect the well-being of the people using the service. We received from the Registered Manager the completed Annual Quality Assurance Assessment (AQAA) document, which is the homes self-assessment of the Care Homes for Older People Page 6 of 41 standards within the home. We sent out 18 surveys to people using the service and their relatives, of which 10 were returned. The responses and comments received indicated people were very satisfied with the standard of care and the quality of service they received. The responses indicated that people were able to continue their choice of lifestyle, participate in social events and staff that help them to maintain their independence and well-being. We sent out 18 surveys to staff, of which 13 were returned. The responses and comments received indicated the staffing levels meet peoples needs, staff work well as a team and there is good communication between the staff. It also told us that there are good management systems and staff have access to regular training, updates and supervision. We visited on 1st April 2009, starting at 10am and finishing at 4pm. The Registered Manager assisted us during the site visit. The main method of inspecting we used was case tracking. This means looking at the range of care people receive that is met by the staff who ensure peoples rights, choices and independence is promoted. We selected three people to case track, all of whom had differing needs, abilities and included a person that was new to the home. We spoke with those people and other people using the service. We read the care files containing information about peoples care needs, lifestyle and how these were met and respected. We made observations of people, how they were treated and how staff interacted with them. We spoke with visiting family and friends to gather their views about the quality of the care they had observed and experienced by the person using the service. We spoke with the District Nurse to gather their views about how the home ensured peoples health care needs were met. We looked at the accommodation offered to people using the service. This included communal areas, bathrooms and individual bedrooms, with permission. We spoke with staff working on the day to ascertain their recruitment, training and skills to meet the needs of people using the service. We looked at staff files that demonstrated staff recruitment and training. We read the information people received about Freestones Residential Care Home. The policies, procedures and specific records viewed demonstrated the day-to-day management of the service. The Care Quality Commission has a focus on Equality and Diversity and issues relating to these are included throughout the main body of this inspection report. What the care home does well: Freestones Residential Care Home is an established care home and has cared for people, new and those using the service for a number of years. There is a welcoming and homely atmosphere in the home, whereby staff greet people and make the experience at the home pleasant. People are encouraged to relax, socialise and conversation is promoted by the layout of the lounges and the dining area. People are encouraged to continue making decisions about their daily routines and lifestyle. People are involved in their care arrangements to ensure individual choices are respected. There is a positive focus on providing personalised and tailored care, which promotes peoples well-being. People have good access to health care support on a regular basis and when required. People are encouraged to maintain contact with family, friends, the local community and can choose to participate in social events. Visitors are welcome at any time. People are supported to continue observing and practicing their religious or spiritual beliefs. People are offered a good choice of home-cooked meals. Menus and mealtimes are flexible and suitable for individual needs. There is a good complaint procedure and people are encouraged to express any concerns or complaints that they may have, which are addressed quickly. People are encouraged to participate and be involved in discussions that may influence the day-today running of the service. The home welcomes comments and suggestions and sees this as beneficial to improving the quality of the service people receive. There is an established and stable staff team, who have clear roles and responsibilities. Staff skills are maintained through regular training, updates and supervision. The comments we received from the surveys that were returned together with comments made directly to us during the site visit to the home included: I am very happy living here and have made lots of good friends My dad is very well looked after. The staff seem to really like him and make a big fuss of him Usually, a very high standard of care My wife and myself would like to say we are pleased with the way ... is being looked after and attends to her needs. She is always immaculately dressed and very clean. Credit must be given to all the staff and carers for their dedication We visit regularly and we have no complaints, staff and the manager are very easy to get on with, informative and know the residents here Care Homes for Older People Page 8 of 41 The care is excellent, the staff are caring and very kind and attentive Mum is definitely happy here, she has her friends and joins in with activities. We often sit away from her as she enjoys her singing We hold different activities for the service users and people from the community also come in and get the service users involved in singing, arts and crafts, exercise, games and hymns Encourage individuality, choice, respect all individuals religion and faith Were mates, we talk and laugh alot, theres always something that makes us laugh Food is well balanced and prepared in line with the governments healthy eating requirements Its always clean, tidy and a pleasant home to visit The staff, manager and the owner are approachable and willing to listen to make things better for the residents There are enough staff for us to meet the individual needs, we try to spend one-toone time with service users We have competent team leaders who make sure the way information is passed onto staff works well. The manager and team leaders are well qualified and pass down their knowledge to the less experienced staff. We are sent on training courses, which help, e.g. manual handling, etc What has improved since the last inspection? Since the last inspection of Freestones Residential Care Home, Mrs Claire Davidson is the Registered Manager of the service. The assessment and care planning is person centred, holistic and considers the care needs and lifestyle of the individual. The key worker systems promotes better person centred care and staff take responsibility to providing a quality service and lifestyle that promotes peoples well-being. There have been a number of improvements made to the home environment. These include the decoration of some bedrooms, the lounges and the refurbishment of the bathrooms. The layout of the lounges and dining area has been changed to encourage people to talk mingle with each other and promote participation in organised activities. New furniture for the lounge and bedrooms has been purchased such as bed linen and curtains. Staff have received regular updates in training and accessed new training with regards to Deprivation of Liberty, Palliative Care, Dementia and Parkinsons Awareness. We were informed that there are plans to develop a sensory garden and work has begun with the appointment of a gardener and the purchase of garden furniture. A number of sensory items have been purchased such as the magic light ball and lava Care Homes for Older People Page 9 of 41 lamps, to stimulate people who may have dementia or poor eye-sight. 