Care Home: Hedgerows Nursing Home

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What the care home does well The residents are happy living at Hedgerows. They speak positively about the staff team and comments include `they know our needs well` and `the staff are a nice bunch of people`. The home is clean and generally well maintained and the bungalows have a relaxed and homely atmosphere. Residents are happy with the food and overall consultation with residents about all aspects of their life at the home is good. Residents can be assured that they would be listened to if they had any concerns and that they are cared for by a staff team who are recruited properly and who are well trained. What has improved since the last inspection? There were no agenda items at the last inspection. Since our last visit there have been ongoing improvements made to the premises and the manager has introduced a more resident led/person centred care planning system for staff to use with residents. What the care home could do better: Whilst some aspects of the care planning system are good there are areas that still require work. Staff need to continue to develop a more person centred approach to the care they provide and the care planning that they do for and with residents. The approach to residents health care in the form of risk assessments and care planning needs to be better, especially in relation to medical care, specialist needs and ongoing monitoring. This should improve with a more stable management team on each bungalow. A review of the activities programme is needed to ensure that residents have their needs properly assessed and that care staff, as well as the activities staff, see this as a key part of their role. This will help ensure to that residents individual and group needs are met. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hedgerows Nursing Home 256a Ongar Road Brentwood Essex CM15 9EA     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: Diane Roberts     Date: 1 8 0 6 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: Hedgerows Nursing Home 256a Ongar Road Brentwood Essex CM15 9EA 01277202270 01277215520 terri@outlookcare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Outlook Care care home 38 Number of places (if applicable): Under 65 Over 65 0 0 38 dementia learning disability old age, not falling within any other category Additional conditions: 38 38 0 The maximum number of people who can be accommodated is 38 The registered person may provide the following category of service only: Care Home with Nursing -Code N to people of the following gender:- either, whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Learning Disability, not falling within any other category - Code LD Dementia, not falling within any other category - Code DE Date of last inspection Brief description of the care home The Hedgerows is a purpose built bungalow complex sited around a courtyard. There are three bungalows and each one has its own attached small garden. The bungalows are situated within the grounds of Highwood Hospital, close to the centre of Brentwood. The location is convenient to a local bus service and benefits from having a small parade of shops close by. The home was first registered in March 1994. The Service User Guide and Statement of Purpose have been reviewed and the Care Homes for Older People Page 4 of 29 Brief description of the care home residents and their representatives have been provided with this information and the manager stated that the home would provide them with Commission for Social Care Inspection reports too. At the time of this report the manager supplied a scale of the homes charges and fees these range from £600.00 to £1097.00 per week 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: We visited the home for a whole day and met with the manager and her team. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to residents and staff at the home and prior to that we sent out surveys to relatives, asking for feedback on the home. The response was quite good and these comments are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. Care Homes for Older People Page 6 of 29 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: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 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 9 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. Residents can be assured that they would have all the information they needed about the home and that generally they would be assessed properly. Evidence: The manager has an up to date service users guide in place that is available in a standard and pictorial format. This was seen to be appropriate for the resident group and was seen to be available in the bungalows. The manager on the appropriate bungalow undertakes the pre-admission assessments for prospective new residents. If required they will takes another member of staff from the team along as well. Two recent assessments were reviewed and found to be completed quite well, giving a good picture of the resident, their needs and abilities. The assessments were quite person centred and gave residents routines and preferences etc. Staff should be careful to address all of the residents key needs in Care Homes for Older People Page 10 of 29 Evidence: the assessment. For example, one resident had been diagnosed with dementia and this was not noted in the assessment and could significantly impact on the decision to admit someone. The assessments were seen to be backed up with information, such as a care management assessment, from the referring authority where appropriate, or a specialist team. The manager in her AQAA said that we have a detailed referral and assessment procedure and families and prospective residents are given the opportunity to visit the home as many times as necessary prior to