Care Home: Gills Top

What the care home does well We talked to people who live at the home. They are generally very happy with the care they receive. One person said, "Staff are really nice here, they do so much for you and are always cheerful" "I am very lucky to get a place here it is very popular" "We are always having a joke and a laugh with the staff" We spoke to several visitors. They told us they are happy with the care people receive. Relatives and friends told us they can visit anytime and are always made to feel welcome. One visitor said, "It`s lovely, we are made to feel very welcome." Staff were observed dealing with people in a sensitive way. They were seen to take their time with people and were patient and caring for people in a dignified way. People who live at the home and visitors were very complimentary about staff. People described the staff as `hard working`, `caring` and `patient. People enjoy living at the home and have a good variety of stimulating activities to join in if they wish. One person said, "We do baking, drawing and have some good entertainers, the local school children come in and and we have had a group of Dickensian singers" Everyone we spoke to says that the food is good. The meals are planned on a four weekly basis and the Chef asks people what they would like and for ideas for different meals. People live in a very pleasant, comfortable and clean environment. One person who lives at the home said, "I like my room it has a fridge and kettle so I can have a drink when I want." " This place is like a hotel" What has improved since the last inspection? The care plans have been updated and contain more information than at the last visit, all staff are also making sure they sign the daily reports and information that they record. People who self administer their medication have full risk assessments completed to make sure their independence is supported safely. Four staff who administer medication have recently updated their training. This is to make sure their practice remains safe and make sure people get the right medication. The service has recruited more permanent staff and no longer uses agency staff this is to provide more stability and consistency in the staff team. Staffing levels were generally felt to be better. There have been regular visits and closer monitoring from the management team to support the acting manager and improve the quality of care in the home. What the care home could do better: The care plans and daily records could be better organised to make sure staff can access information effectively and provide the right support to people in a consistent way. Some of the care plans omit important information, this could mean that important needs are overlooked. The management must still closely monitor all daily records and care plans to make sure that safeguarding and notifications are managed promptly. Any allegations of abuse or other safeguarding incidences must be responded to and reported promptly. This will make sure people who use the service are safeguarded from abuse. Staff would benefit form further specialist training that will help them understand people`s needs and the service needs to develop more access for the staff to the National Vocational Qualification ( NVQ). This will make sure that more staff have the right training to care for people and meet their needs safely. Staff must also have regular supervision to make sure they are well supported to care for people safely. Key inspection report Care homes for older people Name: Address: Gills Top Scar Street Grassington Skipton North Yorkshire BD23 5AF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Trenouth     Date: 0 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Gills Top Scar Street Grassington Skipton North Yorkshire BD23 5AF 01756752699 01756751804 judith.gibbs@anchor.org.uk www.anchor.org.uk Anchor Trust care home 27 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) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Gills Top provides personal care and accommodation for up to 27 older people and is owned and managed by Anchor Trust. The home is a detached property within a short walk of Grassington village centre. The accommodation is purpose built and is spaced over two floors and all areas are accessed by a passenger lift. The home is set in its own grounds. There is a car park to the front of the home. The weekly fees in December 2009 ranged from £375.77 to £515.00 and did not include costs for hairdressing, chiropody, toiletries and newspapers and magazines. People who use the service/relatives and other interested parties are able to have access to inspection reports as they are displayed in the main hallway of the home. Information about Gills Top including current fees, a statement of purpose and service user guide are available from the home 2 7 0 8 2 0 0 9 0 Over 65 27 Care Homes for Older People Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Care Quality Commission inspects services at a frequency determined by how the service has been risk assessed. The inspection process has now become a cycle of activity rather than a series of oneoff events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk We looked at a selection of records, observed care practice and meal times, looked around the building and talked to people who live at the home, the staff and management. Before our inspection visit we reviewed all the information we had Care Homes for Older People Page 5 of 30 received about the service since the last inspection and we asked the home to complete a self assessment. It provided the information we had asked for and told us what the home did well and what could be improved. We also sent a selection of surveys to the home, for the manager to hand out and ask people to complete and return to us. Seven comment cards were returned and these are included in this report. Information from the self-assessment is also included. The care of three people was tracked to help gain evidence as to what its like to live in the home. Various records were viewed during the inspection. Feedback was given to the acting Manager at the end of the visit. The requirements and recommendations made during this visit are included at the end of the report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? The care plans have been updated and contain more information than at the last visit, all staff are also making sure they sign the daily reports and information that they record. People who self administer their medication have full risk assessments completed to make sure their independence is supported safely. Care Homes for Older People Page 7 of 30 Four staff who administer medication have recently updated their training. This is to make sure their practice remains safe and make sure people get the right medication. The service has recruited more permanent staff and no longer uses agency staff this is to provide more stability and consistency in the staff team. Staffing