Care Home: Homeacre

What the care home does well Relatives and other visitors are made welcome and confirmed in surveys that they are happy with the family atmosphere that Homeacre provides. There is good communication between staff and visitors and they confirm also in the surveys the high standard of care their relatives receive. The home has a stable, committed staff team who know people well and treat them as individuals. As previously reported, the home`s greatest strength is the homely atmosphere and the person centred, individual way that people are treated. The small staff team work well together to ensure people living in the home receive continuity of care. Surveys received from service users stated, "They care for us well". Homeacre provides traditional home cooked food that is enjoyed by people living in the home and staff make sure that people`s likes and dislikes are taken into account when planning meals. What has improved since the last inspection? People moving into the service now have all their needs, strengths and aspirations documented. This ensures that the service is fully aware of these and knows how they will support them before they agree to the admission. The management team and staff have developed care plans and risk assessments. Each person now has a comprehensive plan of care which is person centred and indicates the assistance required to aid the person`s predominant needs such as physical, social and healthcare needs. These plans of care also correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. Transcribed medications now evidence two signatures to ensure service users receive their correct medication. A clearly documented staff rota is available showing the designation of staff, their names and the person in charge. Staff training has been undertaken and an appropriate supervision and appraisal structure for all staff has been implemented. What the care home could do better: The home should ensure that the supervision and appraisal structure for all staff is consistent and ensure appropriate records are kept. This will ensure service users know they are cared for by staff with the specific skills required. The management team should continue to audit the maintenance of the home and ensure any health and safety matters that would put service users at risk are addressed and appropriately risk assessed. Key inspection report Care homes for older people Name: Address: Homeacre 28 Hayes Road Clacton On Sea Essex CO15 1TX     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: Helen Laker     Date: 2 1 0 4 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Homeacre 28 Hayes Road Clacton On Sea Essex CO15 1TX 01255425365 F/P01245425365 homeacrecare@aol.com www.littlehomeacre.co.uk Mrs Kathleen Curtis Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Kathleen Curtis Type of registration: Number of places registered: care home 5 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: 5 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within teh following categories: Dementia - Code DE Date of last inspection Brief description of the care home Homeacre is a care home providing personal care and accommodation for up to five older people with dementia. The home is situated close to the town centre of Clacton and within walking distance of the seafront. Homeacre is a family run establishment, which cares for people in a homely environment. The care and support of people living in the home is carried out by Mrs Curtis assisted by a small number of staff, most of who are family members or family Care Homes for Older People Page 4 of 28 Over 65 0 5 3 0 0 6 2 0 0 9 Brief description of the care home friends. Facilities consist of five single rooms, lounge and dining room/conservatory. To the rear of the property there is a paved patio area and garden, which is fully accessible. There is a small parking area to the front of the property. The home charges 390.00 pounds per week with additional charges for hairdressing services and for personal items such as newspapers and sweets. This information was provided to us in April 2010. Information about the home can be obtained by contacting the manager; inspection reports are available from the home and from the CQC website www.cqc.org.uk 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: The quality rating for this home is two star. This means that people who use this service experience good quality outcomes. This key unannounced inspection looking at the core standards for care of older people took place on a weekday between 10:30 and 15:30. proprietor/manager who for the benefit of this report will be referred to as the manager, and staff were present throughout and assisted with the inspection process by supplying records and information. This report has been compiled using information available prior to the visit such as surveys sent out, evidence found on the day of inspection and the annual quality assurance assessment (AQAA), which is required by law and is a selfassessment completed by the service. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that improvements be noted as this contributes to the inspection process and indicates the homes understanding of current requirements, legislation changes and own audited compliance. This document will be referred to as Care Homes for Older People Page 6 of 28 the AQAA throughout the report. During the day the care plans and files for three of the residents were seen as well as two staff files, the policy folders, the medication administration records (MAR sheets), some maintenance records and the fire log. The manager also supplied a copy of the duty rotas, the menus, and other pertinent documentation which was required. A tour of Homeacre was undertaken and three residents, three members of staff as well as the manager were spoken with. The home was clean and tidy offering homely accommodation to the residents. The residents seen were relaxed and clearly felt at home in the environment using all areas of the building. All the records and files were generally well maintained and easily accessible. Interactions between staff and residents were observed to be friendly and appropriate. 