Care Home: Golden Sands

What the care home does well People living at Golden Sands say that they are made to feel "very welcome" from their very first day living at the home. Important information is obtained about people prior to agreeing to their moving to the home. This helps to reduce the risk of an inappropriate admission to the home and ensures that the team can meet people`s needs. Care plans are well structured around what each person wants from the team. The team of staff have good links with professionals, which helps to improve people`s health. People who live at the home say that the staff are "very attentive" and "know what they are doing" because they are well trained. Their relatives are very satisfied with the care and tell us in surveys that `the home is superb. She is safe, warm, fed properly and the staff and owners are excellent`. People living at the home told us they are treated as individuals. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. At the same time, they are confident about the way staff protect their property for them. They also feel able to voice their concerns, if they have any, and know that these are taken seriously and looked into by the acting manager and provider. Families and friends say that they are encouraged to visit whenever they wish to. The people living at the home get support to keep in touch with their families and friends if they need to. At the same time, the home plays an active part in the community. There is a good choice of appetising and well-balanced meals at Golden Sands. People say that the choice is good and meals are "tasty" and are "always home cooked". People live in a spacious and comfortable home that is well maintained. At the same time, people who use wheelchairs or walking aids find it easy and safe to get around the home. People living there say that they are encouraged to see it as their own home and that it is exceptionally clean. Staff feel well supported and are encouraged to do training so that they have the right skills and knowledge to care for people properly. What has improved since the last inspection? Regular audits of equipment are done and has ensured that these are always fit for purpose and safe for people to use. Recruitment has been tightened up and good practice consistently followed. This is ensuring that people that live at Golden Sands are properly protected and cared for by suitable staff. People are being given more regular opportunities to have a say about the running of the home and are making suggestions about what might be improved. What the care home could do better: More detailed guidance for staff would ensure that `when required` medicines or those with a variable dose are given in a much more person centred way and ensure there is consistency for people. Minor changes to the storage arrangements of controlled medicines will improve the security of people`s medicines. People should have more say about who is recruited as a care worker and ways to do this should be explored with everyone living in the home. Key inspection report Care homes for older people Name: Address: Golden Sands 10 Nelson Road Westward Ho! Bideford Devon EX39 1LF     The quality rating for this care home is:   three star excellent 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: Susan Taylor     Date: 0 7 0 8 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 29 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 29 Information about the care home Name of care home: Address: Golden Sands 10 Nelson Road Westward Ho! Bideford Devon EX39 1LF 01237477730 01237421214 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Thisby,Mr Robert Thisby Name of registered manager (if applicable) Ms Laura Jane Hobbs Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 17 The registered person may provide the folowing category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Golden Sands provides 24-hour personal care for 17 older people who are mobile or weight bearing. The home is situated in the centre of Westward Ho! The home has undergone major refurbishment and renovation. This included the addition of a spacious conservatory and landscape gardens. There is level access to the home. A passenger lift provides access to the first floor. There is also a stair lift leading to Care Homes for Older People Page 4 of 29 Over 65 17 0 Brief description of the care home rooms situated up a flight of four stairs on the first floor. Accommodation comprises of 14 single and 1 double rooms. Five have ensuite facilities. Communal areas comprise of 2 lounges, a dining room and large conservatory. Toilets and bathrooms are easily accessible and include equipment to assist service users. The staff team have a range of skills and experience appropriate for caring for older people. In August 2009 the fees were £535 per week for personal care. Personal items such as newspapers, hairdressing, chiropody for example are charged seperately. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk Care Homes for Older People Page 5 of 29 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 stars. This means the people who use this service experience EXCELLENT quality outcomes. This was a key inspection of Golden Sands Residential Home under the Inspecting for better lives arrangements. We were at the home with people for 8 hours. We looked at key standards covering: choice of home, individual needs and choices, lifestyle, personal and healthcare support, concerns, complaints and protection, environment, staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We met 10 people that live at Golden Sands and observed how staff looked after them. We also met 4 staff. We sent surveys to 10 people living in the home and received all of them back. We sent surveys to 3 GPs and 4 other healthcare professionals and received 0 back. We also sent surveys to 10 staff and received 8 Care Homes for Older People Page 6 of 29 back. The comments from people, the results of surveys and our observations are in the report. In August 2009 the fees were £535 per week for personal care. Personal items such as newspapers, hairdressing, chiropody for example are charged separately. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: More detailed guidance for staff would ensure that when required medicines or those with a variable dose are given in a much more person centred way and ensure there is Care Homes for Older People Page 8 of 29 consistency for people. Minor changes to the storage arrangements of controlled medicines will improve the security of peoples medicines. People should have more say about who is recruited as a care worker and ways to do this should be explored with everyone living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fully involved in their assessment and information is gathered from a range of sources ensuring that individual needs are met. The home does not offer intermediate care; therefore no judgement has been made about this. Evidence: 100 percent of people responding to our survey verified that they received enough information about the home before they moved in so that they could decide whether it was the right place for them. Similarly, everyone that responded in the survey had received a contract. We casetracked a person that had only recently moved into the home. The individual said that the information about the home was detailed and gave a very good picture of what the service provides. They said they felt right at home from the outset and what sets this home apart from others is the staff, theyll do anything for you and theyre very kind and caring. Its the way its run. The manager told us that people are assessed before moving into the home, for Care Homes for Older People Page 11 of 29 Evidence: example whilst in hospital. Information about a persons abilities, needs including medication, family and social networks and equipment required is obtained. We examined 3 care files and tracked the needs of the individuals concerned. All 3 people had had their needs assessed. The team had identified risks for an individual in respect of the persons tissue viability, high number of falls and poor nutrition. One of the people we casetracked said they know everything about me and verified that their needs are well met. We discussed the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards with the manager and senior staff, all of whom had a good understanding of how to ensure that peoples rights are maintained. The manager told us that additional information is being recorded about people living in the home so that everyone is clear about whether an individual has capacity to make decisions about all aspects of their life and care and who will be responsible for this if the person does not have capacity. At the time of the inspection, the manager did not consider any of the people living at Golden Sands needed to be referred for assessment by the local authority under this legislation and our observations concurred with this. The manager verified that intermediate care is currently not provided at Golden Sands. Care Homes for Older People Page 12 of 29 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 receive effective personal and healthcare support that is person centred and is based upon the rights of dignity, equality, fairness, autonomy and respect. Evidence: We casetracked 3 people by speaking to them and also observing the care they were given. We read their care plans and concluded that individual personal preferences, routines and social activities were well known by staff and had been documented. This has ensured that all staff have a good understanding of how each person prefers their care and support to be delivered. We looked at 3 care files, which demonstrated that the home has good professional relationships with general practitioners, nurse specialists and the consultant psychiatrist. For example, a person with dementia had been visited at the home by the consultant psychiatrist and their medication had been reviewed and changed. In addition to this there are good links with the mental health and social services teams. Letters seen on files indicate good communication and partnership working that ensures that people living in the home receive appropriate care. Care Homes for Older People Page 13 of 29 Evidence: The home had clear policies and procedures about risk assessment and management, which had been robustly implemented. All of the care files had guidance about what action should be taken to minimise identified risks with regard to tissue viability, falls, manual handling, and continence. All of the assessments had been regularly reviewed. Where a high risk of development of pressure ulcers had been highlighted, we read similiar entries in the persons care plan and saw that the individual was sitting on pressure-relieving equipment. The outcomes for this person was positive in that their skin was intact and they were free from sores. The individual was complimentary about their care and said I feel well cared for and can do what I want to. There was a high standard of information to ensure that care and health needs were assessed and monitored. Verbal information and feedback in respect of individuals personal and health care needs is given to staff at the start of each shift. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and we tracked medication given to 3 people. Records accurately reflected medication having been given as prescribed by the GP. The member of staff followed best practice and ensured that people received the correct medicines at the right time. One persons care file highlighted that there were risks associated to medicines because the person had dementia and sometimes needs more prompting to ensure they take their medicines. We observed that when this person was given their medicines staff did this by taking account of the individuals disability and also carefully monitored that they had swallowed the tablets. Staff doing this said that all of the staff have training before being allowed to do the medication rounds and XXX assesses people and works alongside staff to ensure they deal with medicines properly. We discussed as required medicines with the manager and staff and looked at how these are recorded as having been given. People had been given the medicines as prescribed. However, there was no clear individualised guidance about how and when each person should be offered and given these. The manager understood that individualised guidance would ensure that the staff have information about the persons capacity to make decisions about the medicine and/or who else should be involved in that process and the steps to be followed. This will ensure that peoples needs are always met in a personalised way. Care Homes for Older People Page 14 of 29 Evidence: All medication was kept in a secure place; controlled drugs were stored in a locked cupboard in accordance with legislation. The manager verified that the cabinet within a cabinet, containing these medicines is not fixed by rag bolts through to the solid wall behind. We recommended that this be done to ensure that peoples medicines are kept as secure as possible. We observed that staff always knocked on doors before entering peoples rooms. People told us that care was always done in the privacy of their room and that staff treated them with respect and kindness. Care Homes for Older People Page 15 of 29 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 diverse needs of people living at Golden Sands are taken account of and ensures that everyone leads a full and stimulating life. Evidence: We case tracked 3 people and saw that each individual had been assessed to find out what their social needs were and how these could be best met for that person. The assessments identified whether a person had capacity and the type of activity, for example sensory or cognitive, was appropriate for the individual. We read a diary of activities that had a record of recent outings that people had been on, for example a trip to Exmoor Zoo. Every day there were activities listed including crosswords, skittles, NEILE. People we met said that ministers from all denominations visit regularly. We saw that holy communion was held on 5th August, which 2people took part in. We had lunch with 6 people and chatted to them about their life at Golden Sands. People made comments like xxxx [activities organiser] is really good and knows exactly what we like to do and I like to knit for charity and were going to Lynton soon for the day out. Another person said they always keep you very well Care Homes for Older People Page 16 of 29 Evidence: entertained, theres always something to do. At lunch people said that the meals are very good and all home cooked wonderful. The atmosphere in the dining room was calm and peoples needs were well attended to. We observed one person ask for my wine which they were given. People were offered second helpings and drinks of their choice. Lunch was a variation of fish and chips and peas with rice pudding for dessert. We also observed how a person with dementia was prompted and helped to eat their meal, whilst retaining as much independence for themselves as possible. This was done in a caring and encouraging way, which was positive. The outcome for the individual was that they ate all of the meal, which they appeared to enjoy. Care Homes for Older People Page 17 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that live at Golden Sands are protected and able to voice their concerns, safe in the knowledge that these will be acted upon. Evidence: Information sent to us by the manager tells us that there is a complaint procedure and complaints are consistently recorded and acted upon. Similarly, people are also encourage to make suggestions about how the service can be improved. In surveys, 100 percent of people living in the home tell us that they are satisfied that the home listens to them and deals with any concerns in a timely way. We spoke to 3 people in depth about their lives at the home and also a group of 6 people at lunch. We received no complaints before or during the inspection. People we met were very complimentary about all aspects of their lives at the home. Similarly, in surveys people tell us that the home is very well run and Golden Sands..is a home and has high standards of care. We saw a copy of the Alerters guide. The home also had a whistle blowing policy, which all of the staff we spoke to understood the principles of. Kind and caring interactions were observed throughout the day between staff and people living in