admission. Care Homes for Older People Page 11 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 can expect to be cared for quite well but in some cases their needs may not always be met in full. Evidence: The manager has a care planning system in place. In her AQAA, the manager said that since the last inspection we have completed the introduction of a person centered care plan that incorporates both social and clinical aspect of service users needs. Where required fully person centred, pictorial care plans have been completed with the input from the resident. Overall, all the care plans were seen to be up to date, quite person centred with a generally good level of information on residents preferences, likes and dislikes and social networks. However more work is needed on this on units where the pictorial care plans are not required. For example, care plans on residents personal care contained limited person centred information, stating have a shower and hair wash twice a week and to have a body wash on waking up and before going to bed or more if needed. Night care plans were seen to be much more person centred and contained the detail of the residents nighttime routines. It was concern that staff on Care Homes for Older People Page 12 of 29 Evidence: the unit, when asked for the residents care plans, did not give us the pictorial care plans to review as part of the working care plan. A physical and social assessment is completed on admission and these were seen to contain information that would help staff decide upon the level of support needed. In some cases it was noted that these had not been completed fully and some key personal preferences had not been listed limiting the person centred approach of some of the plans. Weekly progress reports are completed by care staff and these give a good picture of the residents life in the home and any activities they have taken part in. On speaking to staff, they knew the care needs of the residents quite well and could give an account of the individual preferences and dislikes etc. but they were unsure, in some cases of the residents background and this should be addressed if they want to provide a person centred service. Staff were able to provide a lot more information on the resident than was evident in the care plan. On observation, some residents require more support with their personal care, for example, residents nails were seen to be unkempt. This issue was also reflected in the care staff team meeting on the same unit, where it was raised as an issue for staff to address in May 2009. Overall the quality of the care plans is variable between units and between residents and gaps in the recording could affect the care of the resident and this needs to be addressed. The implementation of a care planning audit system may be of value in addition to the monitoring that is undertaken during the provider visits. The manager confirmed that staff had received training on person centred planning. Putting this training into practice should be reviewed. The manager said that the managers on the units were going to be trained in person centred planning at a trainer level so they could cascade the training down to staff on the units. The manager in her AQAA said that comprehensive person centred plans were in place. We would not fully concur with this at the current time. Residents spoken to on the day of the inspection said that they were very happy in the home, very comfortable and quite happy living here. Relatives who commented felt that the standards of care were good, including medical care. Comments included the care shown by all who deal with my relative is wonderful and caring staff who are responsive to individual needs Plenty of specialist equipment was seen around the home, for example, lifting hoists, chairs, beds etc. and where required ceiling hoists are in place. Residents are risk assessed in relation to developing pressure sores. Care plans were in place for those identified at risk but they were limited in content. For example, staff were guided to check residents skin condition but were not advised to encourage mobility or change of position etc. Residents who were noted to suffer with reoccurring urinary tract infections did not have care plans in place to guide staff on the prevention measures to take. Residents are assessed using a specialist tool in relation to their weight and any nutritional risks. The monitoring of residents weights and nutritional status was Care Homes for Older People Page 13 of 29 Evidence: variable.In some cases, where needed, residents where seen to be steadily reducing their weight and were being monitored regularly. In other cases, from the assessment, those residents were identified to be at risk, had no care plan in place and records showed that they were not being weighed regularly. Other risk assessments were seen to be appropriately completed for the use of bed rails and manual handling. Care needs to be taken to ensure that these are up to date as some had not been reviewed since 2006. Where residents have specialist care needs, such as dementia, staff need more guidance on care planning to ensure that the residents has the best support possible. For example a care plan for a resident with dementia stated staff to orientate as often as possible, at risk of falls and must be attended by two care staff. There was no information as to how the residents dementia exhibited itself, any behavior management, or the promotion of independence, self worth and the retention of skills. Records show that residents have access to health care professionals such as doctors and occupational therapists. It is clear from records that staff are calling the external professionals in a timely manner but are not always recording the outcome of the visit clearly and subsequently care planning where needed. For example, a