Care Home: Hillbeck

What the care home does well The environment is clean, odour free, well maintained and spacious. The residents have plenty of communal space and freedom to move around the home. Outside there is are safe and accessible gardens and patio areas that provide pleasant outside space for the use of residents when the weather permits. The care at the home is good. The health and welfare of the residents is given high priority and all residents were in good health on the day of this visit. The staff team is well trained and there are sufficient staff on each shift to meet the needs of the residents. The home offers a range of interesting and meaningful activities and encourages the residents to participate appropriately. What has improved since the last inspection? The home met all the requirements placed as a result of the last inspection. The way the home is managed has improved. There has been some re-organisation of management structures to allow for an administrator to support the manager, a new manager has been appointed and a head of care post created. Staffing levels and staff training have increased since the last inspection. Staff roles are now more clearly defined. More housekeeping staff have been appointed so that the care staff then have much more time to attend to care needs. In addition, the role of the kitchen assistant has been developed to give more involvement in important aspects of nutrition such as food intake monitoring. There have been great improvements to the environment. Building work that was going on at the last inspection is now complete and there is a new lounge, additional toilets and a new manager`s office that is situated in an area closer to the residents. Activities in the home have improved significantly. New equipment has been purchased and staff have more time to encourage the residents to participate. What the care home could do better: The home must ensure that the progress already achieved is sustained. No requirements were placed on the home as a result of this visit. Key inspection report Care homes for older people Name: Address: Hillbeck The Roundwell Bearsted Maidstone Kent ME14 4HN     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: Wendy Mills     Date: 1 0 1 1 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 28 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 28 Information about the care home Name of care home: Address: Hillbeck The Roundwell Bearsted Maidstone Kent ME14 4HN 01622737847 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: ian@charinghealthcare.co.uk Charing Hill Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 40. The registered person may provide the following category 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: Dementia - DE Date of last inspection Brief description of the care home Hillbeck is a residential care home providing accommodation, personal care and support for up to forty older people who have difficulty managing aspects of their comprehension. The registered provider is a private company and has other similar homes in the region. The home is a property with accommodation on the ground and first floors. There is a passenger lift that gives access to the first floor and step-free access around the building. There are four double rooms although these are being used as single rooms at present. Each bedroom has a wash hand basin. Most bedrooms have en suite facilities and one has its own bath. There is a call bell system that helps people Care Homes for Older People Page 4 of 28 1 6 0 4 2 0 0 9 40 Over 65 0 Brief description of the care home summon assistance when needed. There two lounges, one of which leads onto the dining areas. There are bathrooms and toilets on both floors. Hoists and other equipment are in place to assist those people who have difficulty need assistance to move. The home has been extended to provide additional bedrooms and communual areas as well as two wet rooms. Outside there is ample car parking to the front of the home. There are gardens to the rear of the home. These gardens are landscaped to provide safe outside areas with seating for residents. The home is situated in a quiet residential area approximately a mile from the centre of Bearsted village. There are two pubs, a small number of shops and a railway station in Bearsted. The county town of Maidstone is about three miles away. A bus route runs past the home and there is easy access to the M20 motorway. Further information can be obtained by contacting the manager for the home. The weekly fees range from £432 to £680.00. Fees are based on room size and the assessed needs of the individual resident. Care Homes for Older People Page 5 of 28 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 visit was unannounced and formed part of the annual inspection process of the Care Quality Commission (CQC) under the Care Standards Act. This report is complied using evidence gathered both before the visit, and during the visit. The evidence gathered before the visit includes information that the service is required to give us, such as the homes Annual Quality Assurance Assessment (AQAA) and notifications of significant events that occur throughout the year; and things that other people have told us, these include the results of surveys of the people who use this service and their supporters and comments made by visiting health and social care professionals. The evidence we have found using this process is used to make a judgement about quality rating for the service. During this visit we looked at important documentation such as care plans, staff files and records of management and administration of medicines. We spoke to some of the people who use this service and some of the staff both in private and in the communal Care Homes for Older People Page 6 of 28 areas of the home. We made a tour of the home, discussed care practice and staff training in depth with the registered manager and made a tour of the home. Direct and indirect observations were made throughout this visit. We asked the people who use this service and their supporters how they would like to be referred to in this report. They told us they would like to be called Residents. We have, therefore, used this to refer to them throughout this report. The residents and their relatives, the staff, manager and the registered provider are thanked for the welcome they gave and their help during this inspection. We found that there had been very good progress in