Care Home: Hazelbrae

What the care home does well The home provides prospective residents and their families, with a good level of information about what services are provided at the home. The admission procedure allows for a comprehensive assessment process of any prospective resident. The staff and management of the home are welcoming to all visitors, and visiting is unrestricted. Much of the feedback received from relatives and professionals reflected on the friendly, homely feel promoted at Hazelbrae. Comments received about the care and the staff working in the home were also positive and included `the staff are gems lovely people, all staff are absolutely lovely very warm and welcoming` `my husband is well cared for, and the staff are excellent` `the staff have a good awareness of how to look after residents with a dementia type illness` `care is excellent run like a `home` and they manage complex care needs well` `the home suites a client group that respond to smaller home`. Staff recruitment was found to be robust and thorough and staff training is well promoted and documented. The home listen to residents and relatives views, and use their opinions to change and improve the service. What has improved since the last inspection? On the whole the home has responded to the requirements and recommendations made at the last key inspection. There are however some areas that have not been fully met, and these are recorded in the report. The admission process now ensures that prospective residents are advised in writing if the home is suitable to meet their individual assessed needs, and further attention has been given to recording resident`s preferences and choices, within the care documentation. The infection control practice in the home has been reviewed and staff are no longer hand sluicing soiled linen. New washing machines have been purchased, and a procedure has been written to underpin the homes practice, with regard to the management of laundry in the home. The manager has confirmed that the homes policies and procedures have been reviewed and updated since the last inspection. Nutritional assessments and screening tools have been implemented, along with written individual guidelines for the use of `as required` medicines. A system for recording a plan for ongoing upgrading and general maintenance has been established. The manager has also advised that any records relating to money held on behalf of a resident is regularly audited. The AQAA recorded that the home continues to spend a lot of it`s budget on redecoration and refurbishment of clients private rooms, communal areas and garden, which has much improved the homely setting of the building and will continue to do so as much as the budget restraints allow. What the care home could do better: Two requirements have been made following this inspection, and the manager has undertaken to address some shortfalls recorded within the body of this report. Although there has been ongoing investment in the environment there still needs to be an ongoing commitment both externally and internally. The AQAA also recognises this recording `there are still further decoration and refurbishment needs to be followed up, we need to keep in mind the budget restraints that we have to overcome`. All health and safety measures and fire precautions in the home need to be reviewed with advice and guidance from the Environmental Health department and Fire Brigade respectively, to ensure residents and staff are as safe as possible. Key inspection report Care homes for older people Name: Address: Hazelbrae 76 St Saviours Road St Leonards-on-sea East Sussex TN38 0AR     The quality rating for this care home is:   two star good 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: Melanie Freeman     Date: 1 6 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 30 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 30 Information about the care home Name of care home: Address: Hazelbrae 76 St Saviours Road St Leonards-on-sea East Sussex TN38 0AR 01424425080 01424830686 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Admal Holmwood Limited care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 15 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Date of last inspection Brief description of the care home Hazelbrae is a detached property situated in a residential area of St-Leonards- on-Sea. Local shops are situated within walking distance. The town centre, shops and railway station are situated approximately one mile away. Residents private accommodation is situated on two floors. A stair lift is provided to assist access to the first floor. The home has a rear garden readily accessible to residents. Hazelbrae is registered to provide residential and social care to (15) older people who have a dementia type illness. The registered provider is Admal Holmwood Ltd and Mrs Susan Straughan is the registered manager. The home provides care and support to residents who are both privately funded and Care Homes for Older People Page 4 of 30 15 Over 65 0 Brief description of the care home those who are funded by Social Services. The homes fees as from 01 April 2009 range from approximately £440 -£460 per person per week, depending on the room to be occupied and the care needs of the individual. Additional costs are charged for chiropody, hairdressing, newspapers toiletries and a charge of £6 is made for physical motivation an activity available in the home. Care Homes for Older People Page 5 of 30 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Hazelbrae will be referred to as residents. This was a key inspection that included an unannounced visit to the home on Wednesday 16 September 2009, and follow up contact with relatives and visiting health and social care professionals. The allocated inspector spent approximately six hours in the home and was able to discuss matters with Mrs Sue Strughan the registered manager, who received the inspection