resident who was having possible fits and staff were to observe, did not have a care plan in place. Staff had also completed assessments on residents mental capacity and these were seen to be very informative for staff who would be caring for the individual. It was also noted that recent advice from specialists such as speech therapists was not identified in residents care plans and therefore this aspect of the residents care was not being carried followed. Medication systems at the home were randomly checked on two units. Residents photos were on the record sheets and medication profiles were in place. Recording sheets gave clear prescriptions and staff were seen to be signing correctly. As and when medications were signed correctly identifying when, for example, one or two tablets were given. There were records on the units of daily audits where staff check the balance of the medication. Staff need to pay more attention to the safety of residents by not leaving keys in the medication trolley unattended. Where residents are on topical medications, such as creams, these should be reflected in the care plans. Wound management care plans were seen to be in place that detailed the management of the wound and ongoing progress. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents with differing levels of dependency may experience different outcomes in relation to the daily routine, activities and choices in general. Evidence: The routines of the day were discussed with residents and staff. Staff, whilst they described a person centred routine with regard to choice of rising times etc. some described residents in a task orientated way, for example, they are padded, dressed and then go to the lounge and we have a shower chart we go by every day so we know who needs doing a.m or p.m. This does not demonstrate a fully person centered/resident led approach to the care provided. Residents spoken to said that they had a choice about when they got up and when they went to bed. Residents have pictorial routines of the day displayed in their rooms that include activities but discussions with staff, residents and from records, it is not clear that these routines are always followed. Residents care plans had life histories in place which help staff appreciate the resident as an individual. Social activity care plans were basic and contained no real assessment of need. Some residents did not have a social care plans in place. Care staff writing the plans had the approach that activities were the domain of the activities co-ordinator and wrote, for example, Activities co-ordinator to spend Care Homes for Older People Page 15 of 29 Evidence: time with x and have a person centred action plan in place. Likes to watch TV and encourage x to draw and colour. Care staff need to appreciate their role in this aspect of care and the benefit of social activities and how these can promote residents independence, self worth and help them retain skills. Staff meeting minutes say that staff are to do activities with residents on Tuesdays and Thursdays - colouring, painting, making cakes and playing games. This is not a resident led person centred approach. Weekly progress notes showed that residents had chatted to staff, walked in the grounds of the home, been on an outing to a local farm, been to a table top sale, trip to the coast for fish and chips, wheelchair dancing and church. The residents do have people from the community who come to the home and provide some activities every few weeks and they also benefit from a local organisation who provides funds, for example they are paying for a strawberry tea in the near future. Activities records, which have large gaps, show that when the activities officer is working with residents they also take parts in crafts, pet therapy, music sessions, shopping and prayer meetings. Evidence in residents care plans showed that they were having the opportunity to go away on holiday to places of their choice. In some cases the records show that residents like one to one discussion and on occasions this need is met. The activities officer has been off work for 14 weeks and during this time the records of activities provided were not fully recorded on one unit. Outcomes for residents in this aspect of their life are variable with some residents experiencing a full programme and others having limited input. Residents spoken to confirmed that they had been on outings and were able to go out and visit friends etc. They also said that when the activities officer was not in the care staff did not do anything with them as they did not have the time. Some relatives who commented said that more social stimulation could be provided and that some activities are arranged. Residents were seen to have daily newspapers. The music playing in one of the units was heard to be possibly inappropriate for the resident group and more suited to the staff group. On discussion with the residents, they did not appreciate the thump thump of the music and another was listening to music via earphones as they too did not like what was being played. Staff need to appreciate that the bungalows are the residents homes. The home has access to a large minibus which helps residents access the community and have a more flexible social life. Different menus were seen to be displayed in all three bungalows. Residents and staff confirmed that there was a choice for breakfast and items such as fruit were encouraged to promote a healthy diet. Staff felt that there was always plenty of food available and they or the unit cook had ingredients available to make cakes and snacks etc. Plenty of fresh fruit and vegetables were seen to be available.On the day of the inspection residents were having, on one unit, sausage and mash with vegetables and a desert. Residents were seen to have specialist plates and cutlery available to help Care Homes for Older People Page 16 of 29 Evidence: them maintain their independence and a choice of drinks were available. Condiments were not available for use on the tables. One resident spoken to said that she enjoyed her lunch and it was very nice others said lunch was tasty, the food is lovely and you get a choice and I do go out to the pub to eat and do some food shopping. Drinks were not seen to be freely available other than at set times for drinks rounds. This needs to be reviewed to ensure that reside ts have the fluid intake that they need. On one unit a resident was observed to ask for a drink at 2p.m and was told by the member of staff that drinks were at 3p.m. 