Care Home: Hope Manor

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What the care home does well People told us they liked living at the home and that staff were kind, patient and friendly. Comments included, "the girls are very nice in every way. They never say a wrong word to any of us", Great lot here", "care is second to none", "feels like a home and everyone is very friendly" and "I`m quite happy here, it`s a good place to go if you`ve got to go somewhere". People said staff were quick to get medical help for them if they were unwell and visitors said they were kept informed when there were changes to the condition of their relatives. The home was clean and smelled fresh. People told us they liked the rooms and one person said "the garden is gorgeous". Staff were generally provided in sufficient numbers although the manager did report that she was going to recruit a deputy manager, which we felt would benefit the home as the manager would have more time to plan the overall running of the home and future improvements. 75% of care staff had successfully completed National Vocational Qualifications (NVQ). Both staff and people living at the home said the manager was very approachable. People said they felt able to raise concerns or complaints with her and were very confident she would listen and sort them out. Comments about the manager included, "Oh she`s lovely her", "She comes every day and asks how I am" and "I like her". The manager worked with the carers frequently carrying out personal care tasks and in this way knew each person living at the home very well and was able to ensure that care was provided to meet peoples` needs. What has improved since the last inspection? At the last inspection we made 6 requirements and 4 recommendations. At this inspection we saw that all of the requirements had been addressed, although 2 did need further work and we have made some recommendations about those to ensure that improvement continues in those areas. Two of the recommendations had been considered but 2 still need to be looked at if the home is to continue to improve. The manager had introduced a new care plan format and was trying to include enough information to ensure staff would understand the care they needed to provide, although there were still some gaps in the records. The procedures for managing peoples` medicines had improved to make them safer for people and a new controlled drugs cupboard had been bought to make sure the storage of medicines was secure. At the last inspection we recommended that the manager contacted the Fire Service for advice about the home`s fire risk assessment. In March 2009 we received a letter from Greater Manchester Fire and Rescue Service informing us that they had carried out an inspection of the property and that their outcome was considered satisfactory. A fire risk assessment had been put in place. Procedures for recruiting staff had improved to make sure that new staff had all thenecessary checks before they started working at the home. What the care home could do better: Assessment records need to be more consistent and should clearly show when each person`s care needs were assessed and when they were reviewed. Although people had care plans and risk assessments, the reviews of these could be more robust to make sure all the information in them is up to date and accurate. Where people are visited by other health care professionals, any advice or instructions should be added to their care plan and all staff should be made aware of any changes. Although people said they liked the food in the main, menus should be reviewed to make sure there is enough choice and variety on offer for people and ensure that meals are nutritious. More consideration is needed as to how peoples` need for social and mental stimulation can be met. Social activities and events were very limited. Development of the key worker role may help staff work on a more individual basis with people to explore leisure interests that meet their expectations. This would also enable staff to work with people in allowing them more choice in their daily and weekly routines. The manager and staff need to attend training in the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager needs to develop the quality assurance processes within the home. People living at the home were given opportunities to give feedback and the manager operates an open door policy. However, systems for the review of staff working practices were limited so there was a risk that the manager would not identify potential shortfalls in care delivery. Key inspection report Care homes for older people Name: Address: Hope Manor 220 Eccles Old Road Salford Gtr Manchester M6 8AL 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: Fiona Bryan Date: 1 9 0 1 2 0 1 0 This report is a review of the 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 stars – excellent • 2 stars – good • 1 star – adequate • 0 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. things that people have said are important to them: 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: They reflect the Care Homes for Older People Page 2 of 27 This box describes the information we used to come to our judgement 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 Page 3 of 27 Care Homes for Older People acknowledged as CQC copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Care Homes for Older People Page 4 of 27 Information about the care home Name of care home: Address: Hope Manor 220 Eccles Old Road Salford Gtr Manchester M6 8AL 01617887121 F/P01617887121 anngirgis@ntlworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Coveleaf Ltd Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: A maximum of 26 older people (OP) requiring personal care only may be accommodated. Date of last inspection: Brief description of the care home: Hope Manor is a 24 bed, privately run home for older people, providing personal care. The home is registered in the name of Coveleaf Ltd. The home is