feedback at the conclusion of the visit. All the communal areas were seen along with a selection of the residents rooms. A range of documentation was reviewed including the homes service users guide, preCare Homes for Older People Page 6 of 30 admission assessment procedures, the systems in place for handling complaints and protecting residents from harm, staff recruitment files, staff training records, quality assurance systems and some health and safety records. The care documentation pertaining to two residents were reviewed in depth and the inspector was able to eat a mid day meal with a group of residents in the communal dining room. The required Annual Quality Assurance Assessment (AQAA) was well completed by the registered manager and returned when requested, and was used to inform this inspection report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? On the whole the home has responded to the requirements and recommendations made at the last key inspection. There are however some areas that have not been fully met, and these are recorded in the report. The admission process now ensures that prospective residents are advised in writing if the home is suitable to meet their individual assessed needs, and further attention has been given to recording residents preferences and choices, within the care documentation. The infection control practice in the home has been reviewed and staff are no longer hand sluicing soiled linen. New washing machines have been purchased, and a procedure has been written to underpin the homes practice, with regard to the management of laundry in the home. The manager has confirmed that the homes policies and procedures have been reviewed and updated since the last inspection. Nutritional assessments and screening tools have been implemented, along with written individual guidelines for the use of as required medicines. A system for recording a plan for ongoing upgrading and general maintenance has been established. The manager has also advised that any records relating to money held on behalf of a resident is regularly audited. The AQAA recorded that the home continues to spend a lot of its budget on redecoration and refurbishment of clients private rooms, communal areas and garden, which has much improved the homely setting of the building and will continue to do so as much as the budget restraints allow. Care Homes for Older People Page 8 of 30 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives, with a good level of information about the home, its facilities, services and the costs involved. The admission procedures ensures prospective residents are suitably assessed prior to their admission by a competent person, who ensures that the home admits only those residents whos needs can be met by the home. Intermediate care is not provided at Hazelbrae. Evidence: There is a copy of the homes statement of purpose and service users guide displayed in the front entrance along with the homes registration certificate. These documents are informative and included a copy of the last inspection report. In addition a copy of the service users guide is placed in each of the residents bedrooms, so it is readily available to them, and their visitors. Care Homes for Older People Page 11 of 30 Evidence: There was evidence that assessments are completed before admission, and that this is used with information provided from social services to ensure a full assessment process is followed. All pre-admission assessment are completed by the registered manager, and the documentation used is incorporated into the homes care documentation for each resident. Further information on peoples mental health diagnosis and medical conditions would be beneficial. Once the assessment is completed the manager writes to confirm that the home is able to meet the prospective residents assessed needs, and this allows for an informed decision to be made about admission to the home. The AQAA records that relatives and the prospective residents are encouraged to visit the home before admission to view the support and accommodation, and gain full and accurate information on the facilities and services. Feedback from relatives and professionals with regard to the admission process was positive. One relative commented on how helpful the manager was, and how she progressed the admission as quickly as she could, despite difficulties with the funding arrangements. A relative also indicated that the home was recommended to her, and that she now would have no hesitation in recommending the home herself. Intermediate or rehabilitative care is not provided at Hazelbrae Care Home. Care Homes for Older People Page 12 of 30 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. Residents health and care needs are set out in an individual plan of care. Residents care needs are met taking into account residents dignity with evidence of regular input from health care professionals as necessary. The arrangements for medicine administration in the home were found to be safe. Evidence: The care documentation pertaining to two residents were reviewed as part of the inspection process, and each of these residents were met with during the inspection visit to the home. The plans of care were found to be full and to cover the health and personal care needs of each resident, and to provide detail on how they liked to be addressed, and what each resident is able to do for himself or herself. Care Homes for Older People Page 13 of 30 Evidence: The records indicated that the care plans are reviewed regularly and that residents or their representatives are involved and consulted with as part of the care planning process. Each resident has a recent photograph held within his or her individual records. Daily records are maintained and these are held within the care documentation and are completed by the care staff. The home operates a key worker system where by an identified carer takes a specific interest