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 10 of 41 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 11 of 41 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good information about the service, are involved in the assessment process to make sure their needs are met. Evidence: Freestones Residential Care Home provides information to people who are considering using the home for themselves or their friend or relative, known as the Service User Guide. This includes the Statement of Purpose, which outlines the type of care, accommodation and services people can expect to receive if they choose to move to the home. It also sets out the aims and objectives; the policies and procedures including the complaints procedures; and the skills and qualifications of the Registered Manager and staff. We discussed the Service User Guide and the Statement of Purpose with the Registered Manager in relation to the need to review and update the contents in line with the developments and changes in practice. We received the revised documents Care Homes for Older People Page 12 of 41 Evidence: soon after the site visit. This demonstrated the Registered Manager strives to quickly address inadequacies so that information is up to date. The Registered Manager confirmed that could be made available in large print if people required. We also wanted to find out whether people could visit the home to see if it would be the right place for them or their relative before deciding to move to the home. One person living at the home and visiting relatives said they visited the home and spent time looking around, talking with the people using the service, the staff and the manager to see if the home could meet their requirements. This supported the responses we received in the surveys from people using the service and their relatives. The comments received included: Ive not regretted coming here I cant remember how long Ive been here since but I know that Im happy here I liked the government website, it was very useful for making comparisons before visiting the home. The staff at all the homes we visited were very helpful when we looked round My daughter did all the research, came and had a look around. I was shown this bedroom and liked it because its on the ground floor, I have plenty of sunlight and my own toilet facility I am very happy living here and have made lots of good friends Weve seen other homes but this is right for our mother, she looks happy and we all visit regularly We wanted to find out whether people considering using Freestones Residential Care Home involved in the process to say what help they need on a daily basis. The information we gathered from the self-assessment tool completed by the Registered Manager was brief. It did not demonstrate the assessment process or the involvement people. However, people using the service told us that they met with the Registered Manager who asked them questions about what help they needed. This process is known as the assessment of needs, which considers if the persons care needs can be met by the home. A person we case tracked demonstrated the assessment process by what they said; Claire, came to see me and we chatted about what help I needed and interests I Care Homes for Older People Page 13 of 41 Evidence: have, which she wrote down We read the care files for people we case tracked. We saw evidence of a comprehensive assessment of needs carried out by the social worker, where the person is financially supported by the local authority. We saw the assessment of need completed by the Registered Manager. The assessment showed a range of information gathered about the person, which included their personal details, medical history, medication and allergies, care needs, mental and physical needs and dietary needs. It also included the contact details of significant people that are important to individual or who are involved in their well-being, such as family, next of kin and the General Practitioner. We wanted to find out what information staff receive about a new person that moves to the home. Staff we spoke with confirmed that by the time the person moves to the home, there is a care file containing a care plan detailing the help they require daily. Staff also said they receive information at the handover meeting at the start of each shift and can read the handover book, which is another way staff are kept up to date with the needs of people using the service. This supported the comments we received in the staff surveys. The Registered Manager has introduced an assessment that look at the persons ability to make decisions for themselves. This is in line with the Mental Capacity Act and ensures peoples views and their best interests are advocated. This demonstrated that the well-being of individuals is promoted by a robust assessment process. The comments received from the directly and in the surveys included: Yes, we are given up to date information about the needs of the people we support or care for when we come on duty as this is very important The new handover book, which was introduced when the new owners took over the home, is excellent for passing on information. This works well Updated information is top priority in the care home, therefore, given straight away Claire, manager updates us regularly on anything that has changes with the service user needs and checks the care plans once we have filled out our monthly evaluations. The information gathered from the self-assessment completed by the Registered Care Homes for Older People Page 14 of 41 Evidence: Manager stated signed contracts are in place on file and a copy provided to each person. This supported the responses received in the surveys received from people using the service and their relatives, confirming they do have a contract. Freestones Residential Care Home does not provide intermediate care services. Care Homes for Older People Page 15 of 41 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People s health and care needs are met through person centred care planning that is holistic; personalised and by staff skill mix that promotes well-being and independence. Evidence: We wanted to find out how peoples health and care needs are met. The information we gathered from the self-assessment tool provided a summary of evidence to show the processes in place followed by staff to meet peoples health and social care needs on a daily basis. Additional information received took into account diversity needs and issues. This demonstrated how peoples dignity, rights