the home. Staff engaged positively with people that are less able to do this for themselves and demonstrated genuine warmth towards these individuals. Information sent by the provider told us that 60 percent of the staff have completed Care Homes for Older People Page 18 of 29 Evidence: the NVQ in care, part of which is about safeguarding people. Staff told us that policies and procedures are discussed with them. We looked at training records and saw that Safeguarding Adults training had been provided for staff. Information sent to us by the manager verified that no referrals had been made to the local authority or Independent Safeguarding Authority since the last inspection. We observed that people are treated with respect and encouraged to see Golden Sands as their home. A relative in a survey commented that the home is superb. She is safe, warm, fed properly and the staff and owners are excellent. The manager told us that they had recently sent information to update relatives and people living in the home so that they are aware of the complaint procedure. Staff told us that training had been arranged for them about the Mental Capacity Act. Care Homes for Older People Page 19 of 29 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. People live in a comfortable home that is well maintained and meets their needs. Evidence: We toured the premises and saw that radiator guards were in place throughout the building. Fire exits were clear and accessible. We spoke to 3 individuals about their bedrooms all of which were exceptionally clean, individualised and comfortably furnished. People living in the home told us that there is always a cleaner on duty. One person said I have a lovely room overlooking the sea. Externally there is a large garden area with raised beds, which people were enjoying sitting out in on the day we inspected. Peoples privacy and dignity is maintained because all the wcs and bathrooms have locks on the doors. Communal areas were comfortable and homely. Maintenance certificates were seen for the lift, assisted baths, electrical installation, and central heating and fire alarm systems all of which had recently been inspected by an engineer. Therefore, the equipment is regularly maintained and safe for people to use. Surveys from people living in the home and relatives verified that the home is always kept fresh and clean. All of the staff we spoke to had received training about the prevention of infection and management of infection control. Hand towels and soap Care Homes for Older People Page 20 of 29 Evidence: dispensers were seen in wcs, bathrooms and bedrooms. Good hand washing practices were observed as staff cared for people. The laundry was clean and well organised and people said that their clothes are always well looked after and returned promptly to them. Additionally, the manager showed us the plans they were putting together in the event of an outbreak of swine flu in the home. They were setting out strategies for dealing with staff abscence as a result of sickness for example. All of these measures ensure that the risk of infection to people living in the home is minimised as far as possible. Care Homes for Older People Page 21 of 29 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. Recruitment practice has improved, is robust and ensures that people are protected and cared for by suitably qualified and experienced staff. Evidence: We examined duty rosters for 4 weeks beginning in July 2009. On the day of the inspection there was 3 carers and the manager on duty during the day. In addition to this a cook was on duty every day and domestic staff. One person said the staff are very kind and caring and we were consistently told this as we talked to people living in the home. We examined the files of 3 newly recruited staff. Recruitment checks, including 2 written references, Independent Safeguarding Authority and Criminal Records Bureau certificates had all been obtained before staff had been appointed. Therefore, the legal requirement we made at the last inspection has been met. Recruitment procedures are robustly followed and ensure that people living in the home are safeguarded. We spoke to a group of people over lunch and asked them how much say they had in who was recruited to care for them. People said we dont have a say in who comes to work in the home and all felt they would like to be more involved in the process. We discussed this with the manager who was very keen to involve people in the recruitment process. We have made a recommendation about this and once Care Homes for Older People Page 22 of 29 Evidence: implemented would ensure that people have more say about the running of the home and a greater degree of autonomy. Staff told us that they enjoyed their work and felt well supported. Information sent to us by the manager verified that a wide range of training had been provided over the last 12 months. Records demonstrated that 60 percent (9) carers have achieved the NVQ level 2 award in care. We were shown individual training files, which contained further evidence of specialist training having been provided e.g dementia awareness. Essential training such as fire, manual handling and first aid updates had also been completed by all staff. Induction records demonstrated that training meets the appropriate standards set out by the Skills for Care. The manager told us that a distance learning package had been purchased and is run by Yeovil College. The accredited training package will enable staff to do a wide range of courses