Care Home: Grace Lodge

What the care home does well Thorough health care and risk assessments are carried out by trained staff, prior to residents being accepted for admission, to ensure the home is able to meet their needs. The home welcomes complaints and sees them as a positive process for improving the service. Procedures are in place to ensure that possible complaints and safeguarding issues will be addressed appropriately to afford the best outcomes for the residents and to protect them. The garden, which was accessible from the main sitting room and dining room on the ground floor, was safe and secure to enable the residents to enjoy some time outside safely. The staff were observed to treat the residents with the utmost respect and were cheerful and considerate in their interactions with them. One family member of a resident commented, that the staff were "very kind and attentive and patient", and "there is not anything that they could do more to make the residents happy". A further comment made by another residents family was that "staff are very friendly and caring, management is effective and helpful". A resident stated that the "care and concern is excellent". A well-qualified, experienced manager who operates an inclusive, open and empowering management style manages the home in the best interests of the residents. The home is good at consulting with residents, families and professionals, action is taken as a result of comments received from the homes suggestion box and via direct communication from resident/representatives meetings. One relative commented, "There is an excellent liaison with relatives". What has improved since the last inspection? The previous inspection report was very positive with only one recommendation being made for a barrier to be erected to ensure that residents do not fall or trip while accessing the garden, this has been fully implemented. Grace Lodge continues to develop the home has a maintenance man who regularly checks the building and undertakes remedial work throughout the building. What the care home could do better: This was a very positive site visit as a result no recommendations or requirements have been made in this report. There were however a number of areas where a review of the home current practises were discussed with the manger during the site visit, these have been detailed within the body of the report. 1) The adopting of a uniformed records management system ensuring that all files and information is stored in one agreed way. 2) The introduction of a audit tool for residents who self medicate. 3) the expansion of contact details available to residents and their families in the event tat they want to make a complaint out with the home. 4) A review of the signage used within the home. 5) to review staff files to ensure that any gaps in the eduction and employment histories of staff is explained details retained on the persons file. Key inspection report Care homes for older people Name: Address: Grace Lodge 4 Manor Road South Hinchley Wood Esher Surrey KT10 0QL     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: Kenneth Dunn     Date: 1 5 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Grace Lodge 4 Manor Road South Hinchley Wood Esher Surrey KT10 0QL 02083980580 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: thakur@gracelodge.freeserve.co.uk Mr Vikram Thakur care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 15 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Grace Lodge is a detached property, located approximately two miles from Esher town centre. The property provides two sitting rooms, conservatory and dining room. The home has a mature garden which surrounds the rear of the house. The home has 11 single bedrooms and two shared bedrooms. Nine of the bedrooms have en suite toilets. A lift facility is provided to enable service users to gain access to the first floor bedrooms and bathroom. The home has ample car parking space. The fees for this service range from £650 per week. Care Homes for Older People Page 4 of 28 15 0 Over 65 0 15 Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This site visit was part of a key inspection. The site visit was unannounced. We arrived at 9.15 am and left at 13.00 pm. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment. (AQAA). This is a self-assessment that focuses on how well outcomes are being met for people using the service. We received the AQAA by the expected date, which provided us with all the information we asked for. Reference is made to this assessment throughout this report. In addition to the AQAA the we received twelve completed surveys returned to the commission by people who live in the home, and five completed staff surveys. Reference is made to the completed surveys throughout this report. The inspection process took into account further detailed information provided by the Care Homes for Older People Page 6 of 28 registered manager on duty during the site visit and any information that CQC has received about the service since the previous inspection. A part tour of the premises took place . On the day of this visit the inspector spoke with a number of residents, relatives and staff on-duty. Other methods used to inform our judgements made in this report include discussions with members of staff and community health based professionals. We looked at staff recruitment, and training records, care plans, risk assessments, menus, quality assurance systems, medication administration policies, health and safety records and policies and procedures were sampled. We also reviewed other information that we have received since our previous inspection including notifications that the service is required to inform us about. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: This was a very positive site visit as a result no recommendations or requirements have been made in this report. There were however a number of areas where a review of the home current practises were discussed with the manger during the site visit, these have been detailed within the body of the report. 1) The adopting of a uniformed records management system ensuring that all files and Care Homes for Older People Page 8 of 28 information is stored in one agreed way. 2) The introduction of a audit tool for residents who self medicate. 3) the expansion of contact details available to residents and their families in the event tat they want to make a complaint out with the home. 4) A review of the signage used within the home. 5) to review staff files to ensure that any gaps in the eduction and employment histories of staff is explained details retained on the persons file. