Care Home: Hibbert Lodge

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What the care home does well People using the service are thoroughly assessed prior to admission and have a good range of information to be able to decide if this is the right place to move in to. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and religious or cultural requirements and ensuring that they receive medication in a safe and consistent manner. Food is well presented and varied to ensure that nutritional needs are met. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. The service is clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which is suitable for the range of disabilities that people have. The service provides staff cover to meet needs and undertakes thorough recruitment procedures, with effective training to ensure staff have the right skills and competencies to support the people who live there. The management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? Medication practice is safer and complies with the provider`s policy and Royal Pharmaceutical Society guidance. Verification is being sought from agencies supplying care staff, confirming that they have undertaken enhanced Criminal Records Bureau and Protection of Vulnerable Adults checks. Rotas now have the first and surname of staff and name of agency where relevant, in order that proper records are in place for who is working with people. What the care home could do better: No requirements have been made as a result of this inspection, showing a good level of compliance with the regulations and national minimum standards for this type of service. Recommendations have been made to improve records of activities, to show that people are offered regular opportunities for mental stimulation. Arrangements also need to be established to support people to express their spiritual beliefs. It would be beneficial to the manager to have a copy of the last quality audit in order that she is able to act upon any areas needing improvement. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hibbert Lodge Gold Hill East Chalfont St Peter Bucks SL9 8DL     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: Chris Schwarz     Date: 1 1 0 5 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: Hibbert Lodge Gold Hill East Chalfont St Peter Bucks SL9 8DL 01753885278 01753891491 manager.hibbertlodge@fremantletrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Fremantle Trust The registered provider is responsible for running the service care home 37 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 37 dementia old age, not falling within any other category Additional conditions: 37 0 The maximum number of service users who can be accommodated is: 37 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age- not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Hibbert Lodge provides care and accomodation to older people, including people with high care needs arising from dementia. The home is a detached property set back from the road through Chalfont Common and is divided into four lounge groups. Each group has its own lounge, dining and kitchenette facilities, with bedrooms, bathrooms and toilets close by. There is outdoor space for people to wander around safely with railings Care Homes for Older People Page 4 of 29 1 9 0 5 2 0 0 8 Brief description of the care home to hold onto and various seats and benches to sit on. The home has a cat and budgies in three lounges. Information about the service is provided in a statement of purpose and service users guide. 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: This unannounced key inspection was conducted over the course of a day by Chris Schwarz and covered all of the key National Minimum Standards for older people. The last key inspection of the service took place on 19th May 2008. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion and surveys were sent to a selection of people living at the service, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the required records, Care Homes for Older People Page 6 of 29 observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. Improvement to practice and the overall quality rating was evident at this inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. 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 Care Homes for Older People Page 8 of 29 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 using the service are thoroughly assessed prior to admission and have a good range of information to be able to decide if this is the right place to move in to. Evidence: A revised statement of purpose and service users guide were in place, displayed in the entrance hall alongside other information that prospective users or their representatives may find useful such as the philosophy of care. Both documents had been produced to a high standard and contained all required information, with use of photographs to illustrate provision. An assessment format was in place to note the needs of any prospective service users, with headings which mirrored the services care plan format and covered a wide range of care needs. The manager advised that only senior staff would go out to carry out an assessment. A gentleman who was staying for respite care said he was happy being at Hibbert Care Homes for Older People Page 11 of 29 Evidence: Lodge and enjoying his stay. Staff showed that they were aware of his care needs and were meeting them. People using the service said in surveys that they had received enough information about the service to help them make a decision about whether to move in. They also said they had received a contract. Information about the range of fees may be obtained by contacting the provider or manager direct. