Care Home: Harwood Court

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What the care home does well The service provides good information for service users before they move into the home. And the service assesses the needs of service users fully. This means that people can make informed choices. The service emphasises service user involvement in the service and supports independence and social activity. People who live at the home can influence how and where they spend their time. The views of service users and their representatives are sought regarding the quality of the service. The people who live at Harwood Court have some control over the way the service is delivered. Relatives and visitors are made to feel welcome and involved. People living at the home generally enjoy a high level of contact with visitors. The service provides an attractive and comfortable place for people to live. The service recruits support for service users from volunteers and the local community. This means that people can keep in touch with the outside world. The spiritual needs of service users are well catered for. This meets the expectations of service users. The staff are supported to make their concerns known and this helps protect service users. Staff are being given new opportunities for learning. This means that the people who use the service will have confidence in the staff. The home is well managed and ideas about ways to improve the service are welcomed. What has improved since the last inspection? The way the service plans care with service users has developed further. Service users are involved in planning their short and long term care so that their wishes are respected. More social activities have been introduced and service users have been involved in producing a seasonal newsletter. All staff have recived training in safeguarding service users from harm and this helps to protect people. Where things have not gone well for service users the service has dealt with these properly. The premises and facilities have been further improved to better support service users` independence. The service has recruited a Chaplain to support the pastoral care of service users.The home has developed its quality assurance processes further. And this is leading to on- going improvements in the support that people who live at the home receive. What the care home could do better: Make sure that the way service users` decisions are supported and recorded follows best practice guidelines. Make sure that all concerns are recorded to show how service users are supported to raise minor issues. Key inspection report Care homes for older people Name: Address: Harwood Court Highburn Cramlington Northumberland NE23 6AZ     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: Carole McKay     Date: 1 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Harwood Court Highburn Cramlington Northumberland NE23 6AZ 01670-712492 01670735626 home.cra@mha.org.uk www.mha.org.uk Methodist Homes for the Aged care home 35 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not faling within any other category - Code OP, maximum number of places: 35 Date of last inspection Brief description of the care home Harwood Court is a well established home, which provides single room en suite accommodation and personal care to 35 persons. The premises are purpose built with large gardens and are well located for services and shops in the middle of Cramlington. Run by Methodist Homes for the Aged, a national voluntary organisation, the home has a Christian based ethos and welcomes applications from people of all faiths. The home benefits from the support of a small but committed group of volunteers and has a well-established staff team. Care Homes for Older People Page 4 of 28 Over 65 35 0 Brief description of the care home The current manager is Judith Moffat. Judith has managed the home on a previous occasion, and is registered with the Care Quality Commission (CQC). An emphasis is placed on social activity and independence. The home has a lively social activity programme and volunteers help support service users in maintaining links with the community. Service user involvement in the running of the home is also encouraged. Copies of previous inspection reports are available in the home. The current fees range from £478 to £529. 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: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out:- Before the visit we looked at: Information we have received since the last key inspection visit on the 18 September 2008; How the service dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The managers view of how well they care for people. The views of relatives, staff and people using the service. Care Homes for Older People Page 6 of 28 The Visit: An unannounced visit was made on the 15 September 2009. During the inspection we: Talked with the manager; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff have the knowledge, skills and training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit. We told the manager what we found. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? The way the service plans care with service users has developed further. Service users are involved in planning their short and long term care so that their wishes are respected. More social activities have been introduced and service users have been involved in producing a seasonal newsletter. All staff have recived training in safeguarding service users from harm and this helps to protect people. Where things have not gone well for service users the service has dealt with these properly. The premises and facilities have been further improved to better support service users independence. The service has recruited a Chaplain to support the pastoral care of service users. Care Homes for Older People Page 8 of 28 The home has developed its quality assurance processes further. And this is leading to on- going improvements in the support that people who live at the home receive. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available for people to make an informed choice about coming to live at the home. Service users will be involved in having their needs fully assessed. Evidence: The service is very welcoming to visitors. The entrance hall has a display of information about the Methodist Homes and about Harwood Court. Some of this information is produced by the organisation as a service user guide and some is information gathered together about Harwood Court in the form of a scrap book of events, including photographs and cuttings. The manager of the service has arranged for staff to have their individual photographs taken and for these to be displayed in frames with names and roles attached. The home has a welcome pack a copy of which is provided to each service user on the day of admission. The manager said that fresh flowers are placed in the room in Care Homes for Older People Page 11 of 28 Evidence: readiness for the service user being admitted. In surveys the service user told us that they received enough information about the home to help them make a choice and that they have written terms and conditions of accommodation. We looked at the care records for four people who live at the home. These showed that prospective service users will have their needs fully assessed before coming to live at the home. To do this the home has obtained assessment information from the service users care manager. And carried out a full assessment of need with each service user concerned. These assessments are comprehensive documents that take account of all aspects of service users needs, as well as their wishes and preferences. Service users have been involved in these and have signed the documents. Staff told us that they receive the right amount of information about the needs of service users for them to provide the correct level of care. The home does not provide intermediate care. 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. People using this service will have their health care needs assessed. Clear plans will be made to ensure that their needs are met, within the home or by other appropriate services Evidence: Each service user has a service user plan. The home has updated the paperwork for these. The new plans are very clear, easy to read and accessible to the care staff. They are securely stored. The service users sign the plans. Service users said that they knew about these and that their needs had been discussed with them. All aspects of care are covered in the plans. The home also uses risk assessments for areas of health care such as mobility, nutrition and skin care. These are now in place for all service users. Since the last inspection the provider organisation has developed training for senior staff in supporting service users in end of life planning. This is being used in the home to support service users to explore and disclose, if they wish to do so, any final arrangements and wishes they may have. The process is being sensitively handled. For some people this has resulted in refusal of treatment Care Homes for Older People Page 13 of 28 Evidence: agreements being reached. These are recorded, signed and dated, but in an informal format. The manager should ensure that records to do with capacity and advanced wishes follow best practice examples. Where appropriate referrals are made to other specialists and services. Routine health checks are arranged as necessary. Service users preferences, about how their care is provided, are recorded in the service user plan. For example one persons food preferences were recorded, as well as their need to have food placed on the plate in a specific way due to their sight impairment. A specific plan had been written to explain to staff how to guide this person when walking with them. And this was observed in practice. The staff at the service receive training in the homes values and polices to do with respect and dignity. In surveys, and in conversation with us, service users reported that they were treated well by the staff. One person commented- the care is second to none. The staff are very respectful and extremely helpful. Policies and procedures for safe handling of medication have been updated since the last inspection and there is now a clear protocol for as required medication. Clear records are kept of this in line with the new protocol. Medications are stored safely. The home has a dedicated room for this purpose. It has recently been refitted and is very secure. A lockable trolley is used for the medication rounds. The record keeping for medications is good. The staff who administer medications receive training from an external agent. Their ability to follow the homes procedures is also assessed at the home. These assessments are recorded. One of the staff has responsibility for regular auditing of the medication and the records. Since the last inspection one medication error has occurred. This was reported to us at the time and was appropriately followed through. Service users are supported to control their own medication on the basis of a risk assessment which is regularly reviewed with the service user. Since the last inspection there has been one medication error. This was fully reported, taken seriously and properly followed through. Care planning and recording is monitored as a part of the homes quality assurance processes. Care Homes for Older People Page 14 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. Service users have control over the decisions about how they will spend their time. The service supports and encourages service users to be active and independent, both in the home and in the community. Evidence: The activity organiser was on leave at the time of the inspection. But the home has a programme of activity. This has been designed around the needs and wishes of the service users, so that all people can participate in activity.Since the last inspection the home has introduced theme days and has developed the conservatory as a sensory area where crafts and hobbies can be explored. Photographs from a yellow theme day were displayed. Staff and service users wore yellow items of clothing and the menu of the day was adapted to use yellow foods. The gardens are mentioned in surveys and are very inviting with sitting out areas. Service users commented that they enjoy being able and assisted to walk out in the good weather. During the visit two service users arranged to walk out in the garden together. One person said they would sit outside as much as possible as they liked to be outdoors, having previously been in farming. Care Homes for Older People Page 15 of 28 Evidence: One of the assistant managers is producing a quarterly home newsletter. This involves contributions from the service users and includes their poems, anecdotes