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 Care Homes for Older People Page 8 of 28 order line 0870 240 7535. Care Homes for Older People Page 9 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 10 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. This judgement has been made using available evidence including a visit to this service. People admitted to the home will have their needs assessed and will receive accurate information about what the service can provide. Evidence: The home has a published Statement of Purpose and Service User Guide, both of which are made available to existing and prospective residents at Homeacre. These documents have previously been assessed and contain all the relevant information as required by regulation. The AQAA states We have readily available brochures for prospective service users. The examination of care records showed that the majority of residents had been at the home for some time and generally had their individual needs assessed prior to moving in and these assessments formed the basis of individual care plans. The pre admission assessment used covers a wide range of areas including physical Care Homes for Older People Page 11 of 28 Evidence: needs, dressing and undressing, pressure sores, falls, safe handling, mobility, mood, behaviour, memory, dietary preferences and the background history of the person. The format of the document is mostly a tick box type assessment. However all staff spoken with are able to demonstrate a very good awareness and knowledge of peoples individual assessed needs. The homes AQAA and staff identify that Our staff demonstrate a full awareness and knowledge of service users needs and we cater for all those needs and monitor them closely Three surveys returned by service users and one relative spoken with on the day of inspection, positively noted that they did receive enough information about the home prior to moving in and that care needs were being met. Discussions with staff and service users supported the evidence found in existing care records and indicated that these assessments gained views and insights from the individual, their families and professionals involved in the individuals care. Since the last inspection improvements have been made in the variation of completion of paperwork and new paperwork has helped the home adopt a more consistent approach. Some detail such as dates, times and signatures had been overlooked on some paperwork. A discussion was held regarding the importance of ensuring admission audit trails evidenced clearly that service users were assessed prior to admission, and not on the same day, and evidenced where that assessment took place. Although staff knew the information and residents very well this was not always clear in the assessments formulated or plan of care. The homes AQAA identifies that We are a small home with five residents, we know their needs and wants and they are treated as people not numbers and part of an extended family by us all. Care Homes for Older People Page 12 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. This judgement has been made using available evidence including a visit to this service. People who use this service will have their health needs met, and are protected by the homes management of medication. They can also be sure that their care needs will be documented sufficiently well to ensure their individual healthcare needs are clear to staff and that they can be met. Evidence: A sample of care plans examined show that generally the home aims to develop them from the pre-admission assessments and they are reviewed regularly. The last review recorded in one of the three care plans seen was March 2010. Routines and daily evaluations are generally well documented with good details about how people living in the home like to have their personal care provided. Individuals personal care routines for the whole day are displayed in their care plans and on the inside of the wardrobe in their bedrooms so that all members of staff have the necessary information to ensure care is provided in a consistent manner. Care Homes for Older People Page 13 of 28 Evidence: Care plans have been further improved and developed since the last inspection, to ensure all aspects of the persons care including their likes and wishes around choices and individual behaviours are as well detailed as the care routines. A daily recording system for care plans is now in place which correlates with each care plan and more specific detail was noted to now be included rather than entries such as no problems or usual day. The homes AQAA states We will continue to upgrade our care plans and all aspects of paperwork that centres on person centred care. It also states We regularly monitor our service users and treat them with dignity by giving them a lot of our time in order to personalize our relationship with them. The senior staff spoken with were able to demonstrate a very good awareness of peoples individual healthcare needs. Records examined confirm that people are supported to access healthcare professionals as required. One staff survey stated The home gives me a reason to live I am very happy and comfortable One relative also commented that their relative was provided with all the care they required and overall felt