Care Home: Healey Lodge Nursing Home

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What the care home does well People were given useful information about services available at Healey Lodge; this would help them to decide whether the home was the right place for them. Information regarding resident`s needs had been obtained from various sources prior to admission to the home; this ensured all aspects of their needs would be considered. Residents were given choices about how they spent their day; one resident said `I can do what I want`. Staff confirmed that routines were flexible around residents needs and wishes. The menus offered a nutritious choice of meals with alternative meals provided. Residents said they enjoyed the meals and confirmed that they were offered choices; one said `we have a good cook` and another said `I like the food here`. The complaints procedure was clear and accessible to residents and their visitors. Residents said they knew who to speak to if they were unhappy; two residents said they would speak to the manager as she always enquired how they were. Most staff had attended training that would help them to recognise and respond appropriately to any signs or reports of abuse or neglect; this would ensure residents would be protected from harm. Staff were provided with training to help them to meet residents needs. All care staff had a recognised qualification in care; this would ensure they had the skills and competencies to look after residents properly. Residents were content and happy with the care they received; they made positive comments about the staff including `they are nice friendly staff`, `the staff are very nice`, `there are lovely staff, they spoil me` and `I enjoy the personal touch from staff and management`. What has improved since the last inspection? Improvements to staff training ensured staff had a range of skills and competencies to meet the needs of the current residents. The care plans were detailed and included clear information about the care residents needed to ensure their needs would be met. Residents or their relatives had been involved in decisions about their care ensuring they received the care they both needed and wanted. There were clear medication policies and procedures that would support staff with safe management of residents` medicines. Records were accurate and showed that medicines were managed safely. During a tour of the home it was clear that work had progressed to improve the environment with further plans for improvement; this would ensure that residents lived in a safe, pleasant and comfortable home. Most areas had been refurbished and redecorated and were bright, clean, comfortable and odour free; some residents had brought in personal items to enhance the homely feel of their rooms. Residents said they were happy with their rooms. Staffing rotas showed the home was sufficiently staffed and numbers had been kept under review to ensure resident`s changing needs were met. The manager advised that the staff team was stable and staff confirmed this; one said they enjoyed coming to work and that staff were `a good team`. Staff meetings were held regularly; this ensured they were kept up to date and allowed them to air their views and opinions. One staff said `you can put forward ideas to improve things and they are always welcomed`.A decision had been taken to register the acting manager with the Care Quality Commission and an application would be forwarded; this would provide some stability to the day to day management of the home and would help to improve standards of care and outcomes for residents. Staff made positive comments about the managers contribution to improving the home including `she is fantastic` and `she is fair but strict`; one staff said `we have a good atmosphere with a good manager and owner` and another said `there is improvement everyday`. The home was safe and well managed and people`s views and opinions were sought and used to improve the service. Staff had access to up to date policies and procedures that would provide them with safe guidance in all aspects of their work. What the care home could do better: The home needed a person who would be responsible for meeting residents social and recreational needs as it was not clear whether these were being met. Whilst policies and procedures had been reviewed it was clear that some key procedures were missing; staff needed clear procedures to support them with safe practice. The grounds remained untidy and unsafe in places; the driveway was uneven and some areaswere still overgrown with weeds and did not provide residents with pleasant views from the patio area. Failure to consistently follow safe recruitment procedures could place residents at risk of being cared for by unsuitable people. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Healey Lodge Nursing Home 114 Manchester Road Burnley Lancashire BB11 4HS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marie Matthews     Date: 1 9 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Healey Lodge Nursing Home 114 Manchester Road Burnley Lancashire BB11 4HS 01782717204 01282453750 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Silverdale Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 21 Number of places (if applicable): Under 65 Over 65 21 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home with nursing - Code 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 - Code OP. The maximum number of service users who can be accommodated is: 21. Date of last inspection Brief description of the care home Healey Lodge is a care home offering nursing and personal care for up to twenty-one residents. The home is located on the outskirts of Burnley town centre and is on a main bus route. Shops, pubs, churches, the library and other amenities are within walking distances. There is ample car parking for visitors. Communal areas include a lounge and dining area on the ground floor with a smaller Care Homes for Older People Page 4 of 29 Brief description of the care home lounge on the first floor. There is a passenger lift to access the first floor. At the time of the visit all available bedrooms were being used as single rooms. Residents and their visitors could access a small patio area to the side of the home. A considerable programme of building is planned and large areas of the home have been demolished although progress with this has been extremely slow. Information about the services that the home offers is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. The fees range from £346.00 to £686.47 per week. Additional charges are made for hairdressing. 