and jokes all reproduced in large print. Each person receives a copy. The home has a separate hairdressing room and the hairdresser attends weekly. The home has a strong emphasis on spirituality and the Chaplain visits the home regularly and weekly services are conducted. The importance of these visits to individual service user is noted in service user plans. The home has three communal areas that people can use. One of these lounges is on the first floor. Small kitchens are located on each floor so that visitors can easily make a cup of tea or other refreshments. These have been fitted with water dispensers to avoid the use of hot kettles. There is a strong sense of community in the home. This is one of the values of the service. Service users said that they usually take main meals together in the dining room and meals can also be taken in their rooms. Some service users have newspapers delivered. Individual preferences to do with food are clearly described in the service user plans. So are dietary needs. The cook said that one person required special arrangements for a soft diet. She had recently obtained some advice on this and had attended training for catering for people with dementia. Care Homes for Older People Page 16 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 service openly encourages comments and complaints so that the people who use the service feel confident that they will be listened to. Staff are supported to share concerns and this protects service users. Evidence: The procedure for making complaints and other information about the home is openly available in the entrance hall to the home. There is a comments and suggestions book nearby. Methodist Homes has a system for monitoring complaints in each of its services. No complaints have been raised with the service since the last inspection. The manager said that she attributes this to using the comments and suggestions book to good effect. And to dealing with minor concerns as they arise. These are not recorded in the complaints record. The provider, (MHA) has introduced ways that complaints can be monitored so that underlying problems can be identified and lessons can be learnt. The organisation has introduced a free call telephone line for whistle blowing for staff to use. The home has procedures and guidance for identifying abuse of vulnerable adults and Care Homes for Older People Page 17 of 28 Evidence: for reporting any suspicion that abuse has occurred. The staff files show that staff attend training to do with the local procedures for safeguarding vulnerable adults. They also have in house training in safeguarding and electronic learning opportunities in this subject. In surveys (2) staff confirmed that they know what to do if someone reaises concerns. And (10) service users responded - yes - to the question about knowing how to make a formal complaint. Care Homes for Older People Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers a comfortable,pleasant environment. Service users are involved in making decisions about how the premises are used. And they are supported and encouraged to personalise their own space. Laundry and cleaning arrangements ensure the well being of service users. Access to the gardens and outdoor amenities are highly valued by service users. Evidence: The home is purpose built and is set in large attractive gardens. These are well maintained with safe level access and various sitting areas have been created. Several service users spoke highly of these amenities. It is a highly valued part of the service. There is level access at the homes main entrance. A shaft lift is installed to access the first floor for people who cannot manage stairs. Each floor has a communal lounge and each wing of each floor has toilets, small kitchen areas that can be used to prepare beverages and rest areas along the corridor. Movement sensitive lighting has been installed in the first floor corridor so that full illumination is provided at all times of the day. This is particularly important for people who have a visual impairment. There is a conservatory off the main ground floor lounge and this is used as an area Care Homes for Older People Page 19 of 28 Evidence: for stimulating the senses, by way of music, craft materials and for pursuing other hobbies. The ground floor lounge is the main hub of the home and is used for the weekly shop- run by volunteers, exercise and group activity, such as quizzes and for church services. Harwood Court has been maintained to a good standard. Recently the main corridors have been repainted in lighter, modern colours and new framed pictures have been put up on the walls, using a different theme for each corridor. One of the bathrooms has been improved by installing a new specialised bath. The staff and service users said that this was very easy to use. The rest of the home is clean and well presented. The home has a well-equipped laundry room and separate ironing room. The home employs two laundry assistants. Positive comments were made in surveys about the laundry service. The senior staff have responsibility for routine checks of the building. Also the provider has introduced a self-assessment of its services that includes the premises. The manager said that she now has a spending budget for repairs and improvements. Some improvements have already started, such as a refit of the treatment room and disabled toilet. Others are being arranged. People who use the service are actively encouraged to bring personal items into the home, including furniture if they wish. Individual bedrooms are very personalised and service users can arrange them to suit their own comfort and needs. One service user said that they had been pleased to have been able to bring a nest of tables, a small chair and their own bed. Service users can have photograph of their keyworker in their room if they wish, as a reminder. Bedrooms have en-suite facilities. Since the last inspection each bedroom door has had a small frame fitted to it so that service users can individualise these with a picture or number. One service user had chosen to have a number in the frame and this helped the person to locate the room after leaving the dining room. Some people have placed pictures in the frames or photographs of themselves. Attractive metal lockable mailboxes have been installed beside each bedroom for service user to hold the keys for if they wish to do so. The