and privacy is respected and how the staff support people to promote and maintain their level of independence. We had received a number of surveys from the people using the service and their relatives. All the responses indicated people had their care and health needs met. The comments received in the surveys included: My dad is very well looked after. The staff seem to really like him and make a big Care Homes for Older People Page 16 of 41 Evidence: fuss of him Usually, a very high standard of care My wife and myself would like to say we are pleased with the way ... is being looked after and attends to her needs. She is always immaculately dressed and very clean. Credit must be given to all the staff and carers for their dedication My father needs allot of care because he is bed bound, incontinent and unable to feed himself. The home has provided a special bed and a pressure relieving mattress On the day of the site visit, we saw people were relaxing in one of the two lounges, some people preferring to spend time in the privacy of their bedrooms. A few people were being cared for in bed as they were feeling poorly. We spoke with a number of people using the service including one person we case tracked and visiting relatives. We found that people were involved in developing their care plans to make sure the way the care was provided suited them. People gave us examples of their preferred routines and indicated that the staff treated them well and with respect. We saw evidence of how the care plans were personalised, for example one care plan stated prefers mature staff with bathing not a youngster. We wanted to find out how staff receive information about peoples individual care needs. Staff confirmed they have a care plan that tells them about the needs of the person, their preferences and routines. Staff confirmed they receive regular updates on peoples well-being through the handover meetings at the start of each shift and the handover book in addition to the care plans. This supported the comments we received in the staff surveys, which included the following comments: The new handover book, which was introduced when the new owners took over the home, is excellent for passing on information. This works well As a trainee carers I am always given new and updated on care plans and given support on my care from all members of staff The types of systems we use for communicating are as follows:- monthly staff meetings, care plans - which are regularly updated and staff read them, handover at the start of each shift and supervision, etc We read the care files for the people we case tracked. The files contained copies of Care Homes for Older People Page 17 of 41 Evidence: assessment of risks showing the risks posed to individuals in relation to their mobility. Safety measures considered were included in the care planning process, which also gave clear guidance to staff to follow. The care plans were written in a holistic way, looking at the needs of the individual, taking into account their preferences, routines and social interests, which can affect their lifestyle. The guidance for staff to follow was good. There is the Personal History Profile that gives information about the persons life and interests at different stages in their life. Staff spoken with said this gave them good information on topics that they could speak about. This further supported the holistic approach to care planning and ensures people experience the quality of care and lifestyle of their choice. Staff told us they operate a key working system, whereby a member of staff supports a number of people and are responsible for their care planning and making sure they have everything that they need to be comfortable. We saw evidence of the care plans being reviewed monthly or more often if peoples needs changed. The daily records demonstrated the well-being of the person including one-to-one time spent by staff or joining in social activities. The care planning system is good, whereby checks are routinely made by the Registered Manager to ensure peoples care needs are met by staff that have accurate and up to date care plans. The comments received in the staff surveys included: As a key worker we evaluate the service users care plans open a monthly basis and update the identified needs. Claire, manager updates is regularly on anything that has changes with the service users needs and she checks the care plans once we have filled out our monthly evaluations Staff told us they have good access to training and regular updates and refresher training to ensure their skills and practice are in line with current best practice. This supported by the staff training records viewed, indicating the range of training and skill mix is maintained. This includes health and safety, moving and handling, infection control, dementia awareness and Parkinsons awareness. This demonstrated that peoples well-being is promoted by staff that monitor and respond to changes, good care planning, which is kept under review and staff trained and competent to look after the people using the service. The self-assessment tool stated some senior staff had attended palliative training. This means caring for people that are terminally ill. Staff spoken with demonstrated their knowledge and learning is shared with the staff team through the staff team meetings. This showed learning is shared amongst the staff team. Visiting friends and relatives spoken with said they treated Freestones Residential Care Homes for Older People Page 18 of 41 Evidence: Care Home as the persons home, felt they could visit when they wanted to. They told us they are supported and kept informed of events that would affect their relatives health and well-being, especially if the person was forgetful or were supported by an advocate. We observed good moving and handling practices with staff talking with the person to encourage and guide them to ensure they were steady on their feet and safe. We saw staff speak with people by their preferred names, as stated in the care plans. This showed people were respected. Staff demonstrated how the knowledge gained from colleagues and training in dementia awareness has been put into practice to benefit people using the service. Some of the comments received from people using the service and visitors with regards to being respected and treated with dignity included: I have my own en-suite toilet, so I have my privacy, occasionally ... will pop in and uses my toilet The girls help me with my personal care because I had a stroke I enjoyed .... shaving me today, Ive had a very smooth shave They get the GP out if I need to see them if Im not well I like to do everything myself as much as possible People told us they have good access to their health care needs. The care files contained records that showed visits made by the General Practitioner (GP) and the District Nurse. We were aware that the GP had been called to see a person who was very poorly and was being cared for in bed. The Registered Manager showed compassion and responsibility as the family members were notified. This supported the responses received in the surveys received from people with