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 key unannounced inspection, including a visit to the home, took place on 19th August 2009. There had been concerns raised at the last key inspection of 15th July 2008; a meeting had been held with the registered person and they had been asked to provide us with a plan for improvement. The inspection process included looking at records, a tour of the home, discussions with the registered provider (owner), acting manager, two staff and three residents who lived in the home. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a reasonable picture of what had improved over the last twelve months and where further improvements were needed. Care Homes for Older People Page 6 of 29 Information was also included from survey forms filled in by one member of staff and five residents. What the care home does well: What has improved since the last inspection? Improvements to staff training ensured staff had a range of skills and competencies to meet the needs of the current residents. The care plans were detailed and included clear information about the care residents needed to ensure their needs would be met. Residents or their relatives had been involved in decisions about their care ensuring they received the care they both needed and wanted. There were clear medication policies and procedures that would support staff with safe management of residents medicines. Records were accurate and showed that medicines were managed safely. During a tour of the home it was clear that work had progressed to improve the environment with further plans for improvement; this would ensure that residents lived in a safe, pleasant and comfortable home. Most areas had been refurbished and redecorated and were bright, clean, comfortable and odour free; some residents had brought in personal items to enhance the homely feel of their rooms. Residents said they were happy with their rooms. Staffing rotas showed the home was sufficiently staffed and numbers had been kept under review to ensure residents changing needs were met. The manager advised that the staff team was stable and staff confirmed this; one said they enjoyed coming to work and that staff were a good team. Staff meetings were held regularly; this ensured they were kept up to date and allowed them to air their views and opinions. One staff said you can put forward ideas to improve things and they are always welcomed. Care Homes for Older People Page 8 of 29 A decision had been taken to register the acting manager with the Care Quality Commission and an application would be forwarded; this would provide some stability to the day to day management of the home and would help to improve standards of care and outcomes for residents. Staff made positive comments about the managers contribution to improving the home including she is fantastic and she is fair but strict; one staff said we have a good atmosphere with a good manager and owner and another said there is improvement everyday. The home was safe and well managed and peoples views and opinions were sought and used to improve the service. Staff had access to up to date policies and procedures that would provide them with safe guidance in all aspects of their work. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 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. People were given information to help them to decide whether Healey Lodge was a suitable place for them to stay and whether their needs would be met. Detailed assessments of residents needs were completed to ensure they could be looked after properly. Evidence: New and existing residents and their relatives were given useful information about services available at Healey Lodge; this would help them to decide whether the home was the right place for them. The statement of purpose and service user guide needed to be updated to reflect the current situation in the home and the service user guide should include a summary of the most recent inspection report, service user views and information about complaints. Survey information indicated that people were given the information they needed. Care Homes for Older People Page 11 of 29 Evidence: Each resident had been issued with a copy of the contract or terms and conditions; this ensured they were aware of their rights and responsibilities whilst living at Healey Lodge. Existing residents should also be issued with a contract with the current owners. The records of two recent admissions were looked at in detail. The records showed that information regarding residents needs had been obtained from various sources; this ensured all aspects of their needs would be considered. Residents and their relatives were encouraged to visit the home to view the facilities and to meet with staff and other residents; people were given assurances, in writing, that their needs would be met. Each resident was allocated a member of staff who would answer any questions they might have and to help them to settle into the home. The training plan showed that the provision of staff training had improved; this ensured staff had a range of skills and competencies to meet the needs of the current residents. Qualified nursing staff were available twenty-four hours a day to meet residents nursing needs and the district nursing service provided additional nursing support for residential clients. 