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and religious or cultural requirements and ensuring that they receive medication in a safe and consistent manner. Evidence: Care plans were in place for each person living at Hibbert Lodge. These followed a corporate format and covered areas such as mobility, general physical health, continence, mental health needs, personal grooming, eating and drinking, washing, bathing, social interests, spiritual needs and family and friends. Night time care plans had also been produced. A photograph of the person was in place to readily identify them. A sample of files from two of the four lounges was looked at. All were up to date and had evidence of being reviewed. In one file some sections of the personal lifestyle summary (preferred daily routine) had not been completed for a newer service user and the manager was advised to encourage staff to start noting down their observations of the persons routines and choices to start to build this information up. Care Homes for Older People Page 13 of 29 Evidence: Each file contained essential information about the person, such as name, preferred form of address, date of birth, religion, gender, doctor, next of kin and care manager details. Some files had a life story at a glance which provided useful information about peoples backgrounds and previous occupations. Summaries of care plans had been prepared in order that anyone reading the files could get an overview of the level of support needed. Where people had dementia, reference to this or short term memory loss had been recorded as well as the other areas of support that were needed. Minutes of review notes from a sponsoring authority were read in one of the files for people with dementia, recording that the persons needs were being met appropriately by staff. Risk assessments were in place for moving and handling, likelihood of developing pressure damage and risk of malnutrition. These had been reviewed on a regular basis. Other assessments were in place, according to the persons circumstances. Records were being kept of peoples weight, any visits or appointments with health care professionals and accidents. Daily notes were up to date in the files examined. Medication was being managed using a monitored dose system. Practice was looked at and records examined. There was improvement to practice since the last inspection and a requirement to administer and store medicines in line with the providers policy and Royal Pharmaceutical Society guidance was being met. Medication administration records were being maintained appropriately and cabinets kept secure when not in use. A photograph of each service user was contained in the records folders and samples of staff signatures. A senior member of staff was observed to lock the cabinet in between administering individually and making sure that medicines had been taken before signing the records. One controlled drug was being kept in a separate cabinet which only senior staff had access to. The controlled drugs register and amount in storage tallied. The manager was advised only to store controlled drugs in the controlled drugs section of the cabinet and to store other medicines, such as warfarin, in the space in the main section of the cabinet. People using the service said in surveys that they always/usually receive the support they need. One person said there were staff shortages at present which resulted in her not getting a bath as needed and that she needed to dress herself with difficulty. They said they usually receive the medical support they need. Staff said in surveys that they are usually given up to date information about peoples needs. They considered they usually had the right support, experience and knowledge to meet different needs, including those arising from equality and diversity. Three health care professionals returned surveys. They said the service seeks advice and acts upon it to manage or improve peoples health care needs. They considered peoples health care Care Homes for Older People Page 14 of 29 Evidence: needs to usually be met and said that staff always respected peoples privacy and dignity. One who was in a position to comment said that medication was managed well. One said I am always made to feel welcome. Hibbert Lodge always has a clam, therapeutic environment. Hibbert Lodge always try to meet the needs of residents. In response to a question about what the service does well the following comments were made: day to day care of residents, encourage residents to stay at Hibbert Lodge until end of life, communication, spending time with residents and families, discussing needs with residents, families and professionals, holistic working, keeps in regular contact with care management and is willing to look at different ways of enabling residents to maintain independence and control of their lives. Asked how it could improve they said feel there is a tendency to call for medical help too readily overnight and at weekends. Staff seem too cautious and residents tend to end up in hospital or Accident and Emergency unnecessarily, by ensuring that they retain their experienced staff members and more staff training. 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. Some activities are provided for people using the service but there is weak recording to show the regularity of these and individuals participation. Food is well presented and varied to ensure that nutritional needs are met. Evidence: People using the service said in surveys that activities are sometimes provided for them. One person said would like things to do rather than just singers, another said the service needed more activities and there were no shopping trips. The post for a part time activities organiser had been vacant since the autumn. The pre-inspection self-assessment provided information about activities such as that a hairdresser visits, the service has a minibus and there had been outings to places such as Bournemouth and the London lights at users request. A trip to Kew Gardens was planned for the end of the week. In the pre-inspection self-assessment it said that monthly entertainers are brought in, one to one exercises take place and an interactive games system played through a television had been purchased. Two local churches were said to support the service. Several newspapers were seen Care Homes for Older People Page 16 of 29 Evidence: around the building, some service users took an interest in the budgies in their lounges and the homes cat, Princess, a quiz was said to have taken place in the morning in one lounge. Daily notes in peoples care plan files did not contain much information about how they had spent their days in respect of involvement in activities and it was therefore difficult to see that people were being provided with regular opportunities for mental stimulation and to stop them becoming bored. In three peoples care plans that were looked at there were identified spiritual needs and staff were instructed to note in one case when a priest visited and in another to enable the person to attend in house church services and in the third to offer the chance to practise his spiritual beliefs. Daily notes did not reflect input from visiting clergy either on a one to one or communal basis or external opportunities to worship and in discussion with the manager at