Care Home: Heron Lea

What the care home does well Heron Lea is a small home and manages to create a homely and comfortable atmosphere for the people who live there. Residents appreciate this and we had comments saying they do `everything` well, and `this is the best place. I am glad I came.` The manager works hard to make sure that the home is well decorated and that people`s own rooms are homely and comfortable. A visiting professional considers that the home does well in delivering `individualised care - respecting individual needs of each resident and compliments the home`s `attitudes to the promotion of continence and effective management of incontinence.` Our observations shows that staff communicate well and appropriately with people and are able to use their skills to calm agitation or distress. What has improved since the last inspection? Communication has improved and staff are trying different ways to manage people who become distressed or agitated. This has resulted in a reduction of the use of medication to control people`s behaviour. Medication management and recording has improved significantly, with greater accuracy of record keeping and audits to make sure this is sustained. This has helped improve the arrangements for safe administration and safekeeping of medicines in the home. The manager has improved the content and frequency of staff supervision so that she is able to monitor the work of staff with individuals and to guide and develop staff. What the care home could do better: The manager has identified for herself, in writing to us, where she feels she needs to work to improve the service. She has particularly identified that she needs to improve the range of activities that are offered to people so that they have increased opportunities for a more fulfilling social and recreational opportunities. The manager could use her dementia mapping skills more formally and effectively in this area to identify where people`s well-being and engagement can be enhanced and improved. We also advise that she improves the documentation that is kept. Specifically, assessments, care packages and risk assessments should be dated when they are completed or altered. This is so she can better show that information about people`s needs is gathered promptly and kept up to date. More detail should be included where people need nutritional supplements to boost their food intake or weight. This is to more clearly show that specific nutritional needs or concerns are properly addressed. Key inspection report Care homes for older people Name: Address: Heron Lea Mill Lane Witton Norwich Norfolk NR13 5DS     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: Judith Last     Date: 1 5 1 0 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: Heron Lea Mill Lane Witton Norwich Norfolk NR13 5DS 01603713314 NOFAX# Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miss Valerie Etheridge care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home Heron Lea is a care home providing personal care and accommodation for 13 older people who have dementia. The registered provider is Valerie Etheridge. She is actively involved in the home on a daily basis. The home is situated in the village of Witton, near to Brundall and approximately 7 miles from the city of Norwich. The building is a converted hotel and is set in large grounds. It has 7 single bedrooms, 4 with en-suite facilities. There are 3 double rooms, 2 of which have en-suite facilities. The ground floor accommodation is spacious and there is an enclosed garden area to the side of the building that service users are able to access in the summer months. Care Homes for Older People Page 4 of 29 Over 65 13 13 1 3 1 1 2 0 0 8 Brief description of the care home The home has a passenger lift to aid people moving safely between different floors. The services current fee levels are from £417 to £510 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: Before we visited the home we reviewed all the information we had about it. This included the information the manager was asked to send us in the Annual Quality Assurance Assessment (AQAA). We also had surveys from five of the people living in the home, a relative and a visiting health professional. We visited the home without telling the manager we were coming. The Commissions inspector was accompanied by an Expert by Experience. This is a person who, because of their shared experience of using services and ways of communicating, visits with an inspector to help us get a picture of what it is like to live in or use the service. In total, about 9 hours of inspector time was spent in the home. This includes the time spent by the Commissions inspector and the Expert by Experience. While we Care Homes for Older People Page 6 of 29 were in the home we spoke with the staff on duty, 12 people living in the home, the manager and some visitors. During our visit the main method of inspection we used is called case tracking. These means that we look at records and then find out from observation and discussion, how people are being supported in their daily lives. We used all the information we collected and the rules we have, to see what outcomes there are for people living at Heron Lea. 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 manager has identified for herself, in writing to us, where she feels she needs to work to improve the service. She has particularly identified that she needs to improve the range of activities that are offered to people so that they have increased opportunities for a more fulfilling social and recreational opportunities. The manager could use her dementia mapping skills more formally and effectively in this area to identify where peoples well-being and engagement can be enhanced and improved. We also advise that she improves the documentation that is kept. Specifically, assessments, care packages and risk assessments should be dated when they are completed or altered. This is so she can better show that information about peoples needs is gathered promptly and kept up to date. More detail should be included where people need nutritional supplements to boost their food intake or weight. This is to more clearly show that specific nutritional needs or concerns are properly addressed. Care Homes for Older People Page 8 of 29 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. People (or their representatives) would have the information they need to decide whether the home will meet their assessed needs. Evidence: A relative who wrote to us says that they got enough information about the home to help them decide with the person, whether it was the sort of place they would like to move to. Four people who completed surveys for us, also say that they had enough information to help them decide if the home would be the right place for them. The