ensuring that they have the appropriate skills and knowledge to care for people living in the home. We spoke to staff about their experience and training opportunities and they all verified that this was regularly offered to them. Care Homes for Older People Page 23 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an exceptionally well run home where health and safety and individual needs are at the centre of everything they do. Evidence: Since the last inspection, the Commission has registered a new manager for Golden Sands. The manager has dual responsibility for another home owned by the same provider and is supported by 2 senior staff that are currently doing the NVQ level 4 in Management and Leadership award. The manager holds the Registered Managers Award and a Diploma in Management. She is competent in her role and demonstrated this by having an excellent overview of all the areas of the home that collectively ensures that the aims and objectives are met. We observed that there are clear lines of accountability within the home. People consistently made comments like this is a well run home. Similarly, in surveys people tell us that the home is very well run and Golden Sands..is a home and has high standards of care. A relative in a survey wrote the home is superb. She is safe, warm, fed properly and the staff and owners are excellent. Care Homes for Older People Page 24 of 29 Evidence: The Commission asked for, and promptly received, the AQAA (Annual Quality Assurance Assessment) document. The information was brief and did not entirely reflect the excellent initiatives that have been implemented to seek the views of people living in the home. We saw a certificate displayed, which demonstrated that the service had retained the Investors in people award for a further two years. We read minutes of meetings held with staff and discussed these with the people we met. Staff told us that meetings were held regularly and that there is an open atmosphere in which they feel confident to make suggestions about improving their practice and the quality of life for the people they care for. We received 10 surveys from people living at Golden Sands and 8 from staff. All of the comments were positive and in particular people felt that they were always listened to. Similarly, people living in the home told us that they were always asked how things are. The manager showed us several quality assurance initiatives that had been set up to ensure that everyone with an interest in the home is invited to give formal feedback, for example a residents and relatives meeting had been held on 15/7/09 and we saw minutes of the regular residents forums being held. We read a report of the annual quality audit. The team had used all of this feedback to produce action plans demonstrating that peoples view are listen to and acted upon. For people that are unable to look after their own money, Golden Sands holds a small float of money for people whose relatives are unable to do this for them. The money is kept in safe keeping. People we spoke to verified that this is well managed and works well for them. We saw records and checked balances, all of which were correct for 3 people who we case tracked. Since the last inspection the electrical system was tested in 2008. Comprehensive Health & Safety policies and procedures were seen and had been reviewed in 2009. The organisation uses an external advisor, and we examined the annual audit report that had been completed. The staff we spoke to verified that they had had recent moving and handling training. According to the AQAA, all equipment used in the home had been regularly maintained with dates in 2008 and 2009. Staff on duty had First Aid qualifications. First Aid boxes were accessible to staff. A fire risk assessment and strategy in the event of fire was seen. All of the staff that we spoke to had received training in the last twelve months. We examined the fire log and established that the fire alarm system, emergency lighting and extinguishers had been regularly checked and properly maintained by an outside company. Induction records for new staff were seen. Accident records were examined, were well kept and demonstrated that prompt and appropriate action had been taken. We spoke to 10 people that live in the home, the majority of whom were able to tell us that they are safe and well cared for. One Care Homes for Older People Page 25 of 29 Evidence: person commented were in safe hands because theyre hot about all things to do with safety matters. Care Homes for Older People Page 26 of 29 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 29 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 9 Put in place arrangements to make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance available to staff on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure that there is consistency for people in the home to receive medication when necessary and in line with planned actions. The controlled medicines box should be secured within the cabinet to the load bearing wall with rag bolts so that current legislative requirements are met. This will ensure that peoples medicines are kept secure at all times. People lliving in the home should be more involved in the recruitment process so that they have more say about the appointment of staff that will be responsible for providing care to them. 2 9 3 29 Care Homes for Older People Page 28 of 29 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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