the conclusion to the inspection it was confirmed that there were currently no visiting clergy and that links needed to be reestablished to meet peoples needs. It is recommended that improved records are maintained of activities undertaken by people using the service and that people are supported to access arrangements for expressing their spiritual beliefs. A poster with a timetable of activities in an upstairs lounge was partially obscured by other information and did not reflect what happens during the week, a poster in the main downstairs corridor regarding visiting dogs was no longer applicable. A clothes sale was due to take place shortly after the inspection. Two volunteer workers were visiting regularly to run a residents shop. A four week rotating menu was in use at the service. Copies of the days menus were seen in lounges for staff and service users to refer to and in the homes entrance hall. Lunch time in one of the lounges was observed. Food was delivered in a heated trolley and provided two choices, either home made minced beef and onion pie or cold meats and pickles. There were two vegetables in serving dishes for each table and a choice of mashed or new potatoes. People were asked which option they would like and whether they would like gravy and second helpings. One person who needed assistance was supported discreetly. There was home made treacle sponge and custard to follow the main meal. Service users made comments including its lovely, its really tasty, and nice dinner in conversation with each other around the tables. They were not rushed to finish their meal. Afternoon tea in two upstairs lounges was observed and enjoyed by most people. Cake was served with a cup of tea or other choice of drink. One person who said he was diabetic was given brown bread and butter as an alternative to cake, which was his preference. 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. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. Evidence: Policies and procedures were in place for making complaints and for safeguarding vulnerable adults. Whistle blowing procedures were also included in the operations manual. A copy of the local authority inter agency safeguarding guidance was pinned to the duty room notice board. In the pre-inspection self-assessment the manager said there had been four complaints in the past year about the service, four safeguarding referrals and two investigations. There had not been any use of restraint. The Commission had not received information to the contrary. Appropriate action had been taken in response to allegations and relevant authorities notified. Two staff were identified in the pre-inspection self-assessment as safeguarding trainers and the manager added that a session on the Mental Capacity Act 2005 was now included in staff induction. The operations manual included a 2009 version of guidance on mental capacity. People using the service said in surveys that they knew who to speak with if they were Care Homes for Older People Page 18 of 29 Evidence: not happy and that they knew how to make a complaint. Staff said in surveys that they knew what to do if anyone had any concerns about the service. Health care professionals said the service has responded appropriately if they or anyone using the service has raised any concerns about their care. An Age Concern representative now visits the home and a poster with his name and photograph was displayed at the service. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and providing them with comfortable surroundings. Evidence: Hibbert Lodge is located in Chalfont St Peter and is close to local shops, pubs, transport and other facilities. It is a detached property set back from Gold Hill with parking for a few cars. Accommodation is spread over two floors with two lounge areas on each floor. Downstairs there are Sunrise and Rose Cottage lounges; Rose Cottage provides care to people with dementia and their movement from the lounge area is not restricted by locks or psychological devices to deter them. Sunrise lounge has access to a patio area which was seen in use by a person who smokes. Rose Cottage lounge has access to the gardens and a safe walkway around the grounds and various areas to sit down and watch wildlife and get some air. Upstairs there are Brambleside and Heather View lounges which have the same type of lounge/dining area and integrated kitchen area. In all cases, bathrooms, toilets and bedrooms were close by the groups that people live in. Bedrooms that were seen had been personalised to different degrees and people who were asked said their rooms were comfortable and they had the things they needed. Care Homes for Older People Page 20 of 29 Evidence: Bathrooms and toilets were clean, well stocked and it was noted that toilets had been replaced in three quarters of the building since the last inspection. Two of the lounges and some other areas had been redecorated and new door closures had been fitted. The laundry and kitchen areas were of sufficient size for the number of people living at the service and had the necessary equipment in place. Sluice rooms were kept clean and had necessary supplies in place. There was good regard for cleanliness and odour control around the building. The manager said that the property manager for the provider was due to visit to carry out an annual maintenance assessment of the building to see what upgrading was needed. Response to maintenance issues was described as good. People using the service said in surveys that the home is kept fresh and clean. 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. The service provides staff cover to meet needs and undertakes thorough recruitment procedures, with effective training to ensure staff have the right skills and competencies to support the people who live there. Evidence: People using the service said in surveys that staff listen and act on what they say and they are available to them when they need them. One person added staff very helpful and kind. Staff said in surveys that their induction had mostly covered the areas they needed to know about and that they receive training relevant to their role, which keeps them up to date with new ways of working and helps them to understand and meet the different needs of people using the service. They said they have regular opportunities to meet with their manager for support and thought communication systems worked well. They said there are usually enough staff on duty. Health care professionals who returned surveys said staff usually had the right