Care Home: Hamilton House

What the care home does well The home ensures that people using the service have their needs assessed prior to moving in. This is to ensure that all identified needs will be met. The home ensures that people`s health, personal and social care needs are set out in an individual care plan detailing people`s wishes and how identified needs will be met. The home ensures that the activity facilities provided in the home matches people`s expectations and preferences and satisfies their social, cultural religious and recreational interests. The home has a clear and accessible complaints procedure, which mean that people using the service and their relatives can be confident that their complaints will be listened to, taken seriously and acted upon. The home ensures that people live in a safe and comfortable environment, which is able to meet their changing needs along with their cultural and specialist care needs. The home ensures that the staffing numbers and skill mix of staff are appropriate to meet people using the service diverse needs. People live in a home that is well managed and the health and safety systems in place are regularly reviewed to ensure that people`s safety and welfare are promoted and protected. What has improved since the last inspection? The home has a calm professional atmosphere which enables people using the service to express their personalities fully. The home`s daily activity programme caters for at least three activities to be going on in the home at any one time. This means that people`s social needs are catered for. The home has replaced floor coverings in the corridors and some bedrooms and continue to purchase profiling beds as needs require. This is to ensure that people live in a home that is safe and comfortable. The home has developed a sensory garden, humour therapy and a book of anecdotes to enhance people`s social, cultural, interests and needs. Communication between the staff, relatives and people using the service has continued to grow with staff building confidence through training and supervision. What the care home could do better: Staff`s practice in the recording, handling, safekeeping and safe administration of medicines must be consistent. This is to ensure that people using the service health and welfare is not compromised. When staff are appointed ahead of the full criminal record bureau disclosure a name person, appropriately qualified and experienced must be appointed to supervise the individual until the full clearance is obtained. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hamilton House West Street Buckingham Buckinghamshire MK18 1HL     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: Joan Browne     Date: 2 3 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 28 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 28 Information about the care home Name of care home: Address: Hamilton House West Street Buckingham Buckinghamshire MK18 1HL 01280813414 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Acegold Limited (a wholly owned subsidiary of Four Seasons Health Care Ltd) Name of registered manager (if applicable) Mr Andrew Williams Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 53 The registered person may provide the following category of service: Care home with Nursing (N) to service users of the following gender: Either whose primary care needs on admission to the service are within the following category : old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Hamilton House is situated a short distance from the town centre of Buckingham, a small market town served by local bus networks with a variety of shops and other local amenities. The home is one of the Four Seasons Healthcare Group. It provides personal and nursing care for up to 53 Service Users. Service users are accommodated in one of 39 single or 7 shared rooms, found over 3 floors. The home has 4 dayrooms and 1 dining room. These communal areas provide space for receiving visitors, Care Homes for Older People Page 4 of 28 0 Over 65 53 care home 53 Brief description of the care home participation in activities, watching television and dining for limited numbers. The front door to the building is accessed by two steps, and is therefore inaccessible to wheelchair users. Side entrances to the home can be used for wheelchair access. The home has two passenger lifts, which permit access to all levels of the home. Grab rails are found in toilets, bathrooms and bedrooms. There are hoisting equipment to facilitate safe moving and handling practice and a nurse call system in place. The staff team consists of trained nurses, care staff, domestic, catering and laundry staff. 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: 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: This unannounced site visit which forms part of the key inspection to be undertaken by the Care Quality Commission (CQC) was undertaken by Joan Browne on 23 April 2009 and lasted for approximately eight hours. The last key inspection on this service was completed on 12 April 2007. The CQC Inspecting for Better Lives (IBL) involves an annual quality assurance assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection process and is referred to in the report. The information contained in this report was gathered mainly from records kept at the service and information contained within the AQAA. We also looked at care plan documentation, staff recruitment files, training records, medication documentation, Care Homes for Older People Page 6 of 28 health and safety records and observed staff practice. A tour of the premises was conducted and several visitors to the establishment were spoken to. Comment cards were received from six people using the service and three staff members. Their comments have been reflected into the report. One requirement and one recommendation of good practice were issued on this visit. Please see outcome areas for health and personal care and staffing for full disclosure. Feedback was given to the manager and deputy manager at the end of the inspection. The fees for this service range from 492.66 pounds to 1217.72 pounds. We (The Commission) would like to thank all staff and people using the service who made the visit so productive and pleasant on the day. 