situated in a residential area of Salford on a busy main route and within close proximity to Hope Hospital. The home is accessible by public transport and major motor routes, such as the Manchester Ring Road. Parking facilities are available to the front of the house. The home is close to local shops, shopping areas, such as Salford City precinct, and other Care Homes for Older People Page 5 of 27 Care Home 26 Number of places (if applicable): Under 65 Over 65 0 26 1 5 0 0 2 0 0 9 public amenities. The cost of the service is £380 per week. Care Homes for Older People Page 6 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: two star good service Our judgement for each outcome: Choice of home Health and personal care Daily life and social activity Complaints and Protection Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection, which included a visit to the home, took place on Tuesday 19th January 2010. The staff at the home did not know that this visit was going to take place. All the key standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people living at the home, visitors, the manager and other members of the staff team. Key standards refers to those standards we feel are particularly important in ensuring the health, safety, welfare and quality of life of people living at the home. Care Homes for Older People Page 7 of 27 The care and services provided to two people living at the home were looked at in detail, looking at their experience of the home from their admission to the present day. We also looked at other people in relation to specific needs we identified during our inspection. A selection of staff and care records was examined, including peoples care files, staff personnel files and duty rotas. Before the inspection, we asked for surveys to be sent out to people living at the home and staff asking them for their views of the home. We had replies from one person living at the home and 2 staff and their comments were taken into account. Before this inspection we asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what she felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The AQAA was quite limited in detail and did not give us enough information to show that the manager was able to plan future improvements to the service. We discussed this with the manager and explained how she could expand on the information she provided in the next AQAA we ask for. Care Homes for Older People Page 8 of 27 What the care home does well: What has improved since the last inspection? At the last inspection we made 6 requirements and 4 recommendations. At this inspection we saw that all of the requirements had been addressed, although 2 did need further work and we have made some recommendations about those to ensure that improvement continues in those areas. Two of the recommendations had been considered but 2 still need to be looked at if the home is to continue to improve. The manager had introduced a new care plan format and was trying to include enough information to ensure staff would understand the care they needed to provide, although there were still some gaps in the records. The procedures for managing peoples medicines had improved to make them safer for people and a new controlled drugs cupboard had been bought to make sure the storage of medicines was secure. At the last inspection we recommended that the manager contacted the Fire Service for advice about the homes fire risk assessment. In March 2009 we received a letter from Greater Manchester Fire and Rescue Service informing us that they had carried out an inspection of the property and that their outcome was considered satisfactory. A fire risk assessment had been put in place. Procedures for recruiting staff had improved to make sure that new staff had all the Care Homes for Older People Page 9 of 27 necessary checks before they started working at the home. 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 10 of 27 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 11 of 27 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Enough information about people moving into the home was not consistently recorded so there was a risk that staff would not have all the information to be able to meet their needs. Evidence: A statement of purpose is provided in each persons room and the manager said details about the home were also available on a website. One person living at the home returned a survey, which said they had been given enough information about the home prior to moving in. We looked in detail at the care provided to 3 people. One person had been admitted to the home as an emergency. Salford Council had sent an individual support plan to the manager but there was no information in it and after a short time the manager said it had become apparent that they were unable to meet the persons needs and their care manager (social worker) was trying to find alternative accommodation for them. Whilst we recognise that getting information prior to the admission of someone in the case of an emergency can be difficult, every effort should be made to obtain as much information as possible so the manager can make an assessment as to whether the persons needs can be met at the home. This will reduce the risk that placements will break down. Care Homes for Older People Page 12 of 27 Of the 3 people we looked at in detail, daily needs assessments were completed for 2 of them but these were not dated so it was unclear whether they had been completed before or after admission. The manager confirmed that where possible she went to see people before they were admitted to the home and there were some limited records that were dated which demonstrated this. Actually discussing and completing the daily needs assessment with each person prior to admission and dating it would show better how people are assessed. Care Homes for Older People Page 13 of 27 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. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although written records lacked some detail, staff communicated well in other ways to ensure the health and personal care needs of people were met. Evidence: The manager said that since the last inspection she had introduced a new care plan format, which ensured that more detail was recorded about peoples care needs so staff had more information about what they needed to do to support them. We looked at the care 3 people received in detail. Care plans were in place for 2 of them The other person who had most recently been admitted as an emergency did not have care plans and the manager said this was because it had quickly become apparent after admission that their needs could not be fully met at the home and they were expecting that alternative accommodation would be found for them very shortly. In the interim, care plans should be developed, as a record for staff of what care is needed and a means of recording and monitoring changes to the persons condition. Care plans for the other 2 people did still need more detail, although the manager said she had been working on them to improve them based on our comments at the last inspection. Objectives within the care plans were not very clear, so did not give staff much information about how they were to support people. For example one care plan said the person had dementia, which impacted on how they lived but did not describe in what way or what the aim for staff should be in providing care. The objective for another person regarding their diet was to weigh every month. This did not tell staff what the acceptable weight was for the person or what to do if the person lost weight. Objectives should be more specific so they are measurable and staff can accurately assess if the care provided is meeting needs. Care Homes for Older People Page 14 of 27 Care plans were not always dated so it was not clear how up to date and relevant they were. A separate sheet at the back of each care file recorded when care plans had been reviewed. Reviews were not always carried out monthly and where it was recorded that there were no changes, from other records within the care files it appeared that in fact there had been changes to peoples condition, for example they were being seen by the district nurse. Risk assessments were undertaken for nutrition, falls, moving and handling and pressure areas. It was unclear how accurate the nutritional risk assessments were as staff had used the scoring system to indicate that peoples weight was acceptable for their height. This was discussed with the manager as the assessment was based on observation of the person rather than body mass index (BMI) or any other recognised measure. One person had not been weighed for some time as they were unable to stand on the scales. The manager said they were planning to buy some scales that people could sit down on and we discussed other ways in which weight loss could be measured if sit down scales were not available. People told us that staff were prompt in getting medical treatment for them if they needed it. Records showed that people had been seen by their GPs, podiatrists and opticians. However, at the last inspection we noticed that although the care planning documents gave the opportunity to record visits from health care professionals, documents were not always completed and this was still the case. The daily record for one person said they had been seen by the dietician who had advised that they needed more milky drinks, cream in food and more butter and cheese. This information was not recorded on either the professional visits form or the care plan and it was not clear why the person had been referred to the dietician. Apart from the written records there were other systems in place within the home to ensure that staff were updated about changes to peoples care needs; verbal handovers were given between staff at the start and end of each shift and a key worker system had just been implemented, with care staff allocated to specific people to offer additional support and extra time for communication and interaction. Staff were knowledgeable about peoples care, were able to describe their daily routines and preferences and had acted proactively to promote peoples health and wellbeing, for example staff had arranged for someone to attend audiology and get a hearing aid, which had greatly improved their ability to communicate. Unfortunately the care planning and documentation still did not always reflect the service delivered. We looked at how medicines were managed for a small number of people. Systems had generally improved since the last inspection. People who wanted to manage their own medicines were assessed to make sure they were able to do so safely. Since the last inspection a new controlled drugs cupboard had been bought which complied with legal requirements. Staff had handwritten the administration instructions for the medicines for one person and had written them incorrectly. When staff handwrite instructions, a second person should check it to reduce the risk of errors being made. People living at the home said staff were mostly kind and courteous. Comments included, the girls are very nice in every way. They never say a wrong word to any of us and they are a great lot here. People said staff listened to what they said, for example staff asked them what they wanted to wear in the morning. However, we saw Care Homes for Older People Page 15 of 27 on the notice board a bath sheet giving specific days that people were to be helped to have a bath. This practice does not offer flexibility for people, who may want to choose to bathe on different days. Development of the key worker system would improve choice for people as the key worker could discuss with their clients what days would be best for bathing etc on a weekly basis. People looked clean and well cared for and visitors told us their relatives always looked well presented when they visited. Care Homes for Older People Page 16 of 27 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. This