all the care outcome areas. The quality rating for this home is 2 stars. This means that the outcomes for the people who use this service are good. Care Homes for Older People Page 7 of 28 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 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective service users and their supporters with good information about the home so they can make an informed decision about moving into the home. The home makes thorough pre-admission assessments to ensure that only those people whose needs can be met will be offered a place at the home. Evidence: The Statement of Purpose has recently been reviewed and updated to reflect the changes that have occurred in the home in recent months. The home has a large notice board. This now contains information in a pictorial format that people who use this service can relate to. Discussion with the new manager showed that she has a very good understanding of Care Homes for Older People Page 10 of 28 Evidence: the importance of pre-admission assessment. Although there have not been many admissions to the home since the last inspection, we found good evidence that appropriate pre-admission assessments are made and sound procedures followed, before a place is offered at the home. The home does not offer intermediate care. Care Homes for Older People Page 11 of 28 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 home positively promotes the health and well being of the residents in a way that respects their privacy and dignity. Evidence: There have been significant improvements in the way the home ensures the health and welfare and privacy and dignity of the residents. Nutritional monitoring is now in place. The MUST nutritional assessment tool has been introduced, residents are weighed at least monthly and a new role has been created for for a member of the catering staff to monitor individual food intake. In addition the group catering manager, new manager and the cook have worked together to produce seasonal menus that are nutritious and appetising. On the day of this visit all the residents were appropriately dressed for the time of year. They appeared calm and relaxed. Staff were seen to knock on doors, address residents with respect and to give any assistance needed in a discreet and gentle manner. Care Homes for Older People Page 12 of 28 Evidence: The way other health care professionals are accessed has improved. We received good feedback from health and social care professionals who visit the home. They told us that they had noticed the improvements in the home and that their advice is now followed more consistently. We examined four care plans in detail. Care plans are important documents because they are one of the means by which the residents and their supporters can tell that their needs, and the way those needs will be met, have been identified. In addition, they can provide a good information for acting in the best interests of someone who no longer has sufficient mental capacity to make those decisions for themselves. The care plans have recently been reviewed and a new system introduced. Care plans now contain clear information about health and care, cultural and religious and other needs. The plans are much more person centred and better maintained. The home is working on ensuring that, where possible and where it is the wish of the residents and/or their supporters, the care plans contain life histories. The manager demonstrated a good understanding of the Mental Capacity Act. She told us that when important decisions need to be made about health care, for example, should surgery be needed but the individual is unable to give informed consent, best interests meetings are held. These meetings include next of kin, doctors and other health and social care professionals. We found good evidence that the values equality and diversity. Individual choices are recorded in the care plans and other records, such as the daily log, and activities records show that these choices are respected and promoted. Direct and indirect observation showed that the staff help the residents make choices in an encouraging and patient manner. Where possible, arrangements of managing end of life issues have been discussed and recorded in the care plans. Best interest meetings are set up should a resident need end of life care. As long as the home can meet an individuals needs, the home aims to provide terminal care to ensure that care and support is given in familiar surroundings at this time. Since the last inspection there has been review of the way medicines are managed and administrated. A number of procedures have been improved. For example, there is now a daily count of all medicines to ensure the correct quantities are in place. The head of care and a senior carer take responsibility for overseeing the administration of medicines. There is a room set aside for the storage of medicines. Medicine storage Care Homes for Older People Page 13 of 28 Evidence: was inspected and found to be safe and secure. The Medicines Administration Sheets (MARs) were examined and found to be up-to-date and in order. No medication errors were noted on the records that were examined. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes the Independence of the residents and encourages them to eat well and to spend time in relevant, meaningful and interesting activities. Evidence: There has been a great improvement in activities in the home since the last inspection. The work on the environment is now complete and this has given the residents a new lounge. The gardens are now safe and decking areas with raised planters and pots are more accessible. The raised planters have been well stocked and there are plans to use the garden much more next year. Records show that god efforts have been made to find out past interest of the residents so that activities that they might like can be organised. The variety of activities has increased significantly. Activities include large puzzles such as giant Connect Four, a knitting club, reminiscence, arts and crafts and cinema afternoons where old black and white films are shown on the flat screen television in the new lounge and staff service popcorn and ice cream. An array of photographs around the home show activities that took place in the summer months. A sports day was held for grandchildren and other young relatives Care Homes for Older People Page 15 of 28 Evidence: and friends of the residents and there have been barbeques