Care Home: Hazelmere Nursing Home

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What the care home does well The home ensures that all prospective residents are assessed before an offer of admission is given. Residents and visitors expressed a good level of satisfaction with the care provided in the home. Comments included `I am very happy with the care the home provides` `I can not fault the level of health care` `staff are attentive and very caring` Hazelmere is a traditional nursing home that provides a good standard of general nursing care in a homely environment where a friendly atmosphere is promoted. There is a stable and committed team working in the home, who work well together supporting residents and staff colleagues. The food provided was well received and focuses on home cooking. Hazelmere encourages people to visits, with some spending long periods of time in the home. The care needs of residents are fully assessed following admission and care is planned on an individual basis. The manager is well respected and has a close relationship with residents and their relatives. Staff also feel able to approach the manager to discuss any issue. This encourages people to be open and honest and for their views to be taken into account. What has improved since the last inspection? The admission procedures have been reviewed and now will ensure that all prospective residents are advised in writing that the care home is suitable for the purpose of meeting their assessed health and welfare needs. The care documentation has been developed and in some areas reflects more clearly residents choices and preferences, although further attention to detail is required to promote a fully person centered approach to care. That the communal space has now been provided with an adequate call bell system to ensure residents wanting assistance are able to summon help, if they are able. New dining chairs have been provided for the dining table. The recruitment procedure has been improved and this now includes securing two authentic/appropriate references and the retention of documentation as required, which includes a recent photograph, and evidence of identity. What the care home could do better: The care documentation still needs further development, and the plans of care need to be composed and reviewed with input from the resident and or their advocate, unless the offer is declined. This will ensure that the resident is in agreement to the proposed plan of care to be provided. The handling of medicines in the home still do not ensure safe practice and the maintenance of accurate and meaningful records. The manager has assured the commission in writing that the home`s policies and procedures on medicines will be adhered to in the future. The registered provider has been required to seek advice from the supplying pharmacist to ensure that all medicines are administered safely, ,in a consistent way and that associated records are clear and meaningful. This will ensure that all medicines are handled safely. The registered provider after consultation needs to make appropriate provision for the recreation of residents taking into account their individual needs, and the environment. To ensure residents recreational interests and needs are attended to, promoting an interesting lifestyle. The registered person must ensure that all staff receive suitable training to ensure that they are appropriately qualified and competent and have the skills to meet all the needs of residents in the home. This will ensure that care is appropriate care is provided to residents in a competent and safe way. Key inspection report Care homes for older people Name: Address: Hazelmere Nursing Home 9 Warwick Road Bexhill On Sea East Sussex TN39 4HG     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: 0 5 0 6 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 29 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 29 Information about the care home Name of care home: Address: Hazelmere Nursing Home 9 Warwick Road Bexhill On Sea East Sussex TN39 4HG 01424-214988 01424215118 hazelmerenh@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Rodney Gadsden,Mrs Corinne Gadsden care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 23. The registered person may provide the following category/ies of service only: Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Physical disability (PD) Date of last inspection Brief description of the care home Hazelmere Nursing Home is situated in a residential area approximately half a mile from Bexhill town centre. The main-line station, seafront and local bus services are close by. The home has a large, pleasant and well-maintained garden with an ornamental fishpond to the rear of the building. There are car parking facilities on site and unlimited parking facilities outside the Nursing Home in Warwick Road. There is a pleasant lounge overlooking the garden that is also used as a dining room. The home is registered to provide general nursing care for older people and older people with a Care Homes for Older People Page 4 of 29 Over 65 23 0 0 23 Brief description of the care home physical disability up to a maximum of 23. Both private and socially funded service users are cared for by the home although most residents are privately funded. This home is owned and managed as a family business with Mr Gadsden being the registered owner and Mrs Gadsden being the registered manager. The homes fees range between 500 to 650 pounds per person per week. Additional costs are charged for chiropody, hairdressing, newspapers, any shopping and the use of a private physiotherapist. The homes literature states that `We like to think that all the residents here can also feel part of that extended family. This is home where the members can live their lives in the warmth and security of the care we have to offer. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 uses the term service user to describe those living in care home settings. For the purpose of this report, those living at Hazelmere Nursing Home will be referred to as residents. This was a key inspection that included an unannounced visit to the home on Wednesday 3 June 2009, and a follow up visit made to see the manager on Friday 5 June. The allocate inspector spent approximately six hours in the home and was able to discuss matters with the manager who received the inspection feedback, at the conclusion of the second visit. Following the inspection visits a health care professional was contacted for general feedback on the home. Some of the residents room were seen and time was spent in the communal area with residents and visitors. A range of documentation was reviewed including the homes Care Homes for Older People Page 6 of 29 service users guide, pre 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 three residents were reviewed in depth and the inspector ate a midday meal at the residents dining table. The required Annual Quality Assurance Assessment (AQAA) was completed by the manager and returned when requested and was used to inform this inspection report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The care documentation still needs further development, and the plans of care need to be composed and reviewed with input from the resident and or their advocate, unless the offer is declined. This will ensure that the resident is in agreement to the proposed plan of care to be provided. The handling of medicines in the home still do not ensure safe practice and the maintenance of accurate and meaningful records. The manager has assured the Care Homes for Older People Page 8 of 29 commission in writing that the homes policies and procedures on medicines will be adhered to in the future. The registered provider has been required to seek advice from the supplying pharmacist to ensure that all medicines are administered safely, ,in a consistent way and that associated records are clear and meaningful. This will ensure that all medicines are handled safely. The registered provider after consultation needs to make appropriate provision for the recreation of residents taking into account their individual needs, and the environment. To ensure residents recreational interests and needs are attended to, promoting an interesting lifestyle. The registered person must ensure that all staff receive suitable training to ensure that they are appropriately qualified and competent and have the skills to meet all the needs of residents in the home. This will ensure that care is appropriate care is provided to residents in a competent and safe way. 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 allow for the needs of prospective residents to be assessed by a competent person before admission, and for people to be assured that their needs can be met. Evidence: The combined statement of purpose and service users guide is available in the office on request. There is also a brochure which is available for people who want to retain information on the home. The combined document was informative although it needed to be reviewed and updated, ensuring all the information held within it is fully accurate. It should also reflect residents views on the service, and the last inspection report should be available. How it can be sourced should be recorded in the service users guide. The manager accepted that the statement of purpose and service users Care Homes for Older People Page 11 of 29 Evidence: guide needed to be updated and agreed to do this. An assessment of the admission process followed included the review of the documentation relating to the last two admissions to the home. This confirmed that once an enquiry is made details are recorded, including relevant information about the prospective resident, and the person making the enquiry. If the home has a vacancy the manager then arranges for a pre-admission assessment to be completed. This is completed by the manager and takes into account the care needs of the individual, and the resources of the home. Further attention could be given to ensuring the process is thorough and takes into account other health and social care professionals views, which should be recorded as part of the pre-admission assessment process. The AQAA recorded that both the prospective resident and their relatives are encouraged to visit the home before the admission is progressed, and that both are advised that admissions are subject to a three month trial basis. Records seen confirmed that prospective residents are written to confirming that their assessed needs can be met by Hazelemere Nursing Home. Intermediate or rehabilitative care is not provided at Hazelmere Nursing Home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care documentation provides a framework for the provision of care, it however needs to be extended to demonstrate residents or their representatives consultation. Residents care needs are met taking into account their dignity, with evidence of regular input from health care professionals as necessary. The medicine administration practice in the home does not ensure the best and safest practice is followed and records are not always meaningful. Evidence: Three individual plans of care were reviewed in depth as part of the inspection process and all these residents were seen during the visit. Each resident had a plan of care supported by some