in a small group of residents, they also take responsibility for maintaining the care documentation and providing up to date information for the regular review of the care provided. The care documentation contain risk assessments for a range of areas and it is generally possible to track how the home responds to identified risks, and those assessed included ones associated with nutrition, pressure areas and falls. There was evidence within the care records to confirm that community health care resources are used frequently, to support residents health care needs. Observations confirmed that residents were clean and well looked after and staff responded to them in a patient and sympathetic way. All feedback from relatives and visiting professionals was positive, with comments including particular reference to the homely friendly feel of the home and the good interaction between residents and staff. One relative said The home is nice and small my mother is nice and clean and well cared for. Staff clearly understand her care needs. Practice observed confirmed that medicines are administered in a safe way. The storage arrangements include a locked metal cupboard for medicines. Although the home has a separate cupboard for the storage of controlled drugs when required, on examination the manager was not able to open it. It was also not clear that it complied with the new legislation around the storage of controlled drugs in care homes. It was agreed that the manager would consult with her supplying pharmacist with regard to these facilities to ensure, whenever controlled drugs are bought into the home they are stored appropriately. Further information on this matter is available on the CQC Internet within the guidance document The safe management of controlled drugs in care homes. Some residents are on medicines on an as required basis, and individual guidelines have been provided to ensure these are given in a consistent way. The Medicine Administration Records (MAR) charts were clear and on the whole well maintained, Care Homes for Older People Page 14 of 30 Evidence: although the key used for omissions needs to be clarified and clearly recorded. During the inspection staff were seen to be providing personal care in dignified way and appeared very kind and friendly. The manager is in the home a great deal and directs the care ensuring it is respectful and appropriate, with residents able do what they want, with sympathetic support from staff. Residents individual rooms were personalised with many of them having their own possessions around them. Care Homes for Older People Page 15 of 30 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. Links with friends and relatives are encouraged and choices made are respected. The provision of meals ensures residents have a choice and variety in their diet, and the arrangements for activities provide an interaction and some group entertainment. Evidence: As at previous inspections interaction between residents and staff was noted and found to be positive. The home has an allocated staff member that works in the home four afternoons a week, providing approximately one hour for activities. During the inspection the allocated staff member played a game of ball as noted at the last inspection. The manager later joined in the activity and organised a game of indoor golf, that was enjoyed by residents. The staff employed for the promotion of activities has not been trained in this important area and needs to be suitably trained and supported in order to promote meaningful individual activity, and entertainment for residents. The AQAA and manager advised that some appropriate training is being sourced and choice on activities available are to be developed. The local vicar visits the home once a fortnight, none of the residents currently attend the church. Care Homes for Older People Page 16 of 30 Evidence: Residents and relatives are asked about what residents like to do, and what sort of lifestyle residents have had before admission, and this is recorded within the care documentation. Residents representatives confirmed that interaction between staff and residents is good and an important part of the day, however the promotion of individual activity for residents could be further developed. Some external entertainment is provided and includes a visiting musician and a motivational therapist who promotes physical and mental stimulation, and visits the home on a monthly basis. Visiting is well promoted with no restrictions, and is seen as an important part of residents life. Relatives spoken with said that they were comfortable to visit at any time with one relative saying As a visitor when you arrive you feel like you are coming home and that you are with friends its a warm feeling. Visitors are able to see people in private and staff are mindful of providing privacy to people. The meal eaten with residents was satisfactory with a choice provided, and staff assisting residents as needed in a supportive way, but encouraging independence as far as possible. Residents were able to choose if they want to wear aprons to protect their clothing. The kitchen was seen to be clean and looked to be well managed. Care Homes for Older People Page 17 of 30 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. Procedures and practice in the home ensure that complaints are dealt with effectively. The managers overview of the home would ensure that any safeguarding issue raised would be responded to, however staff understanding needs to be improved to ensure appropriate action is taken in her absence. Evidence: The home has a suitable complaints policy and procedure and the manager has updated this to include contact numbers for Social Services since the inspection visit. A record of complaints is recorded, and the manager confirmed that this was held in a secure way to maintain confidentiality. Relatives spoken to felt confident in raising any concern with the