regards to being kept informed about their relatives health and well-being. We spoke with the visiting District Nurse (DN) who arrived at the home a short while after we did. The District Nurse visits daily to see a number of people who have specific health care needs. The District Nurse said peoples needs are met and staff are alert and confident to seek advice in relation to pressure care management. Some of the comments received included: Care Homes for Older People Page 19 of 41 Evidence: People are well cared for Staff are quick at following up on things and would call us of they are concerned about any particular resident We visit regularly and we have no complaints, staff and the manager are very easy to get on with, informative and know the residents here Its always clean, tidy and a pleasant home to visit We saw the medication trolley stored securely. Staff confirmed they are trained to administer medication and training records viewed supported this. The management and administration of medication is good, from the checks we made by looking at the blistered medication and the medication records. People we spoke with said they receive their medication on time. One person said I take the blood pressure tablets half an hour before breakfast and then I have 6 tablets after breakfast for my heart, angina and water. We checked the care files and found there was an up to date self-medicating risk assessment, which was reviewed on a monthly basis. This showed people are supported to maintain to self-medicate and checks are made to ensure they do so safely. The Registered Manager confirmed that annual Pharmacy inspections are conducted to ensure compliance. In addition, we saw records of the monthly visits carried out by the Responsible Individual (owner) and the quality audit checks carried out by the Registered Manager. This demonstrated that the home has an internal monitoring and auditing system in place to ensure the health and safety of the people living at the home. Throughout the site visit, we observed staff treating the people using the service and their visitors with respect at all times. Peoples privacy and dignity is maintained and there was a family friendly atmosphere by people relaxing, chatting and laughing. We concluded that the systems, practices, staff skills and conduct benefits and provides people with a better quality of life. The comments we received during the site visit were complimentary with regards to the quality of care provided by staff. This also supported the numerous comments we received in the surveys from the people using the service, relatives and the staff in relation to what the service does well, and included: Care Homes for Older People Page 20 of 41 Evidence: Being a small home, we have ample staff to meet the needs of service users As there are a small number of residents we aim to spend ample time with each individual to get to know them well Meeting the care needs of service users offering choices, always trying to improve We look after our service users well and offer support where and when needed. We are introducing new sensory items for service users that suffer with dementia. We work well as a team and have good communication between management and staff. We have a good team of staff here at Freestones, some staff have worked here a long time and are very experienced. The care is excellent, the staff are caring and very kind and attentive Care Homes for Older People Page 21 of 41 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a health choice of lifestyle, maintain contact with the family and the community and offered good choice of meals that promotes their well-being. Evidence: We wanted to find out what social opportunities and activities are available for people using the service. The information we gathered from the self assessment tool completed by the Registered Manager stated people are offered choice, encouraged to have contact with the community, visitors and provided with choice and good balanced meals. We discussed to content of the self-assessment tool with the Registered Manager who acknowledged the content and evidence provided to demonstrate the social opportunities, activities and lifestyle people experience could be improved. Following the site visit the Registered Manager provided us with more comprehensive information to demonstrate and evidence the impact of social opportunities and events benefits people using the service. During our visit to the home, we saw people sat with their visitors, talking in the lounge or in the privacy of their bedrooms. People were relaxing in the morning talking with other people living at the home. We saw staff spending quality time with individuals using the service, talking with them about things that are of interest to Care Homes for Older People Page 22 of 41 Evidence: them. Visitors were seen coming throughout the day and were greeted by the staff, which showed there were no restrictions for when people received visitors. In the afternoon, the Activity Person arrived with the musician and people participated in singing hymns. We saw various notices of planned activities, which showed there is a range of social events and opportunities that people can choose to participate in. These included the monthly visit by Reverend Cannon, prayer reading, armchair aerobics, arts & crafts, music and entertainment. The Easter Raffle is due to take place on 14.04.09, which showed people are informed about future events in celebration of significant religious events. We saw photographs of events and celebrations such as birthday parties and Christmas festivities. We saw a couple of people being entertained and laughing by the magic light ball, that have been purchased to promote and stimulate people. The Registered Manager confirmed that items have been purchased like the lava lamp, shadow ceiling lights, bean bags and developed photo diaries to reminisce, to stimulate people who suffer from dementia. The Registered Manager told us that they have appointed a gardener and purchased garden furniture, so people can sit out in the garden, on warmer days. The Registered Manager said they plan to have a sensory garden with wind chimes and a water fountain. We suggested they seek expert advice from organisations that support people with a sensory impairment. The issue of improving the garden area to benefit the people using the service was identified as an area that the home could improve, in the surveys we received. We saw people throughout the day moving around the home freely. We spoke one person we case tracked who enjoyed spending time in their bedroom, doing crossword puzzles, quizzes and watching the birds feeding outside the bedroom window. Two people told us they prefer not to join in activities but like to go for a walk or spend time talking to each other. This showed peoples well-being; rights and choices about their lifestyle and what they choose to do, are promoted and respected. People living at the home told us about the Residents and Relatives Meetings held where they have an opportunity to make decisions and suggestions about social events. We read the minutes of the last meeting, which showed