risk assessments. The plans of care gave mostly a basic framework to be followed when providing care, some further detail is required in certain areas. An example of this was the lack of clear guidelines provided to staff, when dealing with a resident who could be aggressive. The standard of the plans of care did vary and a clear structure and process for there completion should be established. This should include ways of recording peoples choices and preferences. Care Homes for Older People Page 13 of 29 Evidence: There was evidence that the plans of care are reviewed regularly, and that care professionals are consulted about health care needs. It was however noted that there was no evidence that residents or their representatives are consulted about the plan of care, or agree with its contents. Two of the three care documentation records reviewed did not have an individual photograph, and the manager said that these were on her camera awaiting development, and would be available shortly. Daily records are maintained and the care documentation recorded the pressure area care provided, and indicated that this resulted in pressures sores healing, and a good level of skin care. The nursing care is very traditional and focuses on established nursing techniques ensuring residents have there basic care needs attended to. An example of this was regular drinks being provided with many having cranberry juice for urinary health. During the inspection visit staff were observed moving residents with hoists and with handling belts, ensuring safe practice for staff and residents. Visitors and residents spoken to shared a satisfaction with the care provided at Hazelmere nursing home and comments included I can not fault the level of health care staff are attentive and very caring I am very happy with care provided. Observation and discussion with the registered nurse on duty and the manager at the second visit established, that some of the qualified nurses, who administer all medicines in the home, are still not following the homes medicines procedure, or the Nursing and Midwifery Councils guidelines. They are choosing to dispense a group of residents medicines into pots before administration and then returning to the medicines room to sign the medicine chart. In the medicines room, pots were seen along with laminated labels. The registered nurse confirmed that when medicines were dispensed into pots these labels were placed in the pots too, there were however no lids to the pots or way of securing the label. The medicines were then transported on a tray. A requirement was made about this poor practice at the last inspection that has not been actioned. Further discussion with the manager confirmed that she would ensure that all staff in the future follow the homes procedure. This assertion was confirmed in writing. The medicine administration records were on the whole accurate and clear, although when medicines are omitted a regular key to confirm the reason or omission is not used. In addition, it was noted that ticks rather that signatures are used to record the administration of eye drops and creams. This does not provide a meaningful record and staff need to ensure clear records are maintained. Care Homes for Older People Page 14 of 29 Evidence: The Controlled Drug cupboard and register were checked and found to be well maintained, and records were accurate. Some residents are prescribed as required medicines and individual guidelines should be established so that all medicines are administered in a consistent way by all staff. All issues relating to the medicines handling were fully discussed with the manager. During the inspection visit six residents were sitting in the lounge, many residents had chosen to stay in their own rooms and said that they preferred this. Staff were attentive to resident needs during the inspection and they were asked what they wanted to eat and drink. The promotion of individual choices on a daily basis needs to be further reflected through the homes documentation, and the ethos of autonomy. Contact between and staff and residents was seen to be positive and appropriate, with staff using a preferred term of address when talking to residents. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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. Residents opportunities for stimulation through leisure and recreational activities are minimal and do not meet individual needs. Residents receive a wholesome and appealing diet. Evidence: The level of activity in the home was minimal and although there was some social interaction between staff and residents, this was limited by the time available. There is no activities person and there was no evidence of an ongoing activity plan. Two staff and one visitor said that the level of activity and stimulation in the home was not good. There is an afternoon club on Thursdays and movement to music activity/health arranged every six weeks. Discussion took place around the provision of entertainment and activity, and the manager said that it needed to be developed, and attention to this area was needed. As identified at the last inspection the communal space does not promote social interaction for example the television is on through out the day and dominates the only communal room in the home. Although there is a dining table this was not used on the day of this visit, and those who were in the Care Homes for Older People Page 16 of 29 Evidence: communal area had individual tables placed in front of them for meals to be eaten. Ways of improving the environment for social interaction should be considered. A visiting professional commented theres nothing much going