manager said that some people were now using these. There are two domestic staff on duty each day. These staff said that they have the equipment and time necessary to keep the home clean. The home has hand-wash and paper towels installed in bathrooms and toilets. It is clean and well presented throughout. Care Homes for Older People Page 20 of 28 Evidence: 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. Service users are supported by a stable and well trained team of care staff and also benefit from voluntary and pastoral support. Evidence: The home has retained its senior staff team over a period of years. The rotas show that the home has good care staff numbers. These staff are supported by four kitchen staff, two laundry staff, domestics and administrative staff. A team of volunteers also provides support to service users for social events and general outings. In surveys most service users described the staffing as always or usually available when they needed them. Though two people responded sometimes. One comment was added that there had been shortages - but that the staff rally round and do the work. Staff turnover is low. Currently there is a member of staff on long term sick leave and two people on maternity leave- for which the manager has been recruiting cover recently. Since the last inspection the home has recruited on to the staff team a chaplain, who has 15 hours per week allocated to the home. The purpose of this is to provide pastoral care to service users and to the staff; to be a support to service users in decision making about life and end of life choices and to provide independent social and emotional support Care Homes for Older People Page 22 of 28 Evidence: Recruiting staff is a structured process and includes formal applications and interviews. The process adheres to equal opportunity processes. Two written references are requested. The providers personnel department supports the manager with this part of the process. There are clear recruitment procedures that she must follow. The manager said that the provider has a training budget allowance for staff of five days per year. 99 of the staff have a national vocational qualification (NVQ) and this will rise to 100 if those staff currently in training complete their qualification. Each member of staff has a personal training plan. These ensure that staff receive the basic training they must have with periodic refreshers. The plan also identifies special learning needs. Recently training in new safeguards for service users interests has been undertaken by senior staff. Senior staff take part in management training. Staff use Internet learning opportunities that the provider has made available to them. Since the last inspection a data base and audit process has been introduced for the purpose of updating staff training. 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. The home is well run with the best interests of service users influencing planning. The quality of the service is routinely monitored and improvement is ongoing. Evidence: The home has retained the same manager since the last inspection. The manager, Judith Moffatt is qualified and experienced. Judith demonstrates a sound knowledge of the providers value base and operational planning. Since the last inspection the manager has led improvements to the service. New training initiatives have been introduced, the fabric of the home and its amenities have both improved. And the service user plans have become more person centred, with a marked improvement in the quality of record keeping in these. Records are stored securely and at the same time are accessible to service users. The home is kept as a safe environment by a system of regular checks carried out by a designated member of staff. Contracts are in place for routine servicing of equipment and aids. Accidents are fully recorded and there is a system of analysis. Care Homes for Older People Page 24 of 28 Evidence: The organisation also monitors these areas through returns of data into a central system. Staff records show that staff are trained in health and safety matters and a process of monitoring mandatory training has been introduced. The manager could describe how this has affected the outcomes for service users by way of responding to individual requests to do with end of life planning and consultations. And further personalisation of the environment. Also the manager was able to demonstrate how training is more accessible to staff. Quality monitoring systems have been further developed since the last inspection. A routine quality audit was conducted by Judiths manager on the day of the inspection visit. Internal quality audits of the care planning process were also seen. Each year the provider organisation MHA udertakes a comprehensive review of the service called a Standrads and Values Assessment. This provides the manager with clear action points for the future of the service as well as feedback on positive outcomes for service users. There is evidence that the policies, procedurers and practices at the home are regularly reviewed in light of changing legislation. For example the home now has detailed written procedures under The Mental Capacity Act and Deprivation of Liberty Safeguards. And staff have received, or are about to receive training in these areas. Equality and diversity policies are now in place and the staff receive training in this through the intranet learning tool. Since the last inspection the manager has had to deal with one matter under The Mental Capacity Act, though this is no longer current. In surveys staff described the service as a well run home with high standards. 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 1 11 The procedures and records to do with capacity to consent to treatment, end of life care and advanced wishes should be reviewed under best practice guidance as issued in the relevant Department of Health documents- Advanced Decisions to Refuse Treatment- A Guide for Health and Social Care professionals and Advance Care Planning National Guidelines As best practice all concerns, and the manner of investigation, response and action taken, should be recorded in the concerns and complaints record. This will demonstrate how service users feelings and opinions are valued and taken seriously. 2 16 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). 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