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. Residents can be assured that their concerns would be listened to and that they would be protected, as far as possible, from abuse in the home. Evidence: The manager has a logging system in place for the management of complaints and the complaints procedure was seen to be displayed around the home. The procedure is available in both a standard and pictorial format. The manager keeps a log of all complaints and this shows that since the last inspection four complaints have been dealt with. These covered unexplained falls, residents being put to bed during the day and lack of communication with relatives. These were seen to have been dealt with appropriately and objectively. The manager actively uses advocates from two organisations to support residents in their day to day lives and residents spoken to confirm that they have spent time with advocates. Residents spoken to said that they did not have any concerns about living in the home and if they did they would be comfortable speaking to the manager. The manager in her AQAA said that the organisation have produced a video, with the help of residents, on how to make a complaint. Evidence of compliments were also seen and these covered, standards of care, kindness, patience and general thanks. Relatives who commented said that they knew how to raise any concerns and that if they occurred they were dealt with to their satisfaction. Care Homes for Older People Page 18 of 29 Evidence: Staff spoken to showed an appreciation of adult protection matters and records showed that compliance levels with staff training on this subject were good. In house and local policies and procedures were available. 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. Residents live in a clean, safe and generally well maintained home. Evidence: A tour was undertaken of all three bungalows with the manager. Overall the bungalows were seen to be clean and no odours were noted. Whilst there is a homely feel, staff need to ensure that the bungalows are kept tidy and not used to store items, for example in lounge areas. Storage is an issue in all bungalows and the teams need to take ownership of this on behalf of the residents where need be and think of more inventive ways of how to deal with equipment etc, making the bungalows nicer places to live in. The bathrooms were seen to be clinical and often used for storage. Signage around the bungalows for residents is generally good. Consideration should be given to the height of notices and in some cases pictures, so that residents can actually see them. One unit has a range of sensory equipment available and another has a reminiscence room which the team have recently developed and plan to build into the residents activity plan should they so wish. Some parts of the bungalows need attention with regard to decor and this primarily relates to woodwork being chipped and marked. Bedrooms were seen to be personalised and some do have additional access out onto the small courtyard gardens that each bungalow has, where flowers and vegetables are grown. The attention given to the courtyards and therefore the condition of them was variable with some being more pleasant than others to spend Care Homes for Older People Page 20 of 29 Evidence: time in. This should be addressed. The manager said that there are plans in place to replace carpets and curtains and touch up the decoration in the bungalows. In her AQAA she said that in the last year they have purchased awnings to protect residents from the sun, purchased new bedroom furniture and upgraded the nurse call system. The manager has a maintenance contract in place and uses an odd job man to attend to anything minor. The communal gardens are cared for by a contract gardener. Relatives who commented said that the home is very clean with no unpleasant odours Documentation, including maintenance certificates and risk assessments were reviewed in relation to fire safety and these were found to be up to date and in good order. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for by a generally competent and stable staff team. Evidence: Each bungalow has a manager. One unit has a new manager starting soon. The registered manager for the home said that there have been some times over the past year whereby the consistency of managers on the units has been an issue and in some cases has affected the development of projects. Staff spoken to said that the staffing had improved recently on the units and whilst there was occasional qualified agency staff used, the teams as a whole were more settled and this was better for residents. Staff say that they like working at the home as the units have a relaxed family atmosphere. Residents spoken to said that the staff at the home were a nice bunch of people, the staff are polite, the staff know our ways and the staff are very good. The manager confirmed that she has 5 full time vacancies at the current time and is using some agency staff. This has improved over the year as they did successfully recruit 11 staff earlier in the year and are focusing on recruiting quality staff. Staffing levels are set for each unit in