their needs were met. Individual files contained details of prescribed medication. One of the senior carers has compiled a record book containing details of each individuals medication, what it is prescribed for and the side effects. As at the last inspection visit, no one has the capacity to manage their own medication. Upon inspection of medication practice and procedure this was noted to be appropriate and only one person is currently taking controlled drugs at present. Current storage was noted to meet the requirements for storage of controlled drugs and balances checked were all correct. Items requiring controlled temperatures are stored in an appropriate fridge accessible via a coded door. Medicine Administration Record (MAR) sheets are completed appropriately and staff spoken with are able to demonstrate a good knowledge of medications prescribed for people living in the home. Transcribed medications on the administration charts now evidence two signatures and effective checking procedures. This now ensures service users receive their medication safely. Staff spoken with all demonstrate good individual, intuitive person centred approaches to caring for the people living at Homeacre. Service users spoken with were complimentary about how staff cared for them. Surveys stated I am happy her I always have someone to talk to. The AQAA tells us that We encourage service user choice in everything they do and support those choices. We also support their relatives and show our feelings as if they were our own Observations on the day of the inspection showed that people are treated with dignity and respect. Staff were observed to have a good rapport with service users and were respectful and polite to service users. 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. This judgement has been made using available evidence including a visit to this service. People who use this service will have opportunities to be part of the local community and be able to maintain contact with their family and friends following a lifestyle they would individually choose. They are provided with a varied diet that they enjoy. Evidence: There have been continued improvements in the way people are supported to make choices around activities. The senior carers on duty discussed how they encourage and support people to make choices and have developed a folder containing laminated pictures to help with the process. The AQAA states that people living in the home are happy and contented and that all service users have a say in everything that affects them. This is confirmed by observations on the day of the inspection. Service users were observed smiling and contented and receiving attention when required and one was given compassionate assistance to avoid becoming anxious or upset when confused about a situation. As previously reported at previous inspections, people enjoy watching DVDs and the home has a satellite receiver so that they can enjoy films and a 46-inch television set. The home is situated very close to the town and people are supported to access local Care Homes for Older People Page 15 of 28 Evidence: facilities such as the library. The home has used clay to help people exercise their hands and keep them supple. The home does not have an activities co ordinator or a formulated plan of social events however it was evident at the inspection that every effort is made to ensure service users are given opportunities to enjoy social interaction. One person living in the home attends a club on a weekly basis. The manager and staff have purchased a new mobility scooter, organised internet access and implemented individual social care plans to evidence service user involvement in activities. Additionally we are told that the home has purchased in house activities such as match cards and books specifically for those with dementia. The manager has completed an in depth course in dementia which has given further insight into the social stimulation required and the methods available to aid that. One service user enjoys going out for dinner and another loves going to the pub and participates in karaoke. Feedback gained from relatives confirmed that they are made welcome in the home and the staff team have developed close, supportive relationships with relatives. Staff also confirm that service users are taken out on trips to the shops and beach or where they wish weather permitting. Observations on the day of the inspection confirm that staff are good listeners and communicate well with people living in the home, supporting them to make choices. There is very much a home from home family atmosphere at Homeacre. Staff prepare home cooked food that people are seen to enjoy. Visiting relatives are welcome to stay for a meal and there is a homely atmosphere. Evidence was seen of fresh foods, fruit and vegetables that are used. Appetites are monitored via a portion control tool and a two-week rolling menu which has been developed. Staff have also all been on nutrition training course and the MUST tool can now be used. A nutritious meal of roast chicken, carrots, stuffing, cauliflower, roast potatoes and boiled potatoes followed by home made fruit crumble and custard was served on the day of inspection. Service users commented that food is enjoyable and they were generally asked what they would like to eat which was taken into account when the shopping was done. Service users requiring assistance were noted to be given assistance in a timely manner. 