service users guide sets out clear information about the home. The contact details for the former Commission had been updated since our last visit, but now the Care Quality Commission has taken over responsibility as the regulator for care services, these need changing again. Val Etheridge is aware of this and plans to make the change so we have not needed to make a requirement. Care Homes for Older People Page 11 of 29 Evidence: Records for people show that their needs are assessed and that information is gathered about the sort of support they will need, before they move in. (However, in some cases this is not dated to show when it was gathered or completed.) We could see that information was gathered from previous services if the person was moving from another home to this one, as well as from members of peoples families if the person would find this difficult themselves. Some records also show that the manager has been making efforts to gather information about peoples former lives and backgrounds. She considers that this will help the staff team to relate to and communicate with, people who have dementia in a more effective and personal manner. 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. Peoples health and personal care needs are met as they require. Evidence: In this home, individual care plans or support plans are called Care Packages. We looked at individual Care Packages for four people. These set out what people are capable of and where they will need support from staff. While we were there, one person asked to be taken to the toilet. Staff reminded the person they had just been. The way this was handled could be perceived by any visitors present as potentially disrespecting of the persons wishes, or neglectful. However, a visiting professional specialising in continence management and who makes regular visits to the home, considers that people are supported with their continence very well. They felt that the home does well in respect for privacy, dignity of all residents and in offering individualised care - respecting the individual needs of each resident. They went on to say that they felt there were good attitudes to the promotion of continence and effective management of incontinence. They also felt Care Homes for Older People Page 13 of 29 Evidence: that other homes could benefit if they follow Heron Leas example. One persons mobility has changed and so affects their ability to manage their continence independently. The person was sitting in a wheelchair with a lap belt to prevent them from moving around without assistance. We are informed this is a temporary measure while the person recovers from a leg injury. Information in the persons Care Package had not been updated to show this clearly, although there was guidance easily accessible to staff in the file which includes the persons daily notes. The manager is aware that the Care Package itself needs review and update to reflect these changes and has undertaken to do this. The manager has provided us with information to show that she involved a professional in confirming this was a reasonable restriction of the persons liberty and in their best interests. Five people completing surveys (some with support) say they always receive the medical care they need and a relative says the person they visit always has the care and support they expect or have agreed. Staff record appointments with health professionals in daily notes. These show where people have seen their doctor or dentist. The diary and financial records confirm that people have the opportunity to see the chiropodist regularly and we could see copies of prescriptions from opticians in peoples records. These things show that people have access to and support with visits from health care professionals to help keep them well. The manager has had training in the use of the malnutrition screening tool (MUST), so that people can be assessed to make sure they are not at risk of poor nutrition and remedial action can be taken if necessary. She has arranged that other staff will also have this training. Care Packages show peoples weights are monitored and where necessary record where people are identified as needing a high calorific diet. In one case we could see from records (confirming discussion with the manager and staff) that there had been efforts to work with the doctor to eliminate any underlying physical causes of someones weight loss. Records show the person is now being supervised and encouraged with their meals and whether or not they have eaten their meals well. We saw this monitoring taking place during our visit. However, records do not always clearly show where any additional supplements have been used for individuals, to promote good nutrition. Since our last visit, the medication system has been changed. A staff member told us that they had learnt a great deal about the use and administration of medicines. Another says the new system is working well. Records show that the manager carries out audits to make sure that records and stock Care Homes for Older People Page 14 of 29 Evidence: balances of medications not in blister packs, are accurate. A staff member told us their practice has changed as a result of training in medication and in dementia. We saw staff handling some agitated behaviour and successfully calming the person down. The use of medication to do this has reduced considerably according to staff. This is supported by medication administration records. This helps show that other interventions are tried before medication is considered and helps avoid giving medication to people unnecessarily. We looked at medication charts for everyone living in the home for the month before we visited. These showed only one signature omitted from records for one person for the whole month, but the blister pack showed the tablet had been given as prescribed. One staff member had signed in error for eye drops due to be administered during the evening on the day of our visit. The manager undertook to address this while we were there so we have not made a requirement. Other records such as those for controlled drugs and medications prescribed for use in variable amounts, were clear and accurately tallied with balances available. This shows that systems for administration are safe. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed to show that people are able to make more choices about their lifestyle and that their social and recreational activities better meet their expectations. Evidence: Two people completed their own surveys for us and say there are always activities they can take part in. One person assisted by a relative also says this. A further person, aided by the manager (and known to be able to express their views) also told us they felt there are suitable activities. However, people and relatives we spoke to during our visit, say they feel there could be more activities. One person was asked if they were settled or whether they would like to help set tables while we were there. This shows the staff member was making efforts to encourage the person with familiar activities of daily life. However, there were no organised activities taking place while the expert by experience was present. We spoke to people about the opportunities they have and some did not feel that there was a lot going on. The manager and staff told us about some opportunities people have. These include Care Homes for Older People Page 16 of 29 Evidence: organised group activities and that people sometimes choose to do things like tidying or dusting their rooms. However, the manager also acknowledges that these need to be increased and records of what people have participated in (or been offered and refused) need to be improved. At present they do not fully show that people have opportunities for fulfilling their social needs. Miss Etheridge recognises that improvements in obtaining life histories would help in developing meaningful communication and reminiscence sessions for example, and she has started to develop these. The atmosphere between staff and people living in the home, appeared relaxed and easy at lunchtime, with clear, polite and respectful communication and some humour observed. This indicates that people are comfortable with the staff who support them. The home is in a quiet and somewhat isolated lane. However, it is not very far from Norwich. The manager says there is a car link service she considers to be relatively inexpensive for relatives and friends who do not drive. During this and our previous visits, as well as from records, we could see that many people do receive regular visits from friends and family. The manager states that people are given the opportunity to go with relatives to their rooms for privacy when they visit. Staff say sometimes different peoples visitors converse with each other or staff, rather than communicating directly with the person they have come to see. Our observation is that people generally receive visitors in the same communal area, meaning that this is more likely to take place unless managed effectively to give service users support and encouragement to enjoy these visits. Records also show that a member of the clergy visits the home regularly to provide spiritual support for people who wish for this. We were informed that people had chosen what they were going to have for their main meal, on the day before the visit and that this is what usually happens. There was a choice of three desserts and staff did support someone who they knew had chosen something they did not like, to look at options and select an alternative. This means that people do have some choice about what they eat. However, memory problems may mean that people do not remember what they have selected the previous day and our expert by experience did not see people offered alternatives for the main course if they had changed their minds. We also heard that one person requested a cup of tea and that this was not forthcoming as lunch was due. Drinks with lunch were cold ones and not tea as one Care Homes for Older People Page 17 of 29 Evidence: person had requested (or coffee). We did see that someone who needed a lot of time to eat, because of their refusal to wear dentures, was given this and was not rushed by staff. Staff also reheated the persons food during the meal to make sure that this was still palatable and pleasant to eat. Care Homes for Older People Page 18 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. Peoples concerns would be taken seriously and there are measures in place to help protect them. Evidence: Peoples surveys say that they know how to make a complaint if they need to and that they can speak to someone informally if they have concerns. However, in practice, many of the people living in the home would need support from others - such as relatives - to make their concerns known. The manager says in information sent to us, that they could look at options to involve family members more in this area. This would help ensure that people are offered regular opportunities to raise anything they may be concerned or anxious about. Staff say they know what to do if someone has concerns about the service, and a relative told us that they know how to make a complaint. Information is also included in information given to people or their representatives when they are thinking about moving in. Feedback from the managers own survey about service quality shows general satisfaction with the way the service is run. These things help show that the service is willing to listen to peoples concerns and views. Care Homes for Older People Page 19 of 29 Evidence: Staff have training in recognising and responding to abuse. The manager was also clear in discussions with us about how to go about making referrals if there are any concerns about the protection of vulnerable people living in the home. The manager recognises that the service could improve the depth of understanding of staff who have training in deprivation of liberty safeguards to further enhance the protection of people who may have difficulty making decisions and understanding risks. These things show that there are measures in place to help safeguard people from abuse and that the manager has plans to enhance this area further. Care Homes for Older People Page 20 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. People benefit from living in a homely, comfortable, and clean environment. Evidence: We looked around parts of the home and could see from improvements that continue to be made, that there is a regular programme of maintenance and redecoration. Some improvements were being made while we were visiting. Some rooms have new soft furnishings and bedding to make them more comfortable and homely. We could see that people are also able to bring some belongings in with them to help personalise their rooms. There are fire exits directly from first floor rooms onto an open fire escape. The manager is aware of her obligations regarding safety and says that there are risk assessments in place. These are intended to ensure that the occupants of these rooms are not at risk of accessing the fire escape unsupervised and so falling and injuring themselves. Our discussion with the manager shows she is aware of the need to keep these under review should individual needs and risk change, or where different people may be admitted to the rooms concerned. We also looked at records to do with fire safety. These show that systems are checked regularly to make sure that they will work effectively to detect a fire or sound the Care Homes for Older People Page 21 of 29 Evidence: alarm. They also show that staff