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. Residents health and personal care needs were met. Residents medicines were managed safely and people were treated with respect. Evidence: Three residents care plans were looked at in detail. The care planning system was in the process of being reviewed. The care plans were detailed and included clear information about the care residents needed to ensure their needs would be met. There was information regarding residents choices and preferences and residents or their relatives had been involved with the development and review of the care plans; this ensured they were involved in decisions about their care and they received the care they both needed and wanted. Any risks to residents had been assessed and appropriate action had been taken to keep residents safe from harm. The use of bedrails had been assessed and discussed with the resident and their relatives but needed to be kept under review to ensure continued use was appropriate (see standard 18). Care Homes for Older People Page 13 of 29 Evidence: Residents health was monitored and they had access to health care services. Staff were trained in health care matters which would help them to identify and respond appropriately to any changes in residents health or wellbeing. Residents said they received the medical care and support they needed. There were systems in place to check whether care records were being completed properly and whether residents needs were being met. There were clear medication policies and procedures that would support staff with safe management of residents medicines. Records were accurate and showed that medicines were managed safely; however it was recommended that the dates of receipt of medicines were recorded on the Medication Administration Record (MAR) to reduce the risk of mis-use. There were systems in place to check whether staff were following medication policies and procedures. Staff responded to residents and visitors to the home in a friendly and respectful manner. One resident said she had been visited by her GP in the privacy of her room. Staff were given training to help them to understand the principles of privacy, respect and dignity. There were procedures to support staff with death and dying. Residents final wishes had been recorded in their care plans and staff would ensure these were followed. Care Homes for Older People Page 14 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. Not all residents social and recreational needs and expectations were being met. Residents were provided with a healthy, varied diet that met their dietary needs and preferences. Evidence: From discussion with residents and staff and observation it was clear that residents were given choices about how they spent their day. One resident said I can do what I want. Staff confirmed that routines were flexible around residents needs and wishes. The home was trying to recruit a replacement activities co-coordinator. A range of activities had been provided prior to the activity person leaving and it was clear from discussion with staff and residents that staff had tried to maintain the weekly plan of activities. However staff were often called away to respond to other residents and there were no records to support that a range of activities and entertainments were being provided. A number of residents and their relatives had been involved in developing a My Life Story Book which provided useful information about residents routines, lifestyles and Care Homes for Older People Page 15 of 29 Evidence: preferences; this would help staff to provide residents with more individualised activities. One resident was able to go out with her family and friends and another visited her husband with support from care staff. One resident said she enjoyed spending time alone watching TV or listening to her music and this was respected by staff whilst another enjoyed books from the mobile library service. Visitors to the home were made to feel welcome and able to visit in any area of the home. The menus offered a nutritious choice of meals and records showed that alternatives to the menu were provided. Residents said they enjoyed the meals and confirmed that they were offered choices; one said we have a good cook and another said I like the food here. Dining areas were clean and bright and staff were patient and considerate with any residents who needed extra support at mealtimes. Residents said they had enjoyed their lunch and said they could either dine in their bedrooms or choose to join other residents in the dining room. The cook was aware of residents dietary preferences which would help to ensure their dietary needs and preferences were met. Records showed that special occasions were celebrated; one resident said she enjoyed a weekly portion of fish and chips from the local chip shop. The environmental health officer had recently inspected the kitchen areas and recommendations were being progressed. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had access to a clear complaints procedure and were protected from abuse and neglect by staff awareness. Evidence: The complaints procedure was clear and accessible to residents and their visitors. Staff surveyed indicated they were aware of how to respond to any concerns or complaints; this would ensure peoples concerns would be dealt with properly. Residents said they knew who to speak to if they were unhappy with the care they received; two residents said they would speak to the manager as she always enquired how they were. Since the last key inspection there had been one complaint referred to the local authority (social services) relating to staffing issues; this had been responded to properly and resolved. We were told that the safeguarding (formerly abuse) procedures had been reviewed by head office although the home had not yet been provided with a copy; staff needed to read the procedure to ensure they responded appropriately to any abuse or neglect. We were advised that a copy was forwarded the following day; the manager was advised that the contact information for the local agencies involved in any referral should be included in the procedure and to ensure this was discussed with and read by staff. Care Homes for Older People Page 17 of 29 Evidence: Most staff had attended training that would help them to recognise and respond appropriately to any signs or reports of abuse or neglect; this would ensure residents would be protected from harm. There were also procedures to support staff with reporting any poor practice; staff said they were aware of the procedures. Standards of care were discussed during regular staff meetings; this would ensure that staff continued to be aware of their responsibility to protect residents from harm. One referral had been made by the home under the safeguarding procedures; this showed that staff were aware of the local procedures and had acted promptly to ensure residents were safe. There were procedures to support staff with the Mental Capacity Act although none regarding the Deprivation Of Liberty Safeguards; staff need to understand their responsibilities when residents were unable