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. This judgement has been made using available evidence including a visit to this service. Service users can access the complaints procedure and be confident their concerns will be taken seriously. They can also be assured they will be protected from abuse as staff have appropriate training, and procedures and plans are in place to safeguard people living and working in the home. Evidence: As at the last inspection, the home has an appropriate policy and procedure around complaints. The AQAA details that no complaints have been received in the last twelve months and none have been received by the Care Quality Commission directly. Surveys returned spoke positively about the service indicating there had never been any situations which gave rise for complaints. The home does have a formal recording system for complaints now however, the small size of the home and the family culture ensures that any minor concerns are dealt with as they arise. Service users spoken with confirmed that they are confident that any concern would be sorted out. Documenting minor concerns as well as major complains and recording the outcome would demonstrate that peoples concerns are taken seriously and acted upon. This was discussed with the staff and manager on the day of inspection. The AQAA states, All staff have had SOVA training and are CRB checked, we would never let a concern become a complaint. All concerns are acted upon and service users listened to. A sample of staff files examined all contained evidence of Criminal Record Bureau (CRB) Care Homes for Older People Page 17 of 28 Evidence: checks. Staff spoken with confirmed that they have received training around Protection of Vulnerable Adults (POVA). This was last held in January 2008 and review of records evidenced that an update is now required. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People living in Homeacre benefit from a homely environment that is clean and pleasant, they can be confident that improvements will be made around safety and maintenance issues addressed so people remain safe. Evidence: A tour of the premises confirmed that there has been redecoration to the inside of the house, new adjustable beds have been purchased, a new metal medicine controlled drugs cabinet installed, and new fire door closures fitted to all fire doors. Discussions with service users did not highlight any concerns about the environment. One stated I have my own belongings and directed us to a certificate on the wall that they were proud of. The furnishings throughout the home remain homely and domestic and hygiene gels have been installed throughout the home. At the last inspection we were informed that the proprietor plans to replace flooring in two bedrooms, this has now been done and there are still plans to have the backyard and garden re slabbed. The AQAA also tells us that the home was hoping to obtain some funding to provide a walk in shower room for residents, however this has proved difficult. Individual bedrooms contain domestic furnishings, beds, chest of drawers and wardrobes and all have washbasins. Temperatures from hot taps in bedrooms tested did not exceed the safe temperature of 43 degrees C. People also have lockable storage space where they can Care Homes for Older People Page 19 of 28 Evidence: keep medication, money or valuables. A lockable case has been provided to each service user. A tour of the premises confirmed that the home continues to be kept very clean and free from offensive odours and staff were observed to demonstrate good practices around keeping the premises clean. Staff were also observed to be cleaning and airing rooms on the day of inspection. 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. This judgement has been made using available evidence including a visit to this service. Residents needs will be met by a staff team, who receive the training they need to meet the needs of the residents. The home adhers to required safeguards to ensure that appropriate staff are employed ensuring residents are safe. Evidence: As highlighted at previous inspections and confirmed via observation at this inspection, the small staff team work closely together in a flexible manner so that they can respond to the needs of people living in the home. The commitment of the management team and care staff ensure that there are always sufficient staff on duty. A clearly documented duty rota is now in place but still needs to highlight the person in charge and designation and contracted hours of staff members. Since the last inspection, staff have undertaken a lot of training including deprivation of liberty, moving and handling, and insight into person centred care planning. Records examined show that five out of a total of seven care staff hold an NVQ qualification. We were told that, upon commencing these qualifications staff were finding it helpful with understanding processes better with things like recruitment and supervision practices and enhancing their body of knowledge on meeting the national minimum standards. The home has a very low turnover of staff and there have been no new staff employed Care Homes for Older People Page 21 of 28 Evidence: since the last inspection. The recruitment procedure remains appropriate. Three staff files were sampled and, as at the last inspection visit, there is evidence of appropriate documentation around recruitment such as staff photographs, proof of identity, declaration of fitness to work in a care home and Criminal Records Bureau (CRB) checks. Staff spoken with show an enthusiasm around training and records examined confirm that staff generally keep up to date with training. Staff commented, We welcome training and are well supported by the manager All staff have attended Safeguarding of Vulnerable Adults(SOVA)training and fire safety and any updates due are being addressed. There are plans for further medication training courses. The benefits of having a training matrix were discussed so that updates are apparent. The AQAA also confirms that in order to progress that the home will continue to Update all staff training needs as required. 