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 28 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. People were confident that the home was meeting their diverse needs. This is because an assessment of their needs was undertaken prior to them moving into the home, which they and people close to them were involved in. Evidence: Information in the AQAA reflected that the home carries out an in-depth pre-admission assessment for all potential people using the service to ensure the placement will be appropriate for them and the home can provide the care and support they require. The pre-admission assessments for two people recently admitted to the home were examined and we found this to be the case. The manager said that either himself, the deputy manager, or an experienced registered nurse undertake assessments and these are carried out in a sensitive manner involving individuals and their family. Wherever possible, people are invited to spend a day at the home and trial periods are provided. Those people who responded to the Commissions survey said that they had Care Homes for Older People Page 11 of 28 Evidence: received enough information about the home before deciding it was the right place to be. Those spoken to during the inspection said that family members had helped them with choosing the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that people are supported with their personal and health care needs using a personalised approach. Improvement in the homes medication system is needed as they do not always follow safe practice. Evidence: The care plans for four people whose care was case tracked were examined. The plans were generated from the comprehensive assessment which was carried out prior to admission.The plans were comprehensive and informative detailing how identified needs would be met. Evidence seen verified that the plans were being reviewed monthly or as and when required. The plans were signed by individuals or their representative confirming their involvement in their development. The care plan documentation contained risk assessments on moving and handling, falls, tissue viability, nutrition, continence and oral care. The home has a system in place to ensure that monthly review of assessments are carried out. Evidence seen indicated that peoples vital signs were being monitored and recorded on a monthly basis or weekly if the general practitioner requested staff to have them checked more Care Homes for Older People Page 13 of 28 Evidence: often. Staff spoken to said that they were able to access the services of other professionals such as the tissue viability nurse and the palliative care nurse. All the people living in the home were registered with a general practitioner who visits the home as and when required. The general practitioner was spoken to during the inspection and she confirmed that staff work closely with her and carry out her instructions to promote peoples health and well being. We found that people have access to the chiropodist, dentist and optician. Hairdressing facilities are available at a small fee. A sample of medication sheets were examined. We found some inconsistencies in staffs practice. For example, a person was prescribed a variable dose of codeine phosphate tablets 15mg to be taken one or two tablets twice daily. Staff were not recording the actual dose given such as, one tablet or two tablets. This meant it was not possible to tell how much medication the individual was receiving. A second person was prescribed for Amoxicillin capsules one to be taken three times daily. We noted that 21 tablets were dispensed. We checked the balance remaining in the packet which was 3. There were 17 signatures recorded on the medication administration record (MAR) sheet to verify that the medication was administered by staff and one tablet was not accounted for. A third person was prescribed for Lansoprazole 15mg one tablet daily. There were two days when the medicine was not administered. No explanation was recorded on the MAR sheet the reason for omission. To comply with best practice guidelines a recommendation was made at the previous inspection for staff to record their full signature rather than initials in the controlled drug register. We found that the recommendation had not been complied with and it is being repeated. A requirement is made for the home to have a system in place for the safe handling, administration and recording of medicines. Since the inspection the manager has notified the Commission the action he has put in place to address the medication shortfalls. Staff were observed interacting with people in a kind and respectful manner. Those people spoken to during the visit said that staff respected their privacy and dignity and staff were marvellous. Peoples attire was clean and tidy with attention to detail. Where people had chosen to share a room screening was provided to ensure that privacy was not compromised when personal care was being given. Staff wore name badges so that people and their relatives were aware of their names and who they were talking to. Medical examination and treatment were carried out in peoples own room to ensure their privacy. Peoples wishes on how they wished to be cared for were recorded in the care planning documentation examined. People who were receiving palliative care had an end of life care plan in place stating their wishes and detailing how they wished to be looked after. For example, being provided with soft music or poetry recital. Plans were signed by individuals or their relatives to confirm their involvement. Care Homes for Older People Page 14 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides facilities for people to take part in cultural and age appropriate activities. Meals provided are healthy, well presented to stimulate appetite and are served in pleasing surroundings. Evidence: The home ensures that the routine of daily living and activities for people are flexible and varied. People spoken to said that they have the opportunity to exercise choice in relation to leisure, social and cultural interests. The home employs an activity person who works closely with the staff team to ensure that the activity provided is imaginative and varied. For example, the activity programme displayed in the home allows for at least three activities to be going on in the home at any one time. Activities provided daily were snoozalan therapy, bingo, board games, exercise, talking books, gardening, arts and crafts, indoor games and film afternoons. One to one room visits are provided to those people who are bed bound and personal shopping can be arranged by appointment. We experienced the snoozalan therapy which was facilitated in the front lounge after lunch. This was very stimulating, relaxing and enhanced peoples mood. Special projects such as, a book of peoples memories, a neighbourhood scheme, gardening and the setting of a sensory garden, humour Care Homes for Older People Page 16 of 28 Evidence: therapy and a book of the residents anecdotes