Care Home: Grange Hill House

What the care home does well We found Grange Hill House to have a relaxed atmosphere about it. People living at the home are able to see visitors and maintain relationships that are important to them. Staff were seen to be welcoming to visitors who seemed to be at ease with staff members. Information about the home is available for people who are thinking of moving into the home. Care needs are assessed prior to admission to ensure that the home is are to meet these. Activities are available within the home and outings are arranged to places such as garden centres. Information available to people about activities is good. The activities available stimulate people living in the home and can take into account people`s interests and individual tastes. We found the home to be well maintained and were told of plans for continual improvements to the environment. The number of staff who have achieved an NVQ (National Vocational Qualification) is commendable. The home has a stable workforce. Recruitment procedures are in place when new staff are appointed to safeguard people living within the home. What has improved since the last inspection? The storage of controlled medication had improved since our last visit. What the care home could do better: During our inspection we found that written records about people living in the home were not always up to date or in place to ensure that staff have guidance in order to meet needs. This can potentially place people at risk or unsafe practices taking place. There needed to be an improvement in the recording of medication. We were assured following our inspection that a full investigation took place and suitable actions put into place to ensure the safety of people using the service. The medication policy needs to be reviewed to ensure that safe systems are in place. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grange Hill House Grange Hill House 516 Bromsgrove Road Hunnington Halesowen B62 0JJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrew Spearing-Brown     Date: 0 4 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Grange Hill House 516 Bromsgrove Road Grange Hill House Hunnington Halesowen B62 0JJ 01215501312 01215506536 grange@carltoncaregroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Carlton Care Homes Ltd T/A Grange Hill House care home 38 Number of places (if applicable): Under 65 Over 65 38 38 38 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 The maximum number of service users to be accommodated is 38. The registered person may provide the following categories of service only: Care Home only To service users of the following gender: Either Whose primary care needs on admission to the home are with the following categories: Old age not falling within any other category OP 38 Physical Disability over 65 years of age PD(E) 38 Dementia over 65 years of age DE(E) 38 Date of last inspection Brief description of the care home Grange Hill House provides personal care and accommodation for up to thirty-eight older people who may have a physical disability and/or a mental health need associated with older age. The main purpose of the service is to provide a high standard of accommodation and personal care in a homely, friendly atmosphere. Within this number there is a smaller unit in the home providing care for four residents Care Homes for Older People Page 4 of 29 Brief description of the care home who are more independent. They may also use the communal space in the main house. The main house and extension provide thirty one beds, three of which are double rooms. One bedroom is used for respite (short stay) care. All the rooms have ensuite toilet facilities. There is a choice of sitting/lounge space for people living in the home to use, and communal bathrooms with lifting equipment, and communal toilets. Access to the first floor is gained by the use of stair lifts. Handrails are provided throughout the home. People have access to a large level garden and the home is surrounded by countryside while have easy access to towns and the motorways. The register providers are Carlton Care Homes Ltd and the registered manager is Mrs Joanne Wheeler. The email address for the home is grange@carltoncaregroup.co.uk For up to date information upon the fees charged the reader should contact the service directly. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection at Grange Hill House was carried out during April 2007. Since that date we have carried out one Annual Service Review (ASR) during July 2007. An ASR does not involve a visit to the home. This inspection was carried out on a Saturday. This inspection was unannounced therefore nobody within the home knew we were going to visit. The focus of inspections is upon the outcomes for people who live in the care home and includes peoples views of the service provided. The process we use considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Care Homes for Older People Page 6 of 29 Prior to the visit taking place we looked at the information that we have received since the ASE. This information includes the Annual Quality Assurance Assessment (AQAA). The AQAA is a document completed by the home and provides us with information about the home and how they believe they are meeting the needs of people living there. We sent a number of questionnaires to the home and requested that these were completed by some people living at the home and by some members of staff. We took the information included within those returned into account as part of this report. We looked around the home. We viewed records in relation to some people living in the home such as care records, risk assessments and medication records. We also looked at some records relating to some members of staff and regarding health and safety. We were able to speak to the registered manager and the deputy manager. We also spoke to a number of people living in the home, some relatives and some members of staff. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is available to help people make a choice about whether they would like to live there. The needs of people who may use the service are assessed prior to their admission so that they and their relatives can be assured that these needs can be met and an initial care plan established. Evidence: We were given a copy of the homes service users guide during our visit. The guide was available in the reception area of the home. The guide, which was last up-dated in April 2008, contains useful information about the service to help people reach a decision about whether the home could meet their care needs. The guide we saw contained no information regarding fees or how the fees are established. We were later informed that information on fees is included within the contraxt and that a draft contract is given with the Service Users Guide. Care Homes for Older People Page 10 of 29 Evidence: The service users guide states that people normally come to the home on a trial period of one month. This period of time is seen to be an opportunity for both parties to see if they are satisfied and happy with the placement. The users guide states that a full assessment, prior to admission, will be carried out either by the placing agency, or where the prospective resident is self -funding by a fully trained member of staff. The guide explains that this is to ensure that Grange Hill House is able to meet all the identified needs of the individual. Within the AQAA (Annual Quality Assurance Assessment) the home manager wrote We offer a trial day for prospective clients to partake in meals, activities and daily living within the Home. From the AQAA we established that somebody from the home writes to confirm that they believe they are able to meet a persons needs following the assessment. We viewed the assessment of one person who was recently admitted into the home. We saw evidence that a family member had visited the home and had signed a contract. The assessment was carried out prior to the admission and contained sufficient information to draw up a care plan which was done just under a fortnight after the admission. The manager was aware of some changes in care need that had happened or had become apparent between the assessment and the current care plan. Prior to this inspection we received a number of questionnaires back, the majority of which were completed by people living in the home. Everybody answered yes when we asked whether they had received a contract and if they received enough information about the home before moving in. One person wrote all arrangements for me to come here were made by my family. Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff demonstrated an understanding peoples needs and encourage independence where possible. There is a risk that some needs are not met consistently because of identified shortfalls in care planning and medication records and practices. Evidence: Each person residing at Grange Hill House had a written care pan. This is a document designed to guide staff about the level of care required by each individual to ensure that identified needs are met and people receive the support they required. We viewed a number of care plans, risk assessments and other associated documents such as daily records. Care plans covered many aspects of care in relation to identified needs. We saw risk assessments and systems of work which described how care tasks are to be performed although some of these were generic and not specific to the individual. Care Homes for Older People Page 12 of 29 Evidence: When we last visited Grange Hill House we wrote Information had not always been added to this document (the care plan) but regular reviews / evaluations had been undertaken in which changes had been noted. This had resulted in out of date and uninformative assessments and care plans. We found some similar issues as part of this inspection. We read care notes which showed that one person had been quite poorly at one time. Despite this change in care needs the care plan was not amended at that time. Furthermore the monthly review did not capture the fact that between the reviews a temporary change had happened. We did not however find any evidence to suggest that care needs were not met. The registered manager confirmed that care plans are not in place for people who are prone to chest infections to detail the likely signs an individual may display prior to the infection. Furthermore care plans are not devised once a person has a chest infection detailing the care regime put into place. Since our inspection the provider has assured us that our comments have been taken on board and actioned. The registered manager assured us, during our inspection, that comprehensive hand overs take place, and that staff are aware of care needs. One health professional commented on a questionnaire that the service keep very good surveillance of health problems and contact our surgery whenever appropriate. The vast majority of people living in the home answered always to our question on whether people receive the medical support they need. Everybody responded always when we asked if people receive the care and support needed. During our visit we noticed a mattress on one bed which appeared to be an overlay mattress and not a full mattress. We requested that advice was sought from a community nurse. After our visit we followed this up with the home. We were told that the nurse had confirmed what we believed however felt that it would not have had any ill effect on the person concerned. We acknowledge that this mattress was not originally provided for tissue viability reasons. Nevertheless we strongly recommend that a risk assessment is undertaken to safeguard the persons pressure