skills and experience to support peoples social and health care needs and that the service always responds to the different needs of people, such as needs arising from equality and diversity. Interactions between staff and people using the service were, on the whole, gentle and appropriate. The managers attention was drawn to one person working in Rose Care Homes for Older People Page 22 of 29 Evidence: Cottage, where service users have dementia, who informed a service user that his nappy needing changing and could be heard saying this from the far end of the lounge. The manager confirmed that it was unusual for two new staff to be working on Rose Cottage during the morning but that had been unavoidable due to someone telephoning in sick. Medication administration for this lounge was seen to be carried out by an experienced person, the duty senior. Rotas were being maintained. Surnames of staff had been added to them since the last inspection to better identify who had been working with service users. A recommendation to ensure that agencies supplying staff verify that they have undertaken an enhanced Criminal Records Bureau check and Protection of Vulnerable Adults check was also being met. Some agency staff were being used by the service at the time of this inspection. Proformas for staff supplied for the previous week confirmed that the agency had undertaken all required checks. Criminal Records Bureau checks had been undertaken for the two volunteers who run the weekly residents shop. A check of staff files showed that appropriate recruitment checks were being undertaken before people started working at the home. Where a new member of staff only had preliminary POVAfirst clearance, the manager said the person would only work alongside other staff and that they would not be permitted to work alone. The duty senior confirmed that the senior team are made aware of such circumstances and would make sure that people using the service are not placed at risk by such staff working on their own. An apprentice was working at the service. The provider runs a scheme whereby care staff between the ages of 16 and 18 can work towards gaining a National Vocational Qualification in care and the scheme works in line with the Leaning Skills Council. A risk assessment was in place and the person was not currently being permitted to undertake personal care tasks. Recruitment and induction processes were the same for other staff taken on by the service. Development files showed that systems are in place for supervising and appraising staff. Frequency of supervision was variable. Nineteen staff had achieved National Vocational Qualification level 2 or above according to information provided in the preinspection self-assessment. Medication training had been undertaken by all relevant staff since the previous inspection. The manager advised that new staff had recently been on dementia courses and their certificates of attendance were awaited. Mandatory training was mostly up to date in the sample of files examined. Fire safety training was booked to take place in July this year for all staff other than those who needed to cover the home. Care Homes for Older People Page 23 of 29 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 management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. Evidence: The manager is registered with the Commission and has the Registered Managers Award. She is experienced in the care of older people and had almost completed National Vocational Qualification level 4 in care at the time of this visit. Monitoring was taking place by the provider to assess quality of care. The last visit took place in February this year. Reports were available of these visits in the duty office. A quality audit had been undertaken last summer although the manager had not been given a copy of the report therefore it was not possible to see what the findings were. It is recommended that she is forwarded the findings to be able to act upon any areas needing improvement. Care Homes for Older People Page 25 of 29 Evidence: Peoples money was being managed either by their families or the providers residents savings scheme. One persons finances were managed by the Court of Protection. The manager and the administrator were the only staff with access to computerised records for service users and only they had the ability in house to authorise debits and credits to accounts. Finance staff at the providers headquarters oversee processes and an external company carry out periodic audits to ensure money is being managed with due care and attention. Printed statement sheets were being kept for families and staff to refer to if need be. Health and safety was being well managed. The services health and safety representative was on duty and described a range of checks and procedures in place to ensure safety of the premises, staff and people using the service. These included monthly water temperature checks, monthly visual hazards checks, personal emergency evacuation plans for each service user, an annual risk assessment of the premises and fire safety checks. Three evacuation mats were seen for use with people who are immobile. These were being kept close to the fire panel for easy access. It was noted that the senior on duty carries a bleep which is linked to the call bell system; wheelchairs are kept in the bedrooms of all service users who need them for quick access. There was current employers liability insurance, certification of satisfactory electrical hard wiring and gas safety. The passenger lift had been serviced at the end of last year, as had laundry equipment. Portable electrical appliances had been serviced in November last year and a pest control company had been contacted at the start of the year after ants appeared in the kitchen. Hoists and baths had been serviced and were due again. The fire risk assessment for the building was last reviewed in November 2008. 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 12 Records of activities need to be maintained on care plan files or mentioned in peoples daily notes, to show that they are offered regular opportunities for mental stimulation. Arrangements are to be established to support people to express their spiritual beliefs. A copy of the last quality audit is to be forwarded to the manager in order that she is able to act upon any areas needing improvement. 2 3 12 33 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. 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. 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