the topics discussed included the Easter Raffle, food, fund-raising events, mothers day and the new staff. This showed people are involved, informed and their views are considered. The comments we received from people using the service, visiting friends and relatives and from the surveys were positive, complimentary and supported our findings on the day. We concluded that people have the opportunity to enjoy Care Homes for Older People Page 23 of 41 Evidence: socialising and participate in activities arranged by the home. The comments received included: We do quizzes, keeps the brain active and ... is always first to answer, she does well considering she has dementia Mum is definitely happy here, she has her friends and joins in with activities. We often sit away from her as she enjoys her singing Its a family atmosphere here. You can see everyone seems to be quite happy here I often exercise using my stepper, holding onto the back of the armchair We hold different activities for the service users and people from the community also come in and get the service users involved in singing, arts and crafts, exercise, games and hymns Encourage individuality, choice, respect all individuals religion and faith I enjoy doing the crossword puzzles and often have to check the spelling in the dictionary I do bird-watching from here, a numerous variety of birds come and eat the seeds and nuts ... blue-tits, finches and robins Were mates, we talk and laugh alot, theres always something that makes us laugh We have a lady that comes in and shes very good at arts and crafts. I liked the napkin holders so much I had to work out for myself how it was done, I like to keep mine with me We wanted to find out what information staff received about peoples interests and choice of lifestyle. Staff told us the care plans and the personal history profiles in the care files, provides them with information as to peoples life, interests and hobbies. Staff said the best way to learn about people is to talk with them and their families. A member of staff told us some people like to help hang out the washing, makes them feel good and involved and they often come out with the most random things and interesting things that they have done when they were younger, its amazing how much energy some people have. The care files we read showed the types of information available to staff, in addition to new information shared through the Care Homes for Older People Page 24 of 41 Evidence: handover meetings. This showed the benefits of key-working and supported our own observations we had made during the day, indicating people enjoy their lifestyle at the home. We concluded that the routine in the home is flexible and people are encouraged to live their choice of lifestyle. Staff are friendly, caring and support the people living at the home. This approach helps people to maintain their independence and exercise choice and control over their life. We wanted to find out what the meals were like. The information gathered from the self-assessment tool completed by the Registered Manager stated there are two cooks. The cook said they meet with the new person moving into the home to find out what their preferred meals are and any special diets, such as vegetarian meals preferred by one lady. The care files read showed the dietary needs and preferences of people. This showed all aspects of peoples lifestyle and needs are considered as part of moving to the home. This ensures there are positive benefits for their health and well-being. The choice of meals and menus are displayed on the notice board. Most of the food is homemade and healthy eating is encouraged. Lunch is the main meal of the day and served formally at the dining table. We saw people eating their meals, whilst talking and laughing, which showed people enjoyed their meals and the experience of mealtimes. We saw people were being encouraged to drink lots of fluids. Hot drinks, water and juice was constantly available to people in the lounges and taken to the people that were in their bedrooms. This showed the staff recognised the importance of making sure people have lots of drinks to benefit their health and well-being. Some of the comments received from the people using the service and in the surveys from relatives and staff regarding meals, included: Very nice food One of the care worker likes to come in on her days off to feed my dad Food is well balanced and prepared in line with the governments healthy eating requirements Care Homes for Older People Page 25 of 41 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident to complain and protected by staff recruitment processes and training to ensure people are safe from harm and abuse. Evidence: We wanted to find out if people were aware of how to make a complaint and what the process was. One person told us they were told about the complaints procedure when they visited and again when they moved into the home. We saw the complaints procedure was displayed and is included in the homes information pack with the Statement of Purpose and the Service User Guide. The complaints procedure is clear, tells people how to make a complaint, the timescale and process to investigate and conclude the complaint. We advised the Registered Manager to ensure the contact details for the Care Quality Commission are updated so that people are aware of the regulating body for health and social care services. The people we spoke with using the service and visiting family and friends. All said they know who to speak with if they are unhappy or have a complaint. People were confident to speak with the staff or the Registered Manager, all who were approachable. We noted that the atmosphere in the home was relaxed and there was a culture of staff being visible, available and approachable. The responses received during the site visit to the home, supported the responses in the surveys indicating they know how to complain. Some of the comments received included: Care Homes for Older People Page 26 of 41 Evidence: Could just tell the staff, manager or the owner who is at the home The staff, manager and the owner are approachable and willing to listen to make things better for the residents The manager is always here from about 7.30am and is contactable at anytime Nothing to complain about I would just talk to Claire if there was a problem The visiting District Nurse said, we visit regularly and we have no complaints, staff and the manager are easy to get on with, informative and know the residents here. Staff that we spoke with were confident to listen to any concerns or issues raised by the people using the service and from visiting relatives that advocates on the persons behalf. Staff demonstrated from our discussion with them that they would share issues brought to their attention with the manager or the person in charge. Some of the comments received included: I advise them to speak with the manager. There are complaint forms to be filled in that are near the entrance to the home, if necessary they can speak to CSCI about their concerns Tell management or senior member of staff The relatives, advocates or friends who has concerns would be referred