and garden parties as well. Plans are now being made to make even better use of the garden next summer. A plastic greenhouse and seating are to be installed in one of the garden areas so that those residents who enjoy gardening, or just sitting and walking outside, can do so. The home employs an activities co-ordinator but staff understand that part of their role is to initiate and encourage activities. Clearer deinitiion of staff roles and responsibilities has contributed to this improvement. A new group of supporters of the home, The Friends of Hillbeck has recently been set up and has begun some fund raising activities. The manager told us that it is hoped the Friends will also get involved in activities as much as possible. The environmental improvements in the home included a small kitchenette in the dining area that is accessed by a security code to ensure the safety of the residents. Visitors and staff can use the kitchenette to make drinks during this visit and staff can make extra drinks for residents as well as themselves throughout the day. The home supplies the tea, coffee, milk and sugar. Food services at the home have improved since the last inspection. The groups catering manager, the manager and the cook have worked closely to produce four weekly, seasonal menus. Nutritional monitoring has improved and with the use of MUST nutritional assessments, better reviews and more frequent weighing for those at risk. The portion sizes are now adapted to individual wishes and the role of the kitchen assistant has been expanded to include monitoring and recording food intake. We spoke to the cook who told us that there is a generous budget for food and that she is able to use plenty of fresh produce. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The concerns of the residents and their supporters are listened to and acted upon and every effort is made to protect the residents from all forms of abuse. Evidence: The home has sound policies and procedures for the handling of concerns complaints and safeguarding. Staff receive safeguarding training as part of their induction and regular updates are now scheduled. Relatives said that there have been a lot of improvements in the home and that they have not recently had to make any complaints. There have been no recent formal complaints but there are sound systems for the recording and monitoring of concerns and complaints. Earlier on in the year there some safeguarding alerts were raised by Social Services. These resulted in a level 3 alert being placed on the home. This means that no new socially funded residents could be admitted. In addition, the home voluntarily stopped admissions of privately funded residents, until they could make the necessary improvements. The registered provider acted quickly and appropriately to address the concerns that had led to the alerts being raised. The problems appeared to have arisen due to a lack of understanding of the individual needs of people with dementia and confusion over staff roles. Since that time a Care Homes for Older People Page 17 of 28 Evidence: number of new staff have been recruited, staffing structures have been revised and staff have received training in dementia care. In addition, the environmental improvements have been completed. Social services are now satisfied that the home has made improvements in all areas and has lifted the alert. Since the safeguarding alerts a new manager has been appointed. Discussion with her showed that she has a clear understanding of the Mental Capacity Act and of dementia care. Staff spoken to understood the importance of safeguarding and of reporting concerns. They said that the manager is open and ready to listen to any concerns they may have. They have confidence that she would act appropriately should the need ever arise. Care Homes for Older People Page 18 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a pleasant and welcoming atmosphere. It is spacious, well maintained, clean and odour free. This gives the residents a safe and homely place in which to live. Evidence: We made a tour of the home in company of the manager. All areas of the home were well maintained, safe, odour free and clean. The home employs a team of housekeeping staff that includes laundry assistants, cleaners and maintenance personnel. They are commended for the improvements that have been made in cleaning services, laundry management and the environment. The extension of the home is now complete. There are four new bedrooms that are ready for use and awaiting final building certificates to be signed off before being registered with the Commission. There is a large new lounge and the garden is now accessible and safe. A new managers office has been created. This overlooks the main lounge and means that the manager can feel much more a part of the day-to-day running of the home. The old office is now being used as a quiet room where staff can study and confidential interviews can take place. Further developments are planed to make the garden more attractive for residents. These plans include a greenhouse and more raised beds and vegetable plots. Care Homes for Older People Page 19 of 28 Evidence: The laundry is now better managed. Care staff are no longer expected to carry out laundry duties and there is a laundry assistant on duty every day. There are better systems for sorting and managing laundry so that infection control is more stringent and there is more diligent sorting of clothes so individual items are less likely to go missing. At present, all the residents are accommodated in single rooms and the registered provider stated that it is the intention to maintain this situation. The homes self assessment quality document, the Annual Quality Assurance Assessment (AQAA), told us that all required safety checks are in place for essential services such as water, gas and electricity. No health and safety hazards were noted at the time of this visit. Care Homes for Older People Page 20 of 28 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. Staffing levels, staff training and recruitment practices are all good. Staff are properly supervised and there is good morale amongst the staff team. This means that the residents are cared for by a well qualified and cheerful staff team. Evidence: Since the last inspection there have been a number of changes to staffing at the home. The organisational structure has been changed and, instead of a deputy manager, there is now a head of care and an