levels were generally felt to be better. There have been regular visits and closer monitoring from the management team to support the acting manager and improve the quality of care in the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed and given good information before they decide to move into the home, this is important to make sure the home is right for them. Evidence: People are well assessed before they moved into the home and given good information from the service. The comment cards from people living at the home all confirmed that they had received good information to help them make a choice that the home is right for them. We tracked the care of three people living at the home during the course of our inspection. One is a new admission to the home and the acting manager had visited the individual before they moved in to make sure the home can meet their needs. People tell us, Care Homes for Older People Page 10 of 30 Evidence: I am just staying here for a while to see if I like it I stayed on respite before I moved in, I was able to see what the home was like I chose this home because it is near my relatives, i think I have been very lucky In the AQQA the manager tells us that an initial needs assessment is always completed to make sure that the service will be able to provide the right care and meet peoples needs. The home offers a trial period of residence if required, so that individuals can experience life at the home before making the decision to stay permanently. This helps to avoid inappropriate admissions, and unnecessary disruption for the individual. People are given a service user guide and contract stating what they can expect whilst living at the home, this is important to make sure they are aware of their rights whilst living at the home. People sign their contract if they are able. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported with their health needs but information omitted from the care planning could mean that important needs are over looked. Evidence: We talked to people who live at the home. They are happy with the care they receive. People say, The staff are excellent here and they cannot do enough for you I always have a good laugh and a tease with the staff When I was really ill, they looked after me so well I felt so loved and cared for People feel that the staff respect their dignity and help in a sensitive way. One individual says that there has been a flood in the home which means that the Care Homes for Older People Page 12 of 30 Evidence: bathroom is out of action. She was concerned about how she was to bathe. A carer reassured her by taking her for a look around the shower room to convince her she would be alright. She was very happy with this as she now isnt anxious when she has to bathe. We spoke to several visitors, relatives and friends of people living at the home, all their comments were very positive about the way in which they feel people are cared for. One relative is very complimentary about the care. She visits every day and is always made to feel welcome and offered a drink. She said that the staff are always caring and a great support to her and her husband. She felt that there is such a lot going on at the home and although her husband isnt always involved she felt that others got a lot out of the interesting activities. She had no concerns re staffing levels and felt that there has been more staff around recently. The staff deal with people throughout the day and we saw that they are aware of the level of support required by each individual. We saw staff take their time, use the persons preferred name and explain what they are doing. People who live at the home know the staff well and referred to them by name. Staff have good knowledge about the people who live at the home and were able to talk about their likes and dislikes and the way they wished to be cared for. Those care plans seen have social and health assessments. The care plans have begun to improve and there is more information recorded including life histories and completed risk assessments. There were examples of good support including help with hospital visits and staff promptly involving the GP where people are distressed or in pain. There are concerns however that there are still some omissions to the care plans and that at times important needs have not been followed up. One care plan has identified mental health concerns but there is no indication of any further action. Similarly so one individual required ongoing physiotherapy and the care plan failed to explain the action that was being taken to make sure this persons needs are met. Where bruising was observed a body map had not been completed. It is important this information is recorded accurately to help monitor the injury. The acting manager says that they are working hard to help staff understand the care plans and what they must Care Homes for Older People Page 13 of 30 Evidence: record and include, they acknowledged the care plans still need close monitoring. The care plans can also be better organised, information is difficult to find, the acting manager is presently reviewing each care plan and demonstrated a new care plan. The new care plan is easier to use and more effective in retrieving essential information. This is important so that staff can easily and quickly access the necessary areas of the care plan to find, analyse and record information accurately. A medication audit was undertaken during the inspection by the visiting manager to the home. The medication was reviewed, there had been a recent error in medication and the manager was conducting an investigation following the medication policy to make sure that peoples health care is well protected. The home uses a monitored dosage system and also administers controlled medication. These areas were reviewed and found to be in order. Risk assessments have been completed where individuals are self medicating. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home are flexible and people have an excellent choice of activities whilst living there, this is to ensure people experience a fulfilling life at the home. Evidence: People have a good choice of communal areas in which to spend their time. During the visit people appeared comfortable and relaxed and staff have a good friendly banter with them throughout the day. Individuals told us that they get up and retire when they wish and spend time in their rooms or join in activities as and when they wish. Gills Top employs an activities organiser who works 20 hours per week. People living at the home said that they have the opportunity to attend various activities such as exercise classes, poetry and reading, music, arts and crafts, quiz corner, coffee mornings, friendship club. They have recently made some Autumn and Christmas decorations. Care Homes for Older People Page 15 of 30 Evidence: People say they have trips out to places of interests such as MillStones restaurant, where they enjoyed a Wartime