to the team leaders or the manager Freestones Residential Care Home has not received any complaints since the last inspection of the service. The Care Quality Commission has received no complaints or concerns regarding the quality of care people receive. We wanted to find out if the staff knew what safeguarding issues meant and how to deal with any allegations or suspicions with regards to abuse. Safeguarding issues means promoting the well-being of people using the service from harm, risk and abuse. Staff that we spoke with ranged from a trainee to a senior carer. Staff demonstrated a good understanding of safeguarding issues, the types of abuse that Care Homes for Older People Page 27 of 41 Evidence: could occur and were confident to raise the issue with the Registered Manager or the senior carer. The staff training records showed staff had received training and updates in the safeguarding procedures. Staff were confident to address poor care practices of colleagues using the whistle-blowing procedure. This was consistent with the responses received in the staff surveys, demonstrating peoples well-being and safety is promoted. We found two sets of the safeguarding policy and procedure, which had slight variations. This could be confusing to staff who may refer to the procedure if an incident had occurred. We raised this with the Registered Manager who confirmed that the local multi-agency procedure would be followed, which was one of the two procedures kept in the file. The Registered Manager said the safeguarding policy and procedure would be updated, shared with the staff and a copy would be available for future inspections. Staff we spoke with confirmed they started work after pre-employment checks were carried out such as receipt of two satisfactory references and a criminal records bureau (CRB) check. This was consistent with the responses indicated in the staff surveys. This demonstrated staff recruitment procedures were followed to ensure peoples health, safety and well-being. We spoke with the trainee and a student on work experience. The trainee confirmed that the whilst they have received training to help care for people they are supervised and work with a senior member of staff with regards to personal care tasks. The two staff confirmed they had an induction and were made aware of their roles and responsibilities. This shows that staff and the people using the service are protected and confident that the homes procedures are followed. Care Homes for Older People Page 28 of 41 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and tidy home that promotes their independence and well-being. Evidence: We wanted to find out the type of home environment people lived in. The information gathered from the self-assessment tool completed by the Registered Manager stated a number of environmental improvements have taken place to benefit the people using the service. These include new radiators and radiator covers, new curtains and bed linen, the entrance and some bedrooms have been decorated. A number of items have been purchased such as furniture and a fire evacuation sledge. External repairs and maintenance have been carried out including the water heating system and painting the fences. It also stated the home has received 4 stars environmental health rating and a gardener has been appointed to maintain the garden at the rear. The surveys responses received from the people using service and their relatives were positive and complimentary with regards to the home environment. People we spoke with on the day including visitors family, friends and the District Nurse also commented on the cleanliness of the home. Some of the comments received included: The improvements made to the home since the new owners took over are excellent, it is nice that rooms are decorated with colour and makes it feel more homely Care Homes for Older People Page 29 of 41 Evidence: You dont get the bad smells here as you do in some homes Its always clean, tidy and a pleasant home to visit On the day of our visit to the home, we saw people were sat in one of the two adjoining lounges. People were seen moving around the home freely or helped by staff who were vigilant. The ambience was pleasant and relaxing. There is lots of natural and good lighting throughout the home. We saw a number of bedrooms some had en-suite toilet facilities and others were close to bathrooms and toilets. We saw a number of bedrooms and one person invited us to speak with people in the privacy of their bedroom. All the bedrooms were well decorated, furnished to a good standard and personalised with photographs, pictures, television and radio. The Registered Manager told us that some bedrooms have been identified where the carpets need to be replaced. We were told that this is done following discussion with the person whose bedroom it is and their family, in some instances. There are three bathrooms that have been decorated and fitted with bathing equipment to help people with limited mobility, such as hoist and grab rails. A number of people are being cared for in bed and special equipment such as nursing beds and pressure relieving mattresses have been provided. This promotes peoples health and well-being. The laundry room is located away from the areas where food is prepared and kept locked. Domestic staff was seen cleaning the bedrooms and bathrooms. This showed the home employs staff with specific duties to ensure the cleanliness of the home. We saw staff wearing protective clothing such as aprons and gloves when preparing to assist people with their personal care tasks and when handling food. Staff spoken with confirmed they have ample supply of protective clothing, which was seen throughout the day. We saw staff put on fresh aprons and gloves each time someone needed help with their personal care. Staff spoken with also demonstrated a good understanding of infection control practices and training records showed staff received regular training and updates. Whilst we had observed good practices throughout the day we also found a used bar of soap left in the bathroom. This would increase the risk of cross infection, if shared. When this was pointed out to the Registered Manager it was returned to the persons bedroom immediately, as they had just finished bathing. Care Homes for Older People Page 30 of 41 Evidence: The Registered Manager discussed some of the improvements that are being considered at the home. There are plans to replace the old bay window with doubleglazing and to develop a sensory garden. We suggested that they consider speaking with experts supporting people with sensory impairment to ensure the development promotes peoples well-being and safety. We also shared the comment received from a visitor who was concerned that they often find her trying to pick the printed flowers in the carpet, due to her dementia and because she was keen gardener. This comment was valuable and showed how dementia can affect people. The Registered Manager confirmed they were aware of this and would discuss this with the owner of the home. Care Homes for Older People Page 31 of 41 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. People