staff, and felt that the manager would deal with it quickly and effectively. The home has a Adult Protection Procedure this now needs to be updated to reflect the local policies and procedures on Safeguarding Vulnerable Adults. Although discussion with the manager confirmed that she had a good understanding of safeguarding matters, and when an incident needs to be referred to Social Service. It was noted while she was on holiday an incident that should of been reported had not. Clearly staff at all levels need to be provided with further training to ensure they respond appropriately to any suspicion, or allegation of abuse. The manager advised that she is attending an update on Safeguarding in the near future and will ensure all Care Homes for Older People Page 18 of 30 Evidence: staff are appropriately trained and updated. Residents are protected by the systems in place to manage their money and the home ensures that staff are employed subject to appropriate recruitment checks. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable homely environment that is being improved with general redecoration. Improvements need to ensure all resident safety issues are fully addressed and maintained. Evidence: Hazelbrae is a converted property that provides a home like environment which residents are able to identify with, and visitors commented on the homely and friendly feel of the home. Although there was evidence within the home of some ongoing redecoration and new commodes had been delivered on the day of the inspection visits. The outside of the home is rather run down needing redecoration and general maintenance, with the garden area and driveway also needing attention. When this was discussed with the manager she advised that builders had been approached and are to be contracted to upgrade the outside of the home, and this is to be progressed by the end of October 2009. She also confirmed that driveways are to be improved and that a regular gardener is to be employed to attend to the front and rear gardens. One relative also raised the poor condition of the exterior of the home as a concern. Monthly reviews of the home are completed to identify areas that need to be maintained and records recorded when these had been addressed, and Care Homes for Older People Page 20 of 30 Evidence: when they were still outstanding. A tour of all communal areas was completed along with a selection of bedrooms. On the whole the home was found to be reasonably well maintained, with a plan for further upgrading and furniture replacement. The standard of cleanliness was good and there is a cleaner working in the home each day. Residents benefit from the use of varied communal areas that include a lounge conservatory and separate dining room on the ground floor. There is also a garden that is accessed via the conservatory, and a visiting professional said that this is well used when weather is good. The home is not designated to provide a service to people with physical disabilities, as the stairs and other access arrangements would make it unsuitable for residents with a permanent restricted mobility. Access to the first floor is via stairs or a chair lift, further steps are found upstairs. During the inspection visits it was noted that all chairs in the lounge are the same height and did not allow for physical variations in residents. Discussion took place with the manager with regard to seeking the advise of an Occupational Therapist, who would advise on suitable seating and other adaptations in the home to promote independence, including bathing. Accommodation within the home for staff is limited and the only office facility is situated in the basement. The homes laundry is sited away from food preparation areas and suitable hand washing facilities were found throughout the home. Since the last inspection two new washing machines have been purchased and the manager advised that both are suitable for the washing of soiled laundry. Infection control measures in the home have been reviewed and a new procedure to ensure all laundry is dealt with appropriately is in place. The home has a copy of the Department of Health (DOH) guidelines on infection control in care homes, and now needs suitable procedures, giving clear guidelines for staff on all areas of infection control in the home, for example the emptying and cleaning of commodes. Care Homes for Older People Page 21 of 30 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. Residents are having their needs met by suitably trained staff although the staffing levels need to be constant and reflect the level of activity and dependency in the home. Residents are protected by the homes recruitment policy and practices. Evidence: At the time of this inspection visit there was 14 residents living in the home. The staffing arrangements at the time of the inspection visit included the manager one senior carer with a cleaner, a further carer arriving later in the morning, along with the activities person. The manager has recognised the increasing dependency and activity of the residents in the home, with some needing a high level of supervision. She advised that the home is to be staffed with three carers throughout the day with one waking carer and one sleeping carer at night. Recruitment is taking place to achieve this staffing level, and the manager is currently working a high number of hours to provide the necessary staffing and management time. In addition to the care time provided cleaning, domestic and catering hours are provided, although care staff do complete evening catering duties. The manager is mindful that the staffing levels need to be flexible and must be kept under constant review to ensure staff are available to meet all residents care needs, and respond to Care Homes for Older People Page 22 of 30 Evidence: their preferences. Discussion with visitors to the home indicated that the staffing levels were appropriate and it allowed for a good level