tribute, event. The home also holds parties where everyone is invited such as the Fire work party and Christmas Party. Bell ringers and Carol singers are also performing in The home for Christmas. Local schools visit the home and entertainers regularly perform. The local Wharfedale Cubs also have planted a section of the garden with Spring Bulbs. The daily trolley of sweets and toiletries is taken around the home and there are clothing parties organised regularly for individuals to enjoy. There was plenty of evidence of people choosing different things to do, people were observed in the morning reading magazines or a newspaper, people also seem to enjoy just chatting to each other. People say, I have breakfast in my room and come down late morning for coffee I like the occasional game of dominoes but mostly I like to watch the TV in my room It is lovely here the staff are wonderful, there is interesting things to do do every day we have entered a cake decorating competition I like to spend time in my room and I have various visitors throughout the day. The staff check up on me to make sure I am ok Staff observed are friendly and respectful to people in the home, they know them well and are aware of their personal preferences. Throughout the day there were several visitors to the home. Visiting arrangements are flexible and people spoken to are able to confirm that they can see family and friends whenever they want. The activities coordinator and people who live at Gills Top say that regular church services from the different denominations such as Methodist, Anglican and Congregational take place. Care Homes for Older People Page 16 of 30 Evidence: Special events and birthdays are celebrated and families are encouraged to join everyone in celebrations such as the forthcoming Christmas party. People talked about their birthday celebrations in the home, one person has celebrated their 100th birthday. They held a lovely party for me, it was wonderful, I couldnt thank the staff enough I had such a lovely party, the food was so good,they couldnt have done more, the flowers filled my room The staff have encouraged people to be involved in the recent fund raising in Grassington for Breast Cancer and individuals took part in the sponsored walk. The Wheelchair walk raised £173.61 for the charity. People tell us, We are encouraged to vote if we want to I have my mail delivered to me directly, and staff discuss matters of a personal nature in private with me There is a regular, Gills Top Gazette leaflet produced to give people up to date information about birthdays, staff changes, forthcoming events and events that have occurred at the home. Arrangements for visiting are well published and organised. Visitors say that they are made to feel very welcome at the home and are able to see people in private if they wish to do so. The home provides a good and varied menu. People say that generally the food is good. The dining tables are pleasantly arranged and condiments available for people to help themselves. People are supported with their independence by the provision of specialist cutlery and crockery. Where required individuals are being supported with their meals in a sensitive and dignified way. The kitchen facilities are made available during the night so that staff can prepare snacks for people if they become hungry. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safeguarding practices have improved but there needs to be further improvement to make sure that people are properly protected and safe at the home. Evidence: There is a comprehensive complaints procedure in place, which is displayed on the information board as well as being in the Service User Guide. All of the people we talked to said they would take any concerns to the manager or their key worker. A relative said they would not hesitate to take any concerns to the manager. They said the management and staff are always available and they were confident any concerns would be dealt with properly. The comment cards all confirm that people know how to make a complaint. There is also a minor complaintsbook for people to record concerns. Information was available in the book about the immediate action taken, any follow up action taken and the conclusion to the complaint. There have been two safeguarding alerts at the home which have now been investigated and completed. It was found that the service needed to improve the way in which it deals with concerns and allegations that are made at the home. All staff have now completed renewed safeguarding training and the Anchor Care Homes for Older People Page 18 of 30 Evidence: Safeguarding Policy is in place and covers the protocol required in reporting suspected abuse situations. The service has improved some of the communication with the required authorities but this could still be improved. Sometimes information isnt being passed to safeguarding and the CQC for several days. We received an improvement plan from Anchor Trust that told us how the home is going to improve. Some areas of the improvement plan have now been completed with other areas still outstanding. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean comfortable and well maintained to make sure people live in a good quality environment that meets all their needs. Evidence: We toured the premises during the course of our inspection, and we saw a randomly selected number of bedrooms and communal areas. The home is very pleasant, providing lovely surroundings for people to live in. The quality of furnishings and decoration is of a high standard and the home is well maintained so that people are provided with a comfortable and safe place in which to live. Bedrooms are nicely decorated and furnished to peoples individual tastes. Recent flooding problems in the home meant some people have had to move rooms. This has been well managed with the minimum of disruption. One person said, Its like going on a Holiday moving down on to the ground floor for a few days Care Homes for Older People Page 20 of 30 Evidence: People tell us that they are very happy with their rooms, Its grand in here, I even have my own fridge! The beds are lovely I have such a good night sleep on it I have brought a lot of my own things, important things to me People tell us that they can have a key to their room if they wish and have a place to lock things in their room if they need to. All bedrooms have en suite facilities. The home is clean and pleasant smelling. The communal areas are well furnished and tastefully decorated so that those choosing to spend their day in these areas can do so in comfort. One person living at the home told us that they are very happy with their bedroom and that it is very comfortable. There is a large lounge/dining room on the ground floor with a smaller lounge on the first floor. There is a passenger lift and a staircase that allows access to all floors. There is a range of equipment available, including pressure relieving equipment, and hoists. There