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. This judgement has been made using available evidence including a visit to this service. Residents can expect the management team of Homeacre to ensure the home is run in the best interests of the residents. Some further improvements with regard to health and safety need to be made so residents can be confident they are protected by the homes practice and procedures. Evidence: The management team work closely together, the registered manager who is in day to day control of the home has a responsibility to obtain appropriate qualifications so that she meets all standards that apply to the registered manager. They have now completed their National Vocational Qualification (NVQ) level 4 Registered Managers Award. Discussions with members of staff, the management team and relatives show a strong person centred ethos in the home. Discussions with staff highlighted they are able to demonstrate a common purpose, which is to recognise the individuality of all those Care Homes for Older People Page 23 of 28 Evidence: living in Homeacre and to provide care in a way that promotes the homes family atmosphere. The AQAA states We care, we promote individuality and independence, we make sure our service users have all that they need. We provide a service which is second to none. Since the last inspection, the home has made some progress with their quality assurance system. A number of audit processes are now in place and cover areas such as environment, staffing, care practices and medication. We are told the home Listens to their service users and also their families. Questionnaires are offered to be filled in and service users families like the personal approach which is face to face. The management team need is continuing to build on this area around quality assurance and aims to develop an action plan for the home that takes into account feedback from staff, relatives and people living in the home and to demonstrate how they take action and progress the home. The AQAA submitted showed that the staff and manager had a good awareness of the home but did not clarify in all areas what specific actions would benefit the homes progression to benefit those service users living there. Staff spoken with were confident that their views are taken into account. Feedback from one relative confirmed that relatives are very much involved in decision making processes. This was evidenced in care plans where they had been signed by the service user and relative. Completed surveys received contain positive comments about the home. One person said, All care needs are met and staff spoke with said We care that is what matters and we enjoy being here. As at the last inspection, no one in the home has the capacity to manage their own finances and this is carried out by relatives. The home only looks after the finances of one person, who is also a relative of the manager. Records examined show that any money spent is appropriately documented and receipts are in place. The staff at Homecare do have a formalised supervision and appraisal structure. This has been introduced since the last inspection but was noted to need a more consistent approach as those seen did not equate to at least six supervisions annually with one appraisal. This was discussed with a view to it being maintained following this inspection. Also the format of supervision was discussed as it was not specific and did not evidence staff wishes, anticipated training and any areas for development or how that may be achieved. This will benefit the homes staff personal development and ensure service users are being cared for by competent staff. The servicing of equipment is carried out including electrical equipment, the stair lift, fire equipment, gas appliances and emergency call equipment. A sample of records examined confirms that servicing and testing has been carried out. The home has COSHH (Control of Substances Hazardous to Health) assessments on hazardous substances such as cleaning products. These are kept in a locked cupboard. Not all risk assessments for environmental issues such as using the stairlift, and Care Homes for Older People Page 24 of 28 Evidence: possible trip hazards from patio opening doors where a step down was required, were formulated. This was discussed with the staff and manager on the day of inspection. The home needs to carry out a thorough audit of the premises to identify all ongoing areas where there may be health and safety risks for the people living there and make improvements where potential dangers are identified. Overall the kitchen was observed to be clean and staff are aware of good practices around hand washing and a cleaning protocol is in place. Although, as stated in the AQAA, there is a high ratio of staff to people living in the home, people are not constantly supervised and are free to come and go throughout the home as they please. This reinforces the feeling that people are living in their own home. 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 1 36 The home should ensure that the supervision and appraisal structure for all staff is consistent and ensure appropriate records are kept. This will ensure service users know they are cared for by staff with the specific skills required. The management team should continue to audit the maintenance and environment of the home and ensure any health and safety matters that would put service users at risk are addressed and appropriately risk assessed. 2 38 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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