administrative assistant. More staff have been rostered on each shift and the duties of the kitchen assistant have been expanded to include food intake monitoring and recording. There was a significant staff turnover in the months following the resignation of the previous manager. However, recruitment has been very encouraging and there is now a stable and well motivated staff team. Staff said they are very happy with the way the home is now run and praised the progress that has been achieved. One said, Theyve turned this place around. We are all much happier and getting the training we need. There is a good staff induction programme in place and we spoke to new members of staff to see how they were progressing with this. They confirmed that they are being given the support they need to help them become accustomed to working in the Care Homes for Older People Page 21 of 28 Evidence: home. The records of four members of staff were inspected to check that appropriate training is being undertaken and that the required checks are being made on all new staff working at the home. These records show that a good level of training is now being undertaken by staff. The staff we spoke to confirmed that this is the case and that both mandatory and specialist training are being undertaken. We found good evidence that the registered providers make all necessary checks on staff before offering them employment at the home. Criminal Records Bureau (CRB) checks have been made, a minimum of two written references have been obtained, a health check list completed and full previous employment history obtained. Care Homes for Older People Page 22 of 28 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 well managed and the views of the residents and their supporters are given high priority. This means that the home is run in the best interests of the people who use this service. Evidence: Since the last inspection a new manager has been appointed. She has good, relevant experience and qualifications for the role of manager. The manager has had seven years experience of working in care settings. Over the past three years she has worked as the registered manager of a residential care home in Linconshire. She and holds the NVQ IV in management and care and is currently in the process applying to the Commission to register as manager for Hillbeck. The new manager has worked hard to recruit new and well qualified staff and to make improvements in the home. Since the last inspection the registered provider has worked extremely hard to address the concerns raised about the home at that time. There has been a restructuring of the management team and the registered provider has taken a much Care Homes for Older People Page 23 of 28 Evidence: more hands on approach to managing the home. The restructuring process included the creation of the post of administrative assistant. Observation and conversation with the person in this post showed that this role has had a very good influence on the smooth running of the home. Her cheerful disposition and diligence has improved communication in the home and has ensured that documentation is much better organised. All documents requested as part of this visit were readily on hand and in good order. The area manager, who was relatively new to the post at the time of the last inspection, has provided strong and clear leadership for the home. The provider has made significant financial investment in improving the homes environment, management and staff training. We found clear evidence of good team working at management level. This has impacted positively on the staff and care given at the home. The manager told us that she had received excellent support from both the area manager and the provider and has been given the freedom to make positive changes in the way care is delivered. It is very important that the registered provider continues to work in conjunction with the area manager and manager for the home to sustain the significant progress already made. There are now very robust quality assurance systems in place. The home is required, under the Care Standards Act, to send us a self assessment report about the progress they have made throughout the year. This is called the, Annual Quality Assurance Assessment, (AQAA). The AQAA confirmed that the registered provider visits the home frequently and that the area manager visits the home several times each week. It also told us that the home is identifying areas that need improvement and that there are sound systems in place for consulting the residents and their supporters. Relatives told us that the home keeps them well informed of progress and events that are going on in the home. They told us that the recent improvements have made a real difference in the home and have given them much more peace of mind about the care there. One said, I can now go home from visiting my mum without feeling bad that I have left her in a place that isnt right for her. I am happy now that she is in the right place and being well looked after. Im as happy I can be that this place is right for her - I now have peace of mind - its taken a long time but I dont cry now when I leave. Another told us that the home had improved, Out of all expectations, in the last few months. Relatives and staff praised the new manager and the changes she has made. One said, She (the manger)has made a real difference here, its so much Care Homes for Older People Page 24 of 28 Evidence: more relaxed but they (the residents), are doing more - the atmosphere of the place is so much better- more easy going but more going on. More robust systems for staff supervision have now been introduced. Records showed that regular one-to-one supervision is taking place. Staff told us that it is easy to talk to the manager and that she listens to their concerns. They told us that they now see that they have an important role in speaking up for the residents when they are unable to speak for themselves. The AQAA confirmed that all necessary health and safety checks are made on the home and that there is documentation to support this. random sampling of this documentation showed that health and safety safeguards are in place and that checks are being carried out as required. Care Homes for Older People Page 25 of 28 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 28 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 Care Homes for Older People Page 27 of 28 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!