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides sufficient information to prospective residents, families and or their representatives to enable them to decide if Grace Lodge is able to meet their needs. Detailed assessments of prospective residents needs carried out ensure the home accepts only those, whose needs can be met at the home. The home does not provide intermediate care. Evidence: The service user guide and statement of purpose were sampled as part of this site visit. The manager stated that theses documents are reviewed regularly to ensure that accurately reflect the home and the services it provides. A audit of both documents demonstrated that they had been reviewed and updated recently. The documents contained all the information prospective residents their relatives and or their representatives would need to decide if the service was suitable for their Care Homes for Older People Page 11 of 28 Evidence: requirements. Over 90 of the completed surveys returned to the commission by people who live in the home, confirmed that they received sufficient information to help with decision making process prior to moving into the home. A random sample of 3 residents files was completed as part of this site visit, they all contained initial referral forms, a completed pre-admission assessment undertaken by the home before an offer is made to the person being referred to Grace Lodge. The pre-admission assessments sampled were thorough with respect to physical, health care, behavioural, personal care and independence with respect to self-help skills and indicated risk levels associated with each category and the level of staff intervention required. The manager stated that after the decision is made with respect to the needs of the prospective resident, relatives and/or representatives of the prospective resident is invited to visit the home in order to see if they would be happy their and to meet with other residents and staff. The pre-admission form requested information with respect to the prospective residents religion but other information with respect to equality and diversity. The manager stated that after admission the assessment process continues and more information is gathered with respect to the holistic needs of the residents. The manager explained that there is normally a one month settling in period which allows the new resident to experience Grace Lodge and to interact with other residents and staff in order to make the decision to move into the home. The manager stated that this period is flexible and that the home will assist a new resident with as much time as they require before making the decision to move into Grace Lodge. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the residents are recorded in individual care plans and specialist health and social care support is provided according to their assessed needs. Medication is handled, stored and recorded safely and policies and procedures are in place. Residents are treated with respect, their privacy is promoted and their personal care is carried out in a dignified manner. Evidence: The files of three randomly selected residents were sampled as part of this site visit. All three had detailed care plans covering all aspects of health and personal care needs, with instructions to the staff of actions to meet those needs. The care plans included instructions to staff for the promotion of privacy,maintaining dignity, promoting confidence and explaining the procedures to the resident to Care Homes for Older People Page 13 of 28 Evidence: encourage self-performance. The care plans were completed by the staff and demonstrated that they had been reviewed monthly or more frequently as necessary with respect to the changing needs of the residents. The manager confirmed that residents wishes were always taken into consideration when devising the care plan and their preferences were highlighted. The residents files reviewed contained a great deal of relevant information in respect of the care of individuals living in the home. It was note however that there was not one clear system in use for the storage of information, this was discussed with the manager who stated that files will be reviewed and a uniformed system would be introduced. Risk assessments had been completed in relation to moving and handling, falls, mental health, skin, nutrition and where relevant for challenging behaviour. Social and health care professionals visit residents regularly as required. Over 80 of the completed surveys returned to the commission by people who live in the home, confirmed that they always received the care and support that they required, while 20 stated that they usually received the care and support that they required. Additional comments included on the the completed surveys stated that care is exceptional, and, we are overall very pleased with the home and the care received. The medication policies and procedures relating to the handling of medication were viewed and had been reviewed and updated to reflect current practises the policy was last updated November 2009. The medication administration records of three residents were viewed and records were accurately kept. Photographs were in place on residents records viewed. One resident currently living at Grace Lodge has requested to self medicate, the manager stated that they have ensured that provisions for the residents safety is in place. A review of the residents file demonstrated that process have been actioned to ensure that the resident is fully supported by staff to self medicate with minimum intrusion. It was however noted that records were not being retained of any audits undertaken by staff to ensure that the resident is taking all of their medication. The manager stated that the home would introduce a system to ensure that the process of self medication continues to be operated safely. Care Homes for Older People Page 14 of 28 Evidence: Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activity plans meet the collective social, cultural, religious and recreational needs of the residents and take into consideration their individual preferences by offering choice. Contact with relatives, friends and representatives is promoted and supported. The residents benefit from a wholesome, balanced and appealing diet. Evidence: There is evidence that the people living at the home are supported to take part in a variety of