were being launched. People spoken to said that they were able to maintain contact with family and friends and receive visitors in private. People are able to choose whom they see and do not see. Visitors spoken to during the inspection said that the staff make them feel welcome and would always offer them refreshments. People receive visits from people in the community such as, children from the local school. Church services are held weekly to promote peoples spiritual needs if they wish to. Regular residents and relative meetings take place to discuss the activity programme. The staff ensure that traditional celebrations such as birthdays, Christmas and Guy Fawkes are celebrated. One individual spoken to was a keen gardener and was involved with developing the sensory garden. People are encouraged to handle their own financial affairs for as long as they wish to and are able to and have the capacity to do so. The home informs people and their relatives of how to contact external agents for example, advocates. The annual quality assurance assessment (AQAA) reflected that an age concern advocate visits the home twice a month. Evidence seen on the day of the site visit verified that people are made aware of their entitlement to bring personal possessions with them if they wish to. People are offered three meals daily and hot and cold snacks are provided regularly. Those people who responded to the Commissions survey said that they liked the meals provided. Relatives and people spoken to during the visit were also complimentary about the meal provision.The lunch time meal was observed and the menu consisted of two choices which were steak and mushroom pie and macaroni cheese served with peas and carrots. Lunch was presented and served attractively to stimulate appetite in pleasing surroundings. Fruit juices and glasses were seen in the sitting rooms which meant that people were able to help themselves to drinks if they wished to. Staff were observed offering drinks to people throughout the day and recording their fluid intake. The cook was spoken to and she said that special diets were catered for. She also confirmed if people did not like what was on the menu an alternative would be provided. We observed some individuals were provided with omelette as an alternative. Some people were provided with soft diets. For those individuals who required support during mealtimes including those who have swallowing or chewing difficulty staff were observed offering assistance discretly and sensitively. 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. The home has a satisfactory complaints policy and procedure to ensure that people using the service and their relatives concerns are listend to and acted upon. Staff have regular training in the safeguarding of vulnerable adults which should ensure that people are protected from the potential risk of harm and abuse. Evidence: The home has a complaints policy and procedure. Information in the annual quality assurance assessment (AQAA) indicated that the home had investigated ten complaints within the last twelve months. One of the complaints was upheld. People who responded to the Commissions survey said that they knew how to make a complaint. The AQAA stated that there was an open door policy to encourage relatives, residents and staff to raise any issues. A relative spoken to substantiated that this was the case. The individual confirmed that they had cause to raise a concern and the issue was taken seriously and responded to within a reasonable timescale. The homes complaints record folder was examined and all complaints made and the actions taken in response to them were fully recorded. As part of the homes quality assurance procedure a review of the number and nature of complaints is undertaken. The home appears to learn from complaints in order to improve the service delivery and pay particular attention to any themes that refer to dignity, respect, fairness autonomy and equality. Within the last twelve months there have been two safeguarding adults referrals which Care Homes for Older People Page 18 of 28 Evidence: were investigated by the local social services safeguarding team. The Commission has been made aware of these investigations, which to date have not yet been concluded. All staff spoken to during the site visit confirmed that they had undertaken training in the safeguarding of vulnerable adults and knew how to respond in the event of an alert. Training records examined verified that staff have regular training update in the safeguarding of vulnerable adults to update their knowledge and understanding in this area. 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. The home is safe, clean, pleasant, well maintained and is fully able to meet and promote peoples diverse needs. Evidence: The communal areas of the home were found to be pleasantly decorated and furnished. The management and staff encourage people to see the home as their own home. Bedrooms seen during the inspection were personalised with family pictures and mementos reflecting the characters of individuals. The annual quality assurance assessment (AQAA) stated that profiling beds and pressure mattresses and cushions are purchased promptly when required. Bathrooms and toilets were fitted with appropriate aids and adaptation to meet the needs of the people who use the service and to promote independence. The home has a system in place to ensure that equipment used in the home is checked monthly and replaced as required. We were told that the home has an ongoing maintenance programme and carpets in corridors and some bedrooms were recently replaced. A plumbing audit was carried out to remedy outstanding drainage problems. At the time of the inspection hot water taps in some toilet areas were not functioning. Consideration must be made for the problem to be remedied. It was observed that call bells were left within peoples reach. People confirmed that the call bells were answered promptly. The home has a gardener who maintains the grounds and gardens throughout the year. Care Homes for Older People Page 20 of 28 Evidence: The home on the day of the inspection was clean, pleasant, hygienic and free from offensive odours. People who responded to the Commissions survey said that the home was always or usually fresh and clean. Systems were in place to prevent the spread of infection. Hand gel was available at the front of the building so that visitors entering and leaving the building can use to control the spread of infection. The laundry room is situated away from where food was being stored, prepared cooked or eaten and is equipped with driers and washing machines with the specified programming ability to meet disinfection standards. A random review of staff training records demonstrated that they had undertaken training in infection control which was ongoing. On the day of the inspection the deputy manager had facilitated training to some staff on infection control. 