living at the home are supported by staff that have undergone a robust recruitment and training process to care and promote peoples well-being. Evidence: We wanted to find out whether the staff recruitment process and the skill-mix of staff meet the needs of the people living at Freestones Residential Care Home. The information we gathered from the self-assessment tool completed by the Registered Manager stated 92 of staff had attained the National Vocational Qualification (NVQ) level 2 or above in care and a further 25 of staff have or are studying towards the NVQ level 4. It also told us that there is good staff retention and training. We saw the staff rota displayed on the notice board. This indicated that the staffing rota is available for all to see. The staffing included the Registered Manager, care staff, the domestic staff and the Activity Person. We concluded from our observations and comments received throughout the day and in the surveys that staffing levels sufficiently meet the needs of the people using the service. Comments received in the surveys included: We have sufficient staff and having a junior on shift is really helpful giving us more time to spend with the residents Care Homes for Older People Page 32 of 41 Evidence: There are enough staff for us to meet the individual needs, we try to spend one-toone time with service users Being a small home, we have ample staff to meet the needs of service users. As there are a small number of residents we aim to spend ample time with each individual to get to know them well We observed how staff spoke and interacted with the people using the service, their visitors and the visiting District Nurse. Staff were polite, courteous and showed respect. People we spoke with said they liked the staff working at the home, they felt safe, happy and comfortable. All the comments received were complimentary about the staff, their conduct and their nature. We concluded that people were comfortable with the staff that cared for them. Some the comments we received included: Very good team of girls and boys Staff are quick at following up on things and would call us of they are concerns about any particular resident Staff, manager and the owner are approachable and willing to listen and make things better for the residents Staff are always helpful A good team of carers We wanted find out if the homes staff recruitment procedure was followed. All the staff surveys responses received confirmed staff were recruited after the employer had carried out the checks. There were also comments that indicated that there is a staffing structure in place, from students on work experience, trainees to carers and team leaders. We viewed three staff files and spoke with the staff on duty in respect of the recruitment process. The staff files all contained evidence of satisfactory checks such as two written references, protection of vulnerable adults check (pova) and a criminal records bureau (CRB) check. The pova and the CRBs are checks to confirm the person is suitable to work with vulnerable people. We concluded that the staff recruitment procedures were satisfactory. The comments in the staff surveys supported what staff told us with regards to their Care Homes for Older People Page 33 of 41 Evidence: induction and training. Staff training records showed staff complete an induction programme using the Skills for Care induction and training. The staff training records showed staff receive a good training to meet the needs of the people using the service and have an understanding of dementia, Parkinsons and old age through awareness training. Some of the training completed by the staff seen in the staff training matrix included: administration of medication, safeguarding adults, moving and handling, fire safety, food hygiene, Parkinson and Dementia Awareness, cathetar care, first aid, infection control and health and safety. We viewed the staff training matrix and confirmed that the 92 of staff had attained NVQ level 2 or above in care. From the comments received in the surveys and directly from the staff we spoke with, we concluded that the staff skill-mix and knowledge is good, to safely meet the needs of the people using the service. Very professional employers - excellent I am put on different training courses to help me with my role. For example, fire safety, dementia training and manual handling. These help me with my role, how to help move people with disability or help understand people with dementia We attend refresher courses to keep up to date. Just finished my NVQ 3, which looks at different aspects We have competent team leaders who make sure the ways information is passed onto staff works well. The manager and team leaders are well qualified and pass down their knowledge to the less experienced staff. We are sent on training courses, which help, e.g. manual handling, etc The Registered Manager said further specialist training in Palliative Care has been identified upon receipt of funding that has been applied for. This demonstrated that new training courses are being identified to ensure the staff skills are developed as the needs of the people using the service changes. This ensures positive benefits and outcomes for the people using the service and continuity of care. Care Homes for Older People Page 34 of 41 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. People benefit from a well managed home, have opportunities to comment on the quality of the service that promotes their health, safety and well-being. Evidence: Since the last key inspection of Freestones Residential Care Home, Claire Davidson, successfully underwent the CSCI (as it was at the time) registration process to determine her fitness to be the Registered Manager for the home. Claire has many years experience of working in a care home and has completed the Registered Managers Award, the National Vocational Qualification (NVQ) level 4 in care and is considering NVQ 5 in management. Claire has continued to maintain her knowledge and skills on current best practice and changes in legislation by attending training. She has recently attended the Deprivation of Liberty and the Mental Capacity Act training and has already included this into the assessment process for people considering using the service. We wanted to find out how the management of the home benefits the people living Care Homes for Older People Page 35 of 41 Evidence: there. The staff described their roles and responsibilities and we concluded that the staffing structure and levels ensured the needs of people using the service were met. During the site visit to the home, we observed an open culture whereby people using the service, visitors, staff and the Registered Manager approached each other on first name terms. We received positive and complimentary comments about the Registered Manager from the people using the service, visitors, District Nurse and the staff, which included: We have lots of support from the owners and Claire, manager Claires always here and she is good, infact everyone here is good. The manager is always here from about 7.30am and is contactable anytime She is very supportive The management are very