activities and to be a part of the local community. The manager stated that residents are supported to attend various religious events at local Churchs and Mosques. The home has developed excellent relationships with local schools who make visit to the home to interact with the residents. The residents are fully involved in community and national events at the time of the site visit 12 residents had register to vote in the general election via the postal vote system and one resident had requested that he is supported to vote in person at the polling station on the day of the election. The AQAA provided detailed evidence to support this All residents are registered to vote and offered the option of postal vote. The local councillors do visit Care Homes for Older People Page 16 of 28 Evidence: us and see the residents who wish to talk to them. This was reemphasised by the manager during the site visit who again stated that during the local elections the home extends an invitation out to the candidates to come into the home and discuss issues and their proposals to the residents, to allow them to make informed decisions when they make their votes. The manager stated that the activities are constantly being developed and reviewed to ensure that the residents can access areas they are interested in. It is noted however that out of the 12 completed surveys returned to the commission by people who live in the home, 5 stated that the home always arranges activities that the residents can take part in if they want, 4 stated that usually the activities are appropriate and finally 3 stated that only sometimes are there activities that they can take part in. Two of the completed surveys provided additional comments one requesting more activities and the second stating that they would like more social stimulation. There are no restrictions on visitors to the home. The manager stated that as a service they will endeavour to support residents to maintain appropriate relationships with their families and friends. The manager stated that where families are involved they will be invited to be involved in the care of their relatives. There was documented evidence available during this site visit to support the frequent visits and support provided to the residents by their visiting relatives. During the site visit one resident was very proudly showing a friend round the home and spoke very highly of Grace Lodge and the service they provided. The service has a robust policy ensure the respect peoples privacy and dignity by knocking on bedroom doors before entering; calling people by their preferred names and providing personal care in the privacy of their own rooms. During this site visit the interaction observed between the manager, staff and the individual residents was appropriate. Information provided in the AQAA informs that Equality and Diversity are promoted through the Equal opportunities Policies and Procedures. Evidence found during the site visit supports the information sent to us in the Annual Quality Assurance Assessment (AQAA) completed by the provider as part of our inspection. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are welcomed and responded to appropriately in the best interests of residents and their representatives. Residents are protected from potential abuse by the homes policies and procedures and training. Evidence: The Commission For Social Care Inspection has not received any complaints about this home since the last inspection 03/04/2007. A review of the complaints records maintained by the home indicated that there have been no complaints made to the manager and staff since the last inspection. The manager stated during the site visit that the home welcomes complaints and sees them as a positive lever for improving the service. The home has a robust set of policies and procedures in place designed to deal effectively with issues or complaints the residents would wishes to make, the policy was displayed in the home and available in the service user guide. The registered manager stated in the completed AQAA that the complaints policy is kept up to date and given to residents and families. We try and ensure residents and their families are satisfied and their concerns dealt with. Any small matters brought to our notice are actioned immediately. It was however noted that the contacts list for residents to make a complaint was limited to the provider and CQC, this was discussed with the manager and the provider during the site visit and a review of the list will be conducted and the Care Homes for Older People Page 18 of 28 Evidence: manager stated that the list will be expanded to include all relevant agencies. Out of the twelve completed surveys returned to the commission by people who live in the home, eleven confirmed that in the event of them wishing to speak informally to someone if the were not happy they could do so with ease, one person sated that no there was not always someone to talk too id they were unhappy. When asked if the residents knew how to make a formal complaint again eleven individuals stated that yes they did now how to complain and one person stated that they did not know the process. There is a clearly written safeguarding adults procedure and a copy of the local authority safeguarding adults from abuse policy was available. The manager stated during the site visit that all members of staff have undertaken safeguarding training. This was corroborated during a random sample of staff training record. In addition the five completed surveys returned to the commission by people who work in the home, who all stated that they were confident that if someone had concerns about the home they could act appropriately. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable, well-maintained, clean and safe environment, which meets their needs. Evidence: A part tour of the building was undertaken as part of the site visit, this included all communal areas and one bedroom. The home is a large detached building the rooms are spacious, bright and fully accessible to the residents. The home is relatively well maintained and since the previous visit by the commission a the home has developed a timeframe of refurbishment. During the site visit the homes maintenance man was undertaking remedial work on a bedroom prior to it being offered to a new resident. It was noted that the home had a large number of large laminated sign on display, it was discussed with the manager that more homely signs would provided a more appropriate look within the home. The residents spoken with during the site visit confirmed they were happy with the accommodation. The home has a good infection control policy. The staff group have all had regular training to ensure that any health and safety issue can be identified and successfully brought to the attention of the correct maintenance provider. During the inspection the home was clean and free from mal odours. All twelve Care Homes for Older People Page 20 of 28 Evidence: completed surveys returned to the commission by people who live in the home stated that the home is always fresh and clean. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff group appeared skilled and in sufficient numbers to provide 24-hour care within the home. The systems for recruitment and training are designed to be robust and should protect the people who live at Grace Lodge. Evidence: A review of staff duty rotas during the site visit indicated that appropriate staffing levels are maintained in the service at all times. Te manager stated that 90 of the current staff members have completed National Vocational Qualifications (NVQ) (level 2) or have received an equivalent qualification from a UK certified training centre (NARIC) converting their previous overseas nursing awards to an NVQ level 2 or above. This was supported in the completed AQAA and a random review during the visit. The inspector was informed that each member of staff has their own training record in place and it was evident that staff have received mandatory training in safeguarding adults, fire, food handling, food hygiene manual handling, health and safety, first aid and managing medication. This was corroborated during a random sample of staff training record. In addition the five completed surveys returned to the commission by people who work in the home, confirmed that they attended all mandatory training Care Homes for Older People Page 22 of 28 Evidence: and that the home was dedicated to ensuring all staff were appropriately trained. The home has good recruitment policies and procedures, based on equal opportunities legislation. A random selection of three staff files was reviewed during the site visit and all relevant checks had been carried out, however in two files there were gaps in the member of staff education and employment histories. The manager stated that a review of all staff files would be undertaken and any subsequent gaps would be highlighted and documented explaining the gap. The AQAA states that all staff has had a criminal record bureau (CRB) check and Protection of Vulnerable Adult (POVA) check prior to starting work in the home. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Grace Lodge has an experienced and well-qualified manager, with an inclusive management style. The home is run in the best interests of the residents through consultation processes, which influences the development of the home. The health, safety and welfare of the residents are promoted and their finances are safely managed. Evidence: Grace Lodge is a family run residential home, which has developed over a number of years and has a very stable management structure. The registered manger has gained a NVQ level 4 in care and the registered Managers Award. In the AQAA manager states that I work on building close relationships with our residents and their families. Feedback is continually sought from the residents: be it a new dish on the menu to the selection of staff the manager further states that Staff are recruited and trained on the ethos that this is the residents home and nothing is too much trouble to ensure the well being of the residents. This was fully supported by comments Care Homes for Older People Page 24 of 28 Evidence: received from the residents during the site visit one person stated that the manger and staff could never do enough for them and to make sure we are all OK. The management team has an open and inclusive atmosphere and provide clear direction and leadership. This was confirmed during the site visit by direct observation, Completed Staff surveys and a random review of the homes records. During the site visit there was a genuine warmth and friendliness demonstrated by the manger towards the residents, the residents appeared to welcome involvement from the manger who was very knowledgeable about the residents, their families and friends. The home holds regular residents and staff meetings which was confirmed by Resident and staff surveys and from records sampled during the site visit. The manager stated during the site visit that the home holds a limited amount of petty cash for individual residents this ranges from £50 to £100. The registered provider stated that all cash transactions require a signature either from the resident of by the person acting on their behalf, in the event of a member of staff accessing the residents monies a receipt is required to be submitted for transparency. The provider stated that at the end of every month a detailed statement is prepared for all residents to clearly demonstrate their petty cash transactions for that period. The AQAA stated that Residents petty cash records are well managed and receipts sent out at end of each month. The commission received pre- inspection information in the form of a Annual Quality Assurance Assessment, which indicates that Grace Lodge has a range of policies, and procedures for the home. The policies and procedures are regularly reviewed and updated, the manger subsequently brings the information to staff attention during staff meetings. The home hold very detailed records, which appeared to contain sufficient information to safeguard the best interest of the residents. During a random review of the records and files it was noted that there was a lack of a cohesive order or system within the various files and record. This was discussed with the manager during the site visit and an undertaking was agreed that systems would be adopted to ensure that all files and records follow the same systems to allow for ease of access in the future. Substances hazardous to health (COSHH) were stored securely and appropriately. Health and safety checks are completed and recorded regularly, Gas Certificate , Electrical Certificate, Controlled Waste Contract and Insurance Certificate. The manager provided information to indicate that records and certificates and identified systems are in place for routine service and maintenance arrangements for the environment. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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