are also grab rails and a passenger lift, which help people to move around the building independently. Assisted bathrooms and toilets are situated near to peoples bedrooms and communal areas on both floors. The home adheres to infection control practice. There are appropriate facilities throughout the home including hand gel for visitors to use on entry to the home. This is to make sure everyones health is protected. The environment is spotlessly clean, and a credit to the cleaning staff. Relatives told us, The standard of cleanliness is always good Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are supported by a safely recruited and trained staff team. Evidence: Further recruitment has taken place to improve staffing levels at the home. The rotas showed us that the home has consistently met their target staffing levels of one team leader plus three carers on a morning and one team leader plus two carers on an afternoon, and two waking night staff. At least one female staff member is on duty with a male employee so gender preferences are considered and respected where possible. The home no longer uses agency staff, and has a team of bank staff recruited by Anchor. This is to provide a better continuity of care. We spoke to relatives and friends visiting the home who felt that staffing levels have improved and there is a more consistent staff team. People living at the home say, The Staff are so helpful they couldnt do more for you Care Homes for Older People Page 22 of 30 Evidence: People described the staff as helpful and nothing is too much trouble Comment cards generally indicated that staffing levels are good. Staff meetings are held regularly. In the AQAA the acting manager told us they have robust recruitment procedures in place and are supported by a central recruitment team. We looked at three staff and their records contained all the documents that are needed when carrying out a robust recruitment process. Staff files also contained training records which showed us staff have attended regular training courses. Staff say they have attended training that helps them do their job well. Staff access a good variety of training but would benefit from additional training in areas such as palliative care and dementia training. These types of training will help staff have a better understanding of how peoples needs should be met. In the AQAA the acting manager said eight out of twenty care staff hold NVQ level 2 or above, which is below the recommended percentage of 50 . More staff would benefit from NVQ training. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been some improvement in the management of the service but further improvements still need to be made to ensure effective management systems provide a safe and consistent service to people who live at the home. Evidence: The home has a new acting manager from the 14th December, Jason Axford, who is an experienced manager and registered nurse. The service has provided a series of acting managers to support the home whilst the registered manager is away from the work place. Anchor Trust wrote to us and confirmed these management arrangements. The changes of management have created an unsettled period for the home and affected staff morale. It is hoped that with the new management arrangements the areas outstanding on the improvement plan will be addressed. The notifications to CQC have not been made promptly and information has not Care Homes for Older People Page 24 of 30 Evidence: always been detailed enough. The manager must make sure that all relevant agencies are contacted promptly when incidents occur in the home which affect the peoples well being. The intention is that the acting manager is supernumerary to the rota, which means that he can concentrate on managing the home and not working on care. This is important as the home needs consistent management to improve the quality of care. A representative from Anchor is visiting the service regularly to monitor the quality of the home. Visits were carried out regularly in October, November and December 2009. An annual quality assurance assessment (AQAA) was completed. The AQAA gives us important information about how well outcomes are being met for people using the service and some numerical information about the service. During the last inspection we identified areas where the home should make improvements and asked the service to complete an improvement plan. This has been completed and returned to the CQC. Three of the areas identified in the plan still require improvement. This is monitoring of safeguarding and notification of important events at the home and staff training identified in the improvement plan and previous inspection report. Staff meetings and residents meetings are being held at the home. This gives people an opportunity to have their say. Staff have not received formal supervision. Some staff told us, and the acting manager confirmed that, supervision has not been provided to all staff on a regular basis. Staff should have regular supervision at least 6 times per year to make sure that they are supported to do their work in a safe way. In the AQAA the acting manager told us they have all relevant policies and procedures in place, and equipment has been tested as recommended by the manufacturer. The gas and electrical safety certificates were in place. The registration certificate and insurance certificate were displayed in the entrance to the home. The home was awarded a good hygiene award following an environmental health visit in August 2008. The certificate said they have very good controls in place and a high Care Homes for Older People Page 25 of 30 Evidence: standard of cleanliness. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 32 17 The management must monitor the quality of care within the home. To make sure the quality of care is consitent. 26/02/2010 2 37 38 The Care Quality 26/02/2010 Commission (CQC) must be notified of significant events that affect the health and welfare of people who live at the home This will make sure the regulatory authority receives appropriate information and can monitor the health and welfare of people who are living at the home. 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 7 when the care plan is reviewed the information used should Page 28 of 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations be up to date and current. This will help make sure peoples health and welfare can be properly monitored 2 28 The home should have a higher percentage of staff with NVQ level 2 or above. This will help make sure peoples needs are met. Staff should receive further training that will help them understand peoples needs. This will help make sure peoples needs are identified and met. Accidents/incidents should be reviewed for each individual at their monthly review to ensure the care plan remains up to date. 3 30 4 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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