relation to the dependency of the residents living there. Rotas show that the levels are maintained with the use of bank and occasionally agency staff. The full names of staff working on the units should always be recorded as first names do not identify staff fully. The manager in her AQAA said that shifts have been changed to ensure there are more staff around at lunchtime to help residents Care Homes for Older People Page 22 of 29 Evidence: and to ensure that lunch is not rushed. In her AQAA the manager says that she has a specialist link nurse system in place whereby nurses have responsibility for a range of subjects in the home, such as continence, infection control and diabetes. At the current time the reality of this system needs review as many of the link roles are not filled and this may be causing gaps in monitoring systems and staff support. At the current time 41 of the care staff have completed an NVQ qualification and more staff are currently undertaking the courses, which should bring the home over the desired 50 standard this year. Two staff files were checked at random and showed that the recruitment process was robust, with all the required documentation and checks being in place. Staff induction had been undertaken and where required staff were starting NVQ training promptly. Training records show that overall the staff at the home have access to a good ongoing training programme. Records show that staff are up to date with fire safety, manual handling and adult protection. Staff have also been attending training on mental capacity, equality and diversity, first aid and food safety. In the past staff have had training on dementia, activities etc. and the care issues associated with old age. Consideration needs to be given to increasing these more diverse subjects again, to ensure staff can meet the needs of older people with medical needs. Staff at the home said that the training provided was fantastic. 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 management of the home has systems in place to ensure that it is run in the best interests of the residents, with input from them. Evidence: The registered manager is a qualified nurse who holds an diploma in health service management and has completed the registered managers award. She is an experienced manager who has been working at the home some time. The manager holds regular staff meetings and minutes are available that show a wide range of subjects are covered including standards of care, staff training etc. The manager has an annual development plan which is available to residents and can be provided in a pictorial format. The home is audited against this plan on a yearly basis by head office, under their quality management system, and the manager also uses this when supervising the managers on the individual units. Regulation 26 reports are completed by the registered manager with the managers on the units. This is not Care Homes for Older People Page 24 of 29 Evidence: acceptable as the provider should be carrying out these reports as they are not in day to day control of the home. The managers hold resident meetings and minutes are available completed in a pictorial format where required. The minutes show that residents are asked about the food provided, consulted on planned activities and it is clear that they express their preferences. The provider and manager are very focused on consultation with the residents and have a residents committee, which some of the residents spoken to confirmed that they were a member of. Residents spoken to confirmed that they had meetings every month on the units but this was sometimes affected by the lack of managers. They also said that at the meetings they could say whatever they wanted. Relatives meetings are also held but attendance is limited. The management still meet and produce minutes that are then available to relatives. Staff were observed during the day to be moving residents in wheelchairs and not using the footplates, putting residents at risk of injury. Accident records were reviewed and found to be completed well by the staff and there is a system in place whereby the manager reviews all the accidents and a full report is available identifying any trends and any action to be taken. The report for this home shows that the incidence of accidents is low and no trends are identifiable. Where appropriate residents have been referred to the local falls prevention team. 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 8 12 Residents health care and 30/09/2009 specialist care needs require more attention through risk assessments and care planning. So that residents health care and specialist needs such as dementia, speech therapy etc. are met in full. 2 12 16 Provide residents with an activities programme that meets their assessed needs. To ensure that residents individual and group needs are met on a regular basis. 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 3 Systems should be in place to ensure that all significant factors relating to the assessment of a prospective residents are recorded and assessed. Care Homes for Older People Page 27 of 29 2 3 4 5 6 7 10 12 15 19 Continue to develop a person centred approach to care planning. Staff to ensure attention to detail when supporting residents with personal care so their dignity is maintained. More work is needed with staff in order to promote resident led/person centred routines. Staff should ensure that drinks are available to residents at any time. More care should be taken to keep parts of the home, including the small gardens, tidy so that the homes are pleasant places to live. More consideration should be given to the siting of signage and pictures around the home - so residents can see them. 7 19 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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