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 home ensures that all staff receive relevant training that is focused on delivering improved outcomes for people using the service. Evidence: The staffing rota examined demonstrated that the number and grade of staff on duty to provide care and attention to people for any twenty-four hour period was suitable to meet their assessed care needs. People who responded to the Commissions survey said that staff were always or usually available when needed. The home employs a multi-cultural staff team with the appropriate skills and knowledge to meet individuals needs. Staff spoken to during the inspection were confident that they were meeting peoples diverse needs and the service provision was effective and responsive. Staff training records examined indicated that thirteen of the twenty-two permanent care staff had achieved the national vocational qualification (NVQ) in direct care at level 2. The home is aware of the need to achieve the minimum ratio of 50 of staff achieving NVQ at level 2 and was working towards achieving the target. The recruitment files for two staff members recently recruited were examined. The files contained the information required under care homes Regulations 2001 Schedule 2. One staff member was working ahead of the full criminal record bureau (CRB) clearance but with a PoVA first check. The manager stated that the individual was working under the supervision of an experienced member of staff. However, there was Care Homes for Older People Page 22 of 28 Evidence: no written evidence to support this statement. To comply with best practice guidelines when staff are appointed ahead of the full CRB disclosure a named person, appropriately qualified and experienced should be appointed to supervise the individual until the full CRB is obtained. There may be more than one named person but this would need to be clearly identified on the staff rota. Evidence seen confirmed that the home has an ongoing training programme to ensure that staffs mandatory training is updated regularly. The home facilitates weekly in house training. Dates of planned training was displayed on the staffs notice board and included training in the following topics: verification of death, safeguarding of vulnerable adult, health and safety, manual handling and Parkinsons disease. The home is part of the Buckingham cluster group and a list of training arranged by the cluster group between the months of April and July covering topics such as deprivation of liberty safeguarding, food hygiene, first aid, mental capacity act, safeguarding of vulnerable adults, infection control and dementia was displayed on the staff notice, which staff were nominated to attend. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the experience to run the home and works to continuously improve services and provide an increased quality of life for the people using the service. Peoples financial interests are safeguarded and their health, safety and welfare are protected and promoted by the homes policies and procedures. Evidence: The home is managed by a qualified, competent and experienced manager. He is a registered general and mental health nurse and has approximately 24 years experience working in health and social care setting. He has the registered managers award qualification and a degree in nursing and inter professional practice. The manager was able to demonstrate how he updates his knowledge and skills by attending training and seminars and networking with other colleagues. Staff and relatives confirmed that he operates an open door policy. He works continuously to improve the service delivery and provide an increased quality of life for people using the service with a focus on equality and diversity and promoting peoples dignity. An Care Homes for Older People Page 24 of 28 Evidence: experienced deputy manager, registered nurses, carers and other support staff support the manager in the day to day running of the home. Staff spoken to confirmed that there were clear lines of accountability in the home. Regular staff meetings and relatives and residents meetings are held to ensure individuals are given the opportunity to voice their concerns and contribute in the running of the home. The annual quality assurance assessment (AQAA) contained clear and relevant information supported by a wide range of evidence that clearly supports the claims made. Evidence was seen of reports confirming that regular regulation 26 monitoring visits were being undertaken by the regional manager.The home seeks feedback from people living in the home and their relatives and has received a 79 satisfaction rate from the recent customer survey. As a result of the survey there was one issue that needed actioning and this has been addressed. The home manager or the organisation is not an appointee for peoples pensions. However, some money is handed in to the home to cover incidentals such as chiropody treatment and hairdressing. Written records of all transactions are maintained and receipts kept of all incoming and outgoing payments. At the previous inspection a recommendation was made for the home to ensure that money held in the home for people using the service should not exceed the organisations financial limit. It is pleasing to report that the recommendation has been complied with. All staff undertake updated mandatory training in fire safety, moving and handling and food hygiene. The AQAA reflected that regular servicing of the hoists, lifts, portable electrical equipment, fire detection and alarm, gas appliances and heating system is carried out and was up to date. 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 1 9 13 Staffs practice in the recording, handling, safekeeping and safe administration of medicines must be consistent. This is to ensure that people using the service health and welfare is not compromised. 28/05/2009 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 29 To comply with best practice guidelines when staff are appointed ahead of the full criminal record bureau (CRB) disclosure a named person, appropriately qualified and experienced should be appointed to supervise the individual until the full CRB is obtained. Care Homes for Older People Page 27 of 28 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. 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