approachable, friendly and caring with staff and service users The Responsible Individual, who is the owner of the service visits regularly and often helps with the serving of meals, conducts the formal monthly visits and the quality audit checks with the Registered Manager. We read the latest monthly visit report and the quality audits. This demonstrates that the service has an internal system of monitoring and checking the service to ensure it continues to comply with the rules and regulations. We saw displayed notices for the Residents & Relatives Meetings. People using the service and relatives told us that they attend these meetings, where they discuss things about the home. They said, its good that we have a say in what happens here and we are also asked about the meals and activities on offer. We read the minutes of the last meeting that showed the topics discussed included, the Easter Raffle on 14.04.09, food, fund raising for the residents fund, Mothers day and new staff. This demonstrated the ethos of the home is open and transparent as the views of the people using the service are listened to and valued. Freestones Residential Care Home has received a number of compliments in the form of cards and letters of thanks, including an article submitted by a family in the local newspaper. We read a number of the compliments received by the home, which included comments such as, thank you for helping over the last couple of months, this has helped me understand care even more. Care Homes for Older People Page 36 of 41 Evidence: The Registered Manager told us she is considering including the some of the quotes in the compliments received in the homes information pack to reflect the views of people that have used the service and their relatives. This showed initiative and openness by sharing peoples experience and views about the care provided at the home. Freestones Residential Care Home conducts an annual quality assurance exercise and seeks the views of the people using the service, relatives or main carers and the staff. This is done by completing questionnaires. We read the comprehensive report produced with statistical information detailing the findings from the quality assurance, which is also shared with the people using the service. We discussed with the Registered Manager that some consideration should be made to making the report appropriate for the audience, i.e. people using the service and whats important to them and what the numbers or statistical information means for them. We also suggested that consideration should be made to measuring the outcome of the quality assurance against the statement of purpose. This would show if peoples experiences and expectations of the service is consistent, in line with the aims and objectives and would help to develop new aims as the service develops. We wanted to find out how people are supported to manage their money. The home does not keep any money on behalf of the people using the service. Some people said they manage their own money themselves or with the help their family or a power of attorney. This is a person who has a legal responsibility to advocate and act in the persons best interest, such as a member of the family or a Solicitor. The care records viewed for the people we case tracked identified the person responsible for managing money. This showed that the service maintains good information to protects the best interest of the people using the service. The staff surveys responses indicated staff receive regular supervision and appraisals from the Registered Manager and supported the information gathered from the selfassessment tool that stated supervision every 8 weeks and appraisals every 6 months. The staff files contained confidential supervision and appraisals meeting minutes. Staff told us they meet with the Registered Manager regularly and have regular staff meetings. We read the minutes of the last staff meeting, which discussed the daily quality checks, phone calls, nights, service user issues, new sensory items purchased and NVQs. From the evidence gathered with regards to staff supervision and team meetings and the comments received, we concluded that staff are supervised and have development opportunities. Some of the comments received from staff included: Care Homes for Older People Page 37 of 41 Evidence: Supervisions and appraisals are given and if any problems arises they are there to support We work well as a team, we all get on with each other and residents and their family The types of systems we use for communicating are as follows: monthly staff meetings, care plans - which are regularly updated and staff to read them, handover at the start of each shift and supervision, etc We have the right support to help us with service users with dementia or language barriers All the records relating to the people using the service, the staff and the records that demonstrate the management of the service were kept up to date and in good order. The quality of the information was good and provided us with a good overview. For example, the care plans were reflective of the assessments of risks and personalised. The system of monitoring and carrying out key worker reviews showed the well-being of the individual. This practice benefits the people using the service and maintains their quality of lifestyle. The information we gathered from the self-assessment tool completed by the Registered Manager stated all the policies and procedures are reviewed and kept up to date. Although we identified that the safeguarding policy and procedure needed to be reviewed and updated, the remainder were up to date. Staff we spoke with confirmed they have access to the policies and procedures and receive regular updates. This demonstrated there is good communication with the staff team who are kept informed and up to date with changes in best practice. The information we gathered from self-assessment tool completed by the Registered Manager, detailed the programme of maintenance, servicing and testing of equipment and checks in place. This was supported with monthly visits and the quality audit reports viewed and from the comments we received from the people using the service with regards to fire alarm tests carried out regularly. We concluded that the home environment is safe and maintained for the people living and the staff working at the home. Care Homes for Older People Page 38 of 41 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 39 of 41 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 18 The safeguarding procedure should be reviewed and updated to ensure staff have access to the correct and most up to date procedure that gives them clear information about their responsibility. The home should consider measuring the results of the quality assurance against the aims and objectives in the statement of purpose to show if the expectations of the service are met, help identify areas of improvement and ensure the statement of purpose evolves as the service develops. 2 32 Care Homes for Older People Page 40 of 41 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 41 of 41 - 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!