to make their own choices and decisions. The use of bed rails had been risk assessed, recorded and discussed with the resident or their relatives which would help to determine whether this form of restraint was suitable and safe. It was recommended that the assessment was kept under regular review to ensure that the use of bed rails continued to be appropriate. There should be procedures to support staff with dealing with residents finances; this would ensure that residents monies were safeguarded and that staff were clear about their responsibilities. Care Homes for Older People Page 18 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. Residents lived in a safe and well maintained environment with ongoing plans for improvement. External areas were in need of attention to make them safe and attractive. Evidence: During a tour of the home it was clear that work had progressed to improve the environment. There were records of repairs and maintenance and a plan for ongoing improvement; this would ensure that residents lived in a safe, pleasant and comfortable home. Minor areas requiring attention were discussed with the manager at the time of the visit. The grounds remained untidy and unsafe in places; the driveway was uneven and the area to the side of the driveway (the demolished area) remained overgrown with weeds and did not provide residents with pleasant views from the patio area. The registered provider said work to landscape this area would commence the following week. Residents and their visitors were able to sit out in the warmer weather on the patio; however this also needed attention to remove the weeds and dried out flower pots. The building had been inspected by and complied with the fire safety officer and with Care Homes for Older People Page 19 of 29 Evidence: environmental health. Recommendations made at the time of the visits were being progressed. Communal areas were bright, attractive and comfortable. Bedrooms were fitted with washbasins; toilets and bathrooms were well equipped and located close to bedrooms and communal areas. Suitable locks were in place to promote residents rights to privacy. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. Call systems were accessible and available in every room; this ensured residents were able to summon assistance from staff. Most bedrooms had been refurbished and redecorated and were bright, clean, comfortable and odour free; some residents had brought in personal items to enhance the homely feel. Residents said they were happy with their rooms. Each room had a suitable locking device on the door and a lockable storage area and residents were able to have keys as part of a risk assessment process; this supported residents rights to privacy. The laundry was suitably equipped and organised; one resident said her clothes were always clean and tidy. The home was clean and odour free and cleaning products were stored safely. People had access to hand wash and paper towels and were advised about safe hand washing techniques; this reduced the risk of cross infection. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were suitable and competent and provided in sufficient numbers to meet residents needs. Recruitment procedures need to be developed and practices could be improved to ensure residents were protected from unsuitable people. Evidence: Staffing rotas showed the home was sufficiently staffed and numbers had been kept under review to ensure residents needs were met. Six residents said there were sufficient staff, one said staff are always very busy in the mornings and another said I think there could be more staff. Two staff said there were sufficient staff and one said there are never enough staff. The manager advised that the staff team was stable and staff confirmed this; one said they enjoyed coming to work and that staff were a good team. Comments from residents included they are nice friendly staff, the staff are very nice, there are lovely staff, they spoil me and I enjoy the personal touch from staff and management. At the last key inspection visit there had been a clear recruitment procedure but following a review of procedures this had not been replaced in the procedure file. Care Homes for Older People Page 21 of 29 Evidence: Three staff files were looked at in detail and two of these had been employed since the last key inspection visit; the records showed that generally a safe procedure had been followed. However one member of staff had commenced employment before all the required checks were in place as one reference arrived following employment and a check of their current nursing registration status with the Nursing and Midwifery Council (NMC) had not been done; failure to follow a safe recruitment procedure could place residents at risk of being cared for by unsuitable people. (See standard 37 for requirements and recommendations made under the staffing outcomes). Only one file included a recent photograph as a means of identification and records to support that the interview was a fair process were not completed. It was recommended that references should be verified by a telephone call and that the application form clearly indicated the reasons for leaving previous employment and whether the applicant had previously been dismissed or disciplined. There was a training matrix that showed staff were provided with appropriate training to help them to meet residents needs. There were some gaps in the provision of training although the manager was aware of this and had taken appropriate action. Staff confirmed they received relevant training that would help them with their work. All care staff had a recognised qualification in care; this would ensure they had the skills and competencies to look after residents properly. New staff received a period of supervision to ensure they were aware of the routines, their role and how to keep themselves and others safe. Staff meetings were held regularly; this ensured they were kept up to date and allowed them to air their views and opinions. One staff said you can put forward ideas to improve things and they are always welcomed. Care Homes for Older People Page 22 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 safe and well managed and peoples views and opinions were used to improve the service. Evidence: There was an acting manager in post; the registered provider advised that an application