have regular reminders and training in fire safety to make sure they know what action they need to take in an emergency. The exterior of the home remains in need of some work to ensure that it is in good condition. However, this work is now underway. Since our last visit, action has been taken to improve the secure garden - levelling paving to minimise risk of falls for people. Training records show that staff have training in infection control. This supports what the manager said in the information she sent to us before our visit. This helps staff understand how to minimise the risk of any infection outbreak being spread. There were no unpleasant odours in parts of the home seen, that could be associated with poor management of continence. This contributes to providing a pleasant and clean environment for people living in the home. A professional involved in this area considers that continence is well managed in this home. Care Homes for Older People Page 22 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. People are supported by a competent and effective staff team. Evidence: There is a stable staff group at this home, with very little staff turnover. Information from the manager and confirmed in staff files, is that there has been no one appointed in the last 12 months. No staff have left the home. This means that people are supported by a consistent staff team, who they have got to know and who understand their needs and difficulties. When the duty roster permits, there is scope for people to have support with their personal care from a staff member of the same gender. This helps provide some choice for people about who works with them and who they feel comfortable with. Agency staff are not needed in order to provide cover and the manager works regularly alongside staff, particularly during the afternoons. This helps her monitor the way that staff work with people and recognise where peoples needs may be changing. We saw that staff were skilled in their communication with people and were able to resolve and calm situations where people had become agitated or upset. Staff say (and records confirm) they have had training in basic dementia care and this has helped them work more effectively with people. Improvements in staff skills have Care Homes for Older People Page 23 of 29 Evidence: reduced the need for intervention using medication as evidenced in drug records. All but two of the staff have or are working towards, National Vocational Qualifications at level 2 or above. This is above minimum expected standards. Staff records show a range of other training, including moving and handling, medicine management, first aid, abuse awareness, health and safety and infection control. The manager has plans for further training in nutrition. This means that staff have the underpinning knowledge they need to work with people effectively and safely. There have been no new staff recruited since our last visit, against which we could check that recruitment remains robust and induction training is delivered promptly. However, the manager is aware of the importance of proper checks on the suitability of applicants to ensure they do not present a risk to vulnerable adults. She is also aware of the importance of training and induction so staff understand their roles clearly, based on information she has given us and what we have seen in the past. Care Homes for Older People Page 24 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 is managed effectively, taking into account the views of others connected with it, and in a manner that promotes peoples safety and welfare. Evidence: We know from our previous visits that the manager has completed the training we consider is needed to ensure she is able to fulfil her role in managing the home and supporting and advising staff about meeting peoples needs properly. She also completes periodic updates. She has completed training in dementia mapping which helps her understand the specific needs of those living in the home and evaluate what improvements need to be made. The manager looks at the quality of the service regularly. This provides for consultation with people livingin the home and their representatives. The manager completed the annual quality assurance assessment we asked for and this contained Care Homes for Older People Page 25 of 29 Evidence: more information and detail than she submitted last time. This shows that she is looking at ways she can improve peoples experiences of the service. Staff files show that supervision has increased and improved since our last visit and now takes place regularly. Records also showed that appraisals of staff skills and competence also take place. This helps ensure that staff are properly supported to carry out their duties effectively. We looked at a range of records to do with health and safety. These included training records showing that staff do have training to help them work safely with people. Records show that lifting equipment, fire detection equipment, emergency call bell systems and electrical equipment is serviced regularly. This means that the manager is taking steps to promote the safety and welfare of people living in the home. The manager does keep small amounts of money for people, for safekeeping. She is the only person who is able to access this money. We looked at records for the four people as part of our case tracking and could see that entries corresponded with receipts and with information in other records. The balances of monies held were accurate with the records. The manager does not act as an appointee for anyone in managing their pensions or other finances. This helps show that peoples interests are safeguarded. Care Homes for Older People Page 26 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 27 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 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 The manager should ensure that all records, assessments and updates to documentation are dated when they are completed. This is so she improves how she shows that information about peoples needs is gathered promptly and kept up to date. Improvements should be made to detail in the recording and monitoring of food and fluid intake for individuals identified as at risk of poor nutrition. These should make particular reference to the use of any measures to boost nutrition. This is to make it clearer that people who need it are offered food that is appropriate to their specific nutritional needs and problems, to keep them healthy. 2 8 3 12 The manager should consider formally and regularly using her skills in dementia mapping to identify where peoples quality of life, wellbeing and opportunities to exercise choice can be enhanced. 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. 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