areas. On the risk assessment of somebody else the scores were wrong and had been wrong for a number of months however nobody had noticed this error. As part of this inspection we assessed the management and administration of medication. Medication is currently stored within two locked trolleys. The storage arrangements for controlled medication have improved since our last visit to the home. Care Homes for Older People Page 13 of 29 Evidence: Medication administered from its original box did not have the date of opening recorded upon it. This makes undertaking an audit of medication difficult to carry out. We were told that 9 members of staff are currently on their second module of distance training regarding medication. The manager expects staff to complete the training in June 2009. We viewed the current Medication Administration Record (MAR) sheets. A photograph was in place on a separate sheet prior to each individuals MAR sheet. We were told that the supplying pharmacy had visited the home a week before our inspection took place. The report following their visit on the 26th March was seen. The report stated good medication management. The majority of the entries on the MAR sheets were appropriate but we found some gaps where staff had not signed for medication administered or entered a code for why it was not administered. We checked the blister packs and found that in the majority of cases medication was not there which would suggest that it had been given. When we were viewing the MAR sheets between 11.15 and 11.45 am we noted that the medication due to be administered at lunchtime (13.00 hours) had already been signed as given. The medication had not been given and we later saw a member of staff administering this. The only explanation that could be given by staff at the time was that it was an error. We saw MAR sheets where a member of staff had signed for medication as given and then another member of staff had signed over the top. An explanation was given for this. However, as the sheets are a record that the medication is administered, such occurrences should not happen. Following our inspection a meeting took place involving representatives of Carlton Care Homes Limited and ourselves. We were assured following an investigation that our findings were not general practice within the home. We are confident that suitable action was taken with immediate effect to prevent the risk of future occurrences and to ensure that people residing within the home are safeguarded. Due to the above we briefly viewed the homes Medication Policy. The policy was not specific to Grange Hill House and therefore needs to be reviewed. It did however say that All drug sheets must be signed in the appropriate time box following administration. From the above evidence this is not always happening at Grange Hill House so people using the service could be at risk of not receiving their medications as prescribed. Care Homes for Older People Page 14 of 29 Evidence: The codes given for non administration of medication in the policy differed from those on the MAR sheets. This difference needs to be rectified to avoid any potential confusion. We discussed our findings with the registered manager who acknowledged our concerns and undertook to address the shortfalls around recording without delay. We observed staff showing respect for peoples privacy and dignity during the time we were visiting. The atmosphere within the home was warm and welcoming. People living in the home appeared well cared for. 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. People are encouraged and supported in social and recreational activities which reflect their personal preferences. People have freedom regarding their contacts both within and outside the home. A choice of nutritious and varied meals are available for people to enjoy. Evidence: On the questionnaire we sent out most people told us that activities are arranged for them to take part in. These comments were confirmed during our visit. The AQAA stated that a monthly programme is planned and that an activities co-ordinator is employed. We were also told within the AQAA that trips are arranged in a mini bus to garden centres, tea rooms, theatres, shopping and pub lunches. During our visit the registered manager confirmed that the home employs an activities co-ordinator for 12 hours per week. A well designed booklet was available in reception entitled Grange Hill House April 2009 News Events and Social Diary. The booklet contained news about the home, a word search and a listing of planned events for the month. The listing showed a range Care Homes for Older People Page 16 of 29 Evidence: of events such as reminiscing, entertainment, crafts, minibus outings and visits from a beautician and hairdresser. We saw photographs on display from a 1940s afternoon, the summer fete and some showing a time when a number of small animals were brought into the home. A large print Bible was open to a certain page in the entrance hall. We were told that one person living at the home selects the page on display. A minister from a local Pentecostal church visits the home so that people are able to take communion should they wish. We were told that other ministers also visit and that some people go out to local churches. We saw a number of people visiting relatives or friends. Visitors were seen to be made welcome and they seemed to be at ease with the staff. People living at Grange Hill House are able to bring in personal possessions to make their own rooms more homely and individual. On the questionnaire we asked people if they like the meals in the home. The majority of people answered always while everybody else answered usually. These responses were similar to our conclusion within the Annual Service Review in July 2008. Two people wrote a comment on the food as follows: I think the meals are good compliments to the cook. Everything is home cooked and always fresh and nourishing. We saw a thank you card to the staff which mentioned the varied meals. The menu was on display in small plastic holders as well as within a larger menu folder. We were able to join people while they were having lunch during our visit. People were complementary about the food served. The meal we had was warm and tasty. Meals were unhurried and staff assisted where needed in a very discrete style. During lunch people confirmed that they can visit local garden centres. A lot of chatter was going on in the dining room with people engaging a range of discussions including current affairs making the experience pleasurable. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are aware of how they can make a complaint and can be confident that these will be addressed. Staff have sufficient knowledge about safeguarding procedures and systems which are in place within the home. Evidence: Within the last Annual Service Review we wrote that We have not received any concerns or complaints about the service offered at the home since our last visit. The above statement remains the case as we have not received any unfavorable comments about the home. The second section of the AQAA asks for the number of complaints received during the previous 12 months. The figure given was 0. This figure was confirmed by the registered manager when we visited the service. We asked on our questionnaire if people know how to make a complaint. The vast majority answered yes while a couple left the answer blank. One person who did not answer did however add that they would report to whoever is in charge of the desk at the time. The homes complaints procedure was on display in the entrance hall. We Care Homes for Older People Page 18 of 29 Evidence: recommended that the location of the procedures is reviewed as well as the size of the font (type) used. The current location as well as the font could make it difficult to read. Reference is made to compliments and complaints within the service users guide. The guide refers the reader to the procedure on display in the home as well as giving details of our address. The procedure should however make people clear that they are able to refer a complaint to the commission at any stage should they wish to do so. Some improvements in relation to current practices regarding the safe keeping and recording of money held on behalf of people living in the home are referred to elsewhere in this report. We have not received any safeguarding alerts or referrals since the previous inspection and we are not aware of any incidents within the home which would have needed such a referral. Procedures including those prepared by Worcestershire Adult Services were available in the home. We spoke to a member of staff about the action she would take if she was aware of actual or potential abuse taking place. The response was suitable and demonstrated that any abuse would be reported. We were told that staff have received training in safeguarding although we did not assess the contents of the course. 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 clean and pleasant home. Continual improvements enhance the environment further and ensure that people live in a safe, well maintained and comfortable place. Evidence: Grange Hill House is situated down a private drive and is surrounded by well maintained gardens and surrounding countryside. The house has been sensitively developed to provide a pleasant and relaxed environment for people residing there. Since our last key inspection we have registered two additional bedrooms. One of these rooms is designated to provide respite (short stay) care. The home has a large lounge, a separate dining room and a smaller lounge / dining room. Furniture in the lounge is arranged in small groups which can aid interaction. The lounge also includes a flat screen television and a baby grand piano. We found the atmosphere within the home to be relaxed and friendly throughout our visit. The dining room is well furnished and an attractive area to eat. From the dining room it is possible to gain access to the well maintained garden. The views from windows Care Homes for Older People Page 20 of 29 Evidence: around the home are pleasant. Considerable resources were recently placed into landscaping the gardens including lighting to the trees to enhance the appearance at nighttime. Bedrooms are located on both the ground and first floor. People are able to personalise their bedrooms with their own items. We checked the wardrobe in one bedroom and found that it was suitably secured to the wall to prevent accidental toppling. We saw windows with restrictors fitted to them to prevent accidental or deliberate falling to the ground. We were told that checks take place to ensure that the restrictors are in a safe working condition. In one room we noted that screws were coming undone and therefore required attention while in another the catch was broken. Some windows appear to have condensation trapped between the double glazing. The provider is aware of this matter and plans are in hand to replace the glass. Some parts of the home such as the entrance hall, stair case and landing are in need of decoration to bring these areas up to the standard of the rest of the house. We are informed that plans are in hand for these improvements including the services of an interior designer. The home was clean and fresh throughout at the time of our visit. People confirmed both upon our questionnaire and during our visit that the home is clean. There are two laundries with appropriate equipment 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty to ensure that people using the service have the level of support they need. Staff are trained to provide them with the skills and knowledge necessary for them to carry out their role. People using