on when I visit. Visiting is very much encouraged and it was clear from observation and contact with relatives that people are welcomed, and feel comfortable when they visit the home. One visitors said that she was able to come when ever she wanted and helped her mother with her food. The manager confirmed that some residents had been assisted in completing postal votes for the local elections. Some links with the community are maintained including links with the church if wanted. Residents are able to have their own possessions in their rooms, and this was noted in a number of areas. There are some set routines and times in the home, however some flexibility is introduced in response to resident choice. These choices and preferences need to be reflected in the care documentation to evidence that people are given the opportunity to fully discuss, and influence individual care. The documentation should cover choices made around daily activity including the time residents like to go to bed and get up, and what is peoples bathing preference. The meal eaten during the visit was of a good standard and included roast beef and fresh vegetables. There is a dining table and chairs within the communal area, although staff said that this is rarely used. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a suitable procedure for dealing with complaints made to it. The homes management and information in the home ensures that any Safeguarding Vulnerable Adult issue would be responded to appropriately when identified. Evidence: There is a complaints procedure in the home and this is displayed in the front entrance area. Although records within the home identified that there had not been any complaints since 2002, the AQAA recorded one complaint. Discussion with the manager identified that a complaint had been received around practice made by a social worker. This had been dealt with to social services satisfaction, but had not been recorded. The home has a complaints book to record any complaint raised and the need to record all complaints was raised, along with the need to ensure the confidentiality of records relating to any complaint or concern. Relatives and visitors spoken to about raising concerns confirmed that they were confident that any complaints or concerns that they had would be listened to by the manager or nurse on duty, and responded to. The AQAA advised that the relationship between staff, residents and relatives allows for concerns to be raised and dealt with before becoming a complaint. Care Homes for Older People Page 18 of 29 Evidence: The home has suitable Safeguarding Vulnerable Adults Procedure and some staff have received training on this subject. one staff member has completed train the trainer course on Safeguarding with social services. The manager confirmed that she will ensure all staff complete the necessary training in this area in the near future. Staff recruitment files confirmed that staff have a Protection of Vulnerable Adults (POVA) check completed along with a Criminal Records Bureau check (CRB). Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 residents with a clean, comfortable and safe environment, that has a home like feel. Evidence: Hazelmere Nursing home is a converted premise that has retained a home like environment. Accommodation is provided on two floors with disabled access to the first floor via a passenger shaft lift. The atmosphere in the home is relaxed and friendly with visitors commenting on this, one saying the home has a friendly atmosphere and patients are well thought of. There is a large well maintained garden with wheelchair access to the rear of the home, although despite a pleasant day none of the residents were using this facility on the day of this inspection visit. One visitor said that the garden is not well used, further access to the garden should be encouraged. It was noted during the inspection visit that the home has a high number of fixed height beds. As all residents living at Hazelmere are in receipt of nursing care, most need assistance while in bed, or when getting in or out. Clearly in order to maintain resident and staff safety suitable beds must be provided. It was agreed that the manager would risk assess all beds in relation to the residents needs to ensure an appropriate provision is maintained, and that if necessary beds are replaced with Care Homes for Older People Page 20 of 29 Evidence: variable height beds.The AQAA confirmed that a rolling programme of redecoration, maintenance and furniture replacement is in place. The home one communal space room located on the ground floor. The character and facilities in this communal area was found to be domestic and home like. Call bells have been provided to this room so residents, able to do so can call for assistance. Most residents are currently choosing to spend their time in their own room, so space within the communal area is available. The space and facilities in this area need to be kept under review, to ensure it is suitable to meet the needs of all residents. Hazelmere has suitable equipment and facilities to attend to residents with mobility problems, and include adapted bathing facilities. The home was found to be clean with a high standard of hygiene throughout. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers and skill mix normally provide a well motivated team that meets resident health and personal care needs. Staff training needs to be structured to provide staff with the appropriate skills to care for residents in a competent, and safe way. Residents are protected by the recruitment practice followed. Evidence: At the time of this inspection visit there was 18 residents living in the home, and the staffing arrangements provided 5 care staff and one registered nurse in the morning, who were supported by catering and domestic staff. Staff agreed that the staffing levels throughout the day and night were appropriate, although on some occasions there was only 4 care staff on in the morning rather than 5. The duty rota confirmed this, and the manager acknowledged this shortfall, advising that further recruitment would be progressed to address the shortfall. The staffing team on the whole is very stable and everyone appreciated this, as the team knew each other and the resident very well. The AQAA recorded the staff as loyal and are trusted by residents. Feedback about the staff was good and a comment included staff are attentive and very caring. The manager confirmed that over 50 percent of staff have a National Vocational Care Homes for Older People Page 22 of 29 Evidence: Qualification in care at level 2 or above. An induction training checklist for staff is completed along with an induction booklet, in conjunction with a registered nurse. It was however not clear if this covers all areas as set out in the Skills for Care induction training, this needs to be established. The training records examined confirmed that staff had completed fire training, but there was no evidence to support that a rolling programme of training had been established to ensure staff are suitably trained, to look after the residents in the home. The staff training shortfalls were discussed with the manager who said that she was not fully aware that staff training had not been maintained, as the responsibility for this had been allocated to a registered nurse. The recruitment files pertaining to the three staff were reviewed as part of the inspection process, and were found to be full and included an application form, evidence of two references, and the required Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks on all staff. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was found to be managed in a friendly manner, with Mrs Gadsden providing clear leadership. Residents financial interests are safeguarded and some quality monitoring is completed. The health, safety and welfare of residents and staff are generally promoted and protected. Evidence: Mrs Gadsden is the registered manager and joint owner of Hazelmere Nursing Home with her husband, who has been the registered provider for the past ten years. She is a registered general nurse and has managed homes previously, and has also completed relevant management training. She is very involved in all aspects of the homes management, and has a close working relationship with all staff. She is well respected by them, and relatives spoken to, and is know and addressed as Matron. Care Homes for Older People Page 24 of 29 Evidence: The care that she leads is very nurse led although she not only wants to meet the health care needs of the individual she hopes to provide a loving environment, caring as a close relative would. The manager demonstrates a commitment to the home and is very involved in it,s day to day management being readily available on the telephone. Although there was some evidence that questionnaires had been completed in 2007 and April 2008. There was no auditing of these or reporting on them recorded, this was raised with the manager for her to address and to ensure feedback from surveys are shared with residents and their representatives. The AQAA was well completed and returned to the commission as required. A quality monitoring manual provided by a professional consultancy group is also available in the home and is being completed to assess the homes compliance with the National Minimum Standards. The manager confirmed that the home has no dealings with residents monies and that any extra costs incurred are paid by the home, and then individually invoiced on a monthly basis. There was records within individual training records that identified that staff were being supervised on a regular basis. The AQAA confirmed that all the necessary safety checks are completed and that the home has updated its policies and procedures within the last year. It was however noted that some procedures need reviewing and this includes the Whistle blowing procedure. A procedure also needs to be provided to underpin the supervision of staff. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be 03/08/2009 composed and reviewed with input from the resident and or their advocate, unless the offer is declined. This will ensure that the resident is in agreement to the proposed plan of care to be provided. That the registered provider 01/07/2009 seeks advice from the supplying pharmacist to ensure that all medicines are administered safely and in a consistent way and that associated records are clear and meaningful. This will ensure that all medicines are handled safely. 2 9 13 3 12 16 The registered provider after 01/09/2009 consultation make appropriate provision for the recreation of residents taking into account their Page 27 of 29 Care Homes for Older People 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 individual needs and the environment. To ensure residents recreational interests and needs are attended to, promoting an interesting lifestyle. 4 30 19 The registered person must 03/08/2009 ensure that all staff receive suitable training to ensure that they are appropriately qualified, competent and have the skills to meet all the needs of residents in the home. This will ensure that care is appropriate and provided to residents in a competent and safe way. 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 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!