to register her with the Care Quality Commission would soon be forwarded. The acting manager is undertaking a recognised management and care award which would help her with the day to day running of the home; she was able to access support from other managers within the group. The manager has a clear vision for the home and is committed to improving standards of care and outcomes for residents. Staff made positive comments about the managers contribution to improving the home including she is fantastic and she is fair but strict; one staff said we have a good atmosphere with a good manager and owner and another said there is improvement everyday. Staff said they were encouraged to Care Homes for Older People Page 23 of 29 Evidence: discuss any issues and were happy to put forward any ideas for improvements and developments; this showed they were consulted and involved in decisions about the running of the home. There was a development plan in place with clear indicators of where improvement was needed. The home had achieved the Investors In People award; this was a recognised external quality assurance system that monitored the management of the home and the training and development of staff and was used to improve the service. The registered provider (owner) visited the home regularly and produced a report of his findings; this enabled him to monitor the day to day management of the home. Feedback regarding whether residents and their relatives needs and expectations were being met was sought as part of an annual anonymous survey; the results from this were used to improve the service. The manager was advised that the results should be analysed and made available to people. Relatives and residents had recently been invited to a meeting where they could meet with managers and staff although no one attended. However it was clear from interactions observed on the day of the visit that the manager and staff had developed good relationships with visitors and residents and any concerns or issues would be raised and discussed on an individual basis. Consideration was being given to introducing a monthly newsletter as a method of keeping people informed. Any concerns regarding records required by regulation have been referred to under the appropriate outcome area. Requirements and recommendations relating to recruitment have been referred to under standard 37. Servicing records were sampled. Systems and equipment were serviced regularly ensuring peoples safety. The manager advised that personal monies were managed for one resident only; records were checked and found to be accurate. There needed to be a procedure to support staff with dealing with residents finances; this would ensure both staff and residents were safeguarded. (See standard 18). Staff had access to up to date policies and procedures that would provide them with safe guidance in all aspects of their work. Company policies and procedures had recently been introduced although some procedures were missing from the file; these Care Homes for Older People Page 24 of 29 Evidence: included management of finances, safeguarding, recruitment and Deprivation of Liberty Safeguards. Staff need these procedures to support them with safe practice (see under the relevant standard). Systems had been introduced to monitor whether residents needs were being met and whether staff were following safe procedures; this supported the home was committed to improving standards. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us some information about what had improved over the last twelve months and where further improvements were needed. The content of the AQAA was discussed with the manager as we felt there could have been more detailed information. Staff had received training that would help to keep themselves and others safe. 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 37 19 Staff must only commence employment when all the required checks have been obtained. This will ensure residents are protected from being cared for by unsuitable people. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The service user guide should be updated to reflect the current situation in the home, a summary of the most recent inspection report, service user views and information about complaints. The statement of purpose should be updated to reflect the current situation in the home. Existing residents should also be issued with a contract with the current owners; this would ensure they were aware of their rights and responsibilities. The date medicines are received into the home should be recorded; this will ensure there is no risk of error. 2 3 1 2 4 9 Care Homes for Older People Page 27 of 29 5 12 There should be clear records of activities and entertainments that have taken place; this will help to determine whether residents social needs and expectations were being met. Procedures should be developed and discussed with staff to ensure they are aware of the Deprivation Of Liberty Safeguards. The use of bed rails should be kept under regular review to determine whether the continued use of this form of restraint was appropriate. There should be procedures to support staff with dealing with residents monies; this will help to safeguard residents finances. The reviewed safeguarding procedures should be discussed with and read by staff to ensure they are aware of their responsibilities. External areas should be improved to ensure they are safe, accessible and attractive for residents and visitors to the home. An application should be forwarded to register the manager with the Care Quality Commission. The results from the annual survey should be analysed and made available to residents and their relatives and other interested parties. Applicants should provide a recent photograph as a means of identification and this should be maintained on their file. There should be a record of the interview process to support this was a fair process. References should be verified with a telephone call. The application form should indicate the reasons for leaving previous employment and whether the applicant had previously been dismissed or disciplined. A clear and robust recruitment procedure should be available in the procedure file. 6 18 7 18 8 18 9 18 10 19 11 12 31 33 13 14 15 16 37 37 37 37 17 37 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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