the service can have confidence in the homes recruitment processes. Evidence: Within the Annual Service Review which we wrote in July 2008 we stated that since the previous key inspection we were told that staffing levels at the weekend had increased to match the staff during the rest of the week. We were told that currently staffing levels consist of 4 care assistants both in the morning and the afternoon with 2 at night. A member of staff confirmed that these are the staffing levels most days. In addition to care staff are housekeeping staff, catering and maintenance staff. We have previously reported that Grange Hill has a stable work force. The service users guide states The majority of the staff group at Grange Hill House have worked at the Home for many years. The registered manager confirmed that this statement remains to be the case. Care Homes for Older People Page 22 of 29 Evidence: The AQAA stated that all staff have PoVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) clearance. We looked over the file of two new members of staff. We found evidence that references were obtained and a full CRB disclosure check was in place. We found evidence that employees have a written contract of employment. During our inspection the manager confirmed that out of 24 carers all but 3 hold an NVQ (National Vocational Qualification). This is a commendable achievement and should help ensure that people received a quality service. We saw a number of training certificates that needed to be filled. The manager stated that training is an area that the service does well upon the AQAA. A member of staff told us that the training is good and was able to tell us about the training she had done while at the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in a way that involves people and seeks their views. People using the service could have greater confidence in the service once some management systems are developed further. Evidence: The registered manager confirmed during our visit that she holds the Registered Managers Award which is an NVQ (National Vocational Qualification) level 4 in management. In addition we were told that she holds an NVQ level 4 in care. These qualifications are not mentioned within the service users guide. We sought copies of the Regulation 26 reports. These are monthly reports that have to be carried out by the owner or their representative following a visit to the home. This inspection was carried out on a Saturday and the office where these are held was not accessible to the manager therefore we were unable to view them on this occasion. We were later assured that these visits are given high priority and that reports are Care Homes for Older People Page 24 of 29 Evidence: produced. We saw the results of some user satisfaction surveys sent by the home to people living in the home, relatives and professionals. The findings were found to be positive. One relative had written The standard of care has been excellent I know the staff have the residents best interest at heart. Although the home does not manage anybodys money people are able to deposit small amounts of cash for safekeeping. As part of this inspection we checked the balance held in relation to the records maintained for a small sample of people. The balances held were correct against the written records in two out of the three we checked. The other one we checked was in surplus by a small amount. Nobody had noticed this surplus despite financial transactions having taken place. We made other recommendations regarding current practices within the home in order to safeguard all concerned as well as protect peoples right to confidentiality regarding the balance of their account. There was evidence on one staff file to suggest that staff are receiving formal supervision in line with the National Minimum Standards. The certificate of registration and certificate regarding public liability insurance were on display. As indicated earlier within this report, systems to ensure that medication is well managed and properly recorded need to be improved. Care planning also requires further attention. We have therefore concluded that the two main areas for improvement following this inspection are similar to those highlighted within our previous report We briefly viewed the fire records and found that the fire system is tested on a weekly basis in a sequential or structured order. We were informed that there are no outstanding matters following a visit from a fire officer last summer. On the AQAA we request the date when servicing or testing of equipment and supplies last took place. On this we noted that the electrical wiring was last checked during April 2004. As it is recommended that wiring is checked every 5 years we discussed the matter with the registered manager. The registered manager was aware of this and advised us that a rolling programme of testing the electrics is due to commence in April 2009. We saw evidence that the stair lift was last serviced in October 2008. Care Homes for Older People Page 25 of 29 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 1 7 15 Regulation 15 (1). Ensure that care plans are an accurate description of how care needs are to be met. This is to ensure that care is provided in a safe and consistent way 29/05/2009 2 9 13 Regulation 13 (2)Ensure that the medication records are signed accurately and following the administration of medication. This is to ensure that medication is managed safely. 29/05/2009 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 8 You should ensure that pressure care risk assessments are in place and that the give an accurate account of each individual. Appropriative measures need to be in place to reduce any risks identified. Page 28 of 29 Care Homes for Older People Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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