of supervision and interaction to take place. All feedback from contact with relatives and visiting professionals was positive about the staff and comments included the staff are gems lovely people, all staff are absolutely lovely very warm and welcoming, it is a pleasure to go to this home. The staff are helpful and contacted me if they needed any advice the staff have a good awareness of how to look after residents with a dementia type illness the care is excellent meeting the need of a specific client group. The recruitment practice in respect of three staff members was found to be full and robust, and the records checked included an application form, two references and the necessary Protection Of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks had also been obtained. Staff training is well organised and the manager uses a matrix to organise and record the training provided and attended. Contact with staff confirmed that staff training is well promoted. Staff records confirmed an emphasis on training staff and that there is a commitment to train staff so that they achieve a National Vocational Qualification (NVQ) in care at level 2 or above. Care Homes for Older People Page 23 of 30 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 was found to be managed in an open and friendly manner. Systems are in place to safe guard residents financial interests and to monitor the quality of care and services in the home. The health, safety and welfare of residents and staff are generally promoted and protected although further attention is needed regarding general safety checks and risk assessment. Evidence: The registered manager was working in the home at the time of this inspection and facilitated the process. She has substantial relevant experience and has completed relevant care and management qualifications, and has recently enrolled on a counseling course. The manager is clearly very committed to the home and ensuring that it provides a high standard of care to residents. Feedback from all sources confirmed a confidence in the manager, with relatives saying how helpful and kind Care Homes for Older People Page 24 of 30 Evidence: she is. Visiting professionals said that she communicates well and responds to any advise given. Discussion with the manager demonstrated that she cares a great deal about the residents, often spending time with them in hospital to motivate and encourage their recovery. The home is using questionnaires on a six monthly basis to gain residents and their representatives views on the home, and the service it provides. Once these are returned they are discussed at a management meeting and if individual issues have been identified the manager responds to these on a personal basis. The audit of the responses and action taken by the home is documented and made available to interested parties in the service users guide/statement of purpose. The manager confirmed that she now only holds a small amount of money for one resident, and that all relevant receipts are held on record, with a suitable procedure in place to underpin the practice. She also advised that Mrs Detheridge (one of the Directors of the registered company owner) audits the accounts every two months. Records held in the home demonstrated that the environment is checked on a monthly basis, to highlight any maintenance or redecoration work required. At these monthly reviews, work completed is recorded, along with works that still need to be addressed. In this way general maintenance is monitored, and identifies work that can be planned for in the future. Environmental risk assessments however need further attention, all areas inside and outside of the home need to be risk assessed regularly to ensure any risks are identified and responded to, and in this way any risk to resident or staff in the home can be minimised. Following the last inspection the home has reviewed the safety of some windows, and fitted some wooden bars for protection. It was however unclear if all windows had been suitably risk assessed. In addition at the time of this inspection a thorough examination of the stair lift had not been completed, as required at the last inspection. The manager immediately contacted the servicing company, and was able to confirm the next day that an appropriate safety check for the chair lift had been arranged. In order to ensure the home establishes suitable risk assessments and complies fully with health and safety legislation a requirement has been made that they contact the Environmental Health Department for advice and guidance. Although a fire risk assessment had been completed it was noted that some fire escape signage had been removed and not replaced during redecoration. A further Care Homes for Older People Page 25 of 30 Evidence: door that the manager thought was a fire exit, had bolts fitted to lock it. As the fire arrangements were unclear the manager was required to seek appropriate advise to ensure the fire precautions are suitable and safe. The AQAA recorded that all relevant safety checks have been completed and that the homes policies and procedures had been updated. Care Homes for Older People Page 26 of 30 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 30 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 38 23 The registered person shall 02/11/2009 after consultation with the fire authority, take adequate precautions in respect of fire safety. This will ensure that appropriate fire precautions are adopted to safeguard residents and staff. 2 38 13 The registered person shall make arrangements in consultation with the Environmental Health Department, to ensure that all parts of the home are as far as possible free from hazards to safety. This will ensure residents and staff are as safe as possible. 02/11/2009 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 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. 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