is what people staying in this care home experience: Judgement: People using the service adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines were flexible but there was only limited choice for people regarding social activities and meals so their wishes and preferences may not always be met. Evidence: A designated activities organiser is not employed at the home as it is seen as part of the role of the carers to meet peoples social care needs. It was reported that although the manager and staff do try to provide a programme of social events and activities, people living at the home express little interest in general in group activities and leisure pursuits. The manager said people did enjoy entertainers visiting the home to sing and perform, so she tried to organise that on a regular basis and people had enjoyed the Christmas party and a trip to Blackpool. Peoples care files did not in general contain a lot of information about their previous hobbies and interests, former jobs or family background and the manager acknowledged that staff were poor at recording social activities that had taken place or how people spent their time. As discussed in the previous section of this report, development of the key worker system, which had only just started, would help staff work more closely with individuals to identify ways in which their specific social needs and interests can be met, for example one person told us they enjoyed reading but was not able to access large print books easily. The mobile library did not visit the home and this could be arranged. Care Homes for Older People Page 17 of 27 People told us their visitors were made welcome and some people went out of the home with family and friends. Other people preferred to spend most of the time in their own rooms and this choice was respected. Comments about the food provided at the home were mixed. One person said the food was good Lovely and told us that although there was no real formal choice of meal staff knew what she liked and offered her an alternative when something was on the menu that she didnt like. Another person said the food can be good, can be bad. The days menu was displayed on a noticeboard outside the main lounge but no one we spoke to at lunchtime who was sitting waiting for their meal knew what the lunch was going to be and everyone said they never knew in advance but found out when the meal was served. Lunch was bacon, eggs, chips and baked beans. A small number of people were served soup and bread and butter instead; one person told us this was because they needed a blended diet. One person said she did not want the bacon and eggs and was offered the soup instead. The dessert was sponge and custard. Most people seemed to be enjoying their meal and the atmosphere was unrushed and relaxed. Examination of the menus showed that the main meal of the day was served at lunchtime. Typical meals were cottage pie, roast dinners, liver and onions, fish, braised steak, stews and pies with assorted vegetables and potatoes. The menu did state at the bottom that a selection of alternative meals were available daily and gave some examples such as sandwiches, cheese and biscuits, salads, soups and jacket potatoes with various fillings. However, as people did not seem to be told prior to the meal what was being served it was unclear what the system was for enabling people to request alternatives. The menu for tea contained quite a lot of processed foods such as chicken dippers, turkey drummers, fish fingers and sausage rolls and hardly varied from one week to the next even though the menu was supposed to rotate over a 4 week period. No information was given as to whether a dessert was provided at teatime. The menus should be reviewed as they could be improved to offer more variety and choice. Care Homes for Older People Page 18 of 27 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. This is what people staying in this care home experience: Judgement: People using the 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 were protected by the complaints and safeguarding procedures, which were understood by staff. Evidence: A copy of the complaints procedure was available in the service user guide that was located at the entrance to the home. In the AQAA the manager reported that there had been one complaint made since the last inspection and this had been resolved within 28 days. Since the last inspection the manager has started to record complaints and from the record we saw that the complaint reported in the AQAA had been dealt with appropriately. People living at the home and visitors said they would speak to the manager if they had any concerns and they were very confident that she would listen to them and address any issues seriously. One visitor said, she (the manager) has told us that if we have any problems to let her know. People told us they felt safe living at the home. Since the last inspection the manager had obtained a copy of the Salford Social Services safeguarding policy and ensured this was available to all staff. Staff were aware of the procedures to follow if they suspected abuse but had not yet had training regarding the Mental Capacity Act (Deprivation of Liberty Safeguards). Care Homes for Older People Page 19 of 27 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. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hope Manor provides a clean and comfortable environment for people to live in. Evidence: We visited several areas of the home including bedrooms, bathrooms and communal areas. Peoples rooms were nicely personalised with pictures, ornaments and small items of furniture. The double rooms all contained privacy screens. People said they liked their rooms. One person said, I love my room and the garden is gorgeous. Communal areas were clean and tidy. The home smelled fresh and clean. On the first floor one bathroom contained a medi bath, which the manager said no one used as most people did not like the design of the bath. Consideration should be given to converting this room to a wet room to give people more options for bathing or showering. At our last inspection we recommended that the manager contacted the Fire Service for advice about the homes fire risk assessment. In March 2009 we received a letter from Greater Manchester Fire and Rescue Service informing us that they had carried out an inspection of the property and that their outcome was considered satisfactory. A fire risk assessment is now in place. Care Homes for Older People Page 20 of 27 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. This is what people staying in this care home experience: Judgement: People using the 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 arrangements, recruitment and training ensure that people are cared for and supported safely. Evidence: On the day of our inspection there were 24 people living at the home. The manager and 3 carers were on duty, which we were told was the norm. The manager usually worked office hours from Monday to Friday and a senior carer was in charge at the weekends and in the evenings. The manager said she was intending to have another carer on duty in the mornings as this was the busiest time and she was also considering recruiting a deputy manager, as the previous deputy had left the home in March 2009 and had not been replaced. Appointment of a deputy manager would benefit the home as this would free some of the managers time to do some more quality assurance work and planning for future improvements. We looked at 2 staff personnel files. All the necessary checks had been carried out to ensure they were suitable to work in a care home. Staff told us they had been doing quite a lot of training over the past year, including first aid, food hygiene, safeguarding, moving and handling and fire safety. The manager had a staff training matrix to keep track of staff training needs. This showed that ongoing training was provided in health and safety topics. Staff had not undertaken much training in specific topics relevant to the conditions of the people they were caring for, such as dementia so the manager should consider this and access further appropriate training where it is identified as needed. In the AQAA the manager said that 75 of carers had successfully completed NVQs. Care Homes for Older People Page 21 of 27 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. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although formal quality monitoring systems needed improvement, opportunities existed for people to have their say about the home and people were listened to. Evidence: Although the manager has been in post a year she has still not applied to us to be registered and she must now do this as a matter of priority. Both people living at the home and staff told us that the manager was very approachable and supportive. Comments included, Oh shes lovely her, She comes every day and asks how I am and I like her. Staff said that they worked well as a team and staff morale was good because the manager worked with them. The manager said that the owner of the home visited at least once a week and spoke with staff and people living at the home but did not provide a written report to summarise the visit. The owner should undertake such visits and prepare a written report about them to be available to us when required. Several people told us there had been residents meetings but they had not attended. Satisfaction surveys had been distributed in August 2009 and a number of people living at the home or their representatives had returned them. The comments from these surveys was predominantly positive with only the provision of social stimulation being an issue that needed addressing. Comments on the surveys, to the question What does the home do well? included The informal approach whilst being professional. The care shown to X and the way staff know and understand her personality, care is second to none feels like a home and everyone is very friendly and it is very clean and they welcome you at any time. One person had responded Care Homes for Older People Page 22 of 27 more could be done to stimulate the residents and to interact with each other. There was no formal system of audit within the home to check that staff were working in accordance with the correct procedures, for example in respect of care planning, medicines management etc. and the manager needs to develop this. The AQAA did not provide enough information to demonstrate to us that the manager could identify what the home did well, what areas needed further improvement and how future plans could address them. The manager did not tell us in the AQAA if the requirements we made at the last inspection had been addressed, although during our inspection we found that most of them had, at least in part. We discussed with the manager the type of information that needed to be included in future AQAAs. Records were available to show that health and safety checks had been carried out in the building and equipment had been regularly serviced. Procedures for the management and safekeeping of peoples money were satisfactory. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes No x 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 24 of 27 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 Staff must attend training in 30/04/2010 the Mental Capacity Act (Deprivation of Liberty Safeguards). This will ensure that staff have the knowledge and understanding to take appropriate action to protect and promote peoples rights and choices. The manager must submit 17/03/2010 an application to be registered with the Care Quality Commission. To comply with legislation the home must have a registered manager in place. 2 31 8 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Detailed records of peoples assessed needs should be Page 25 of 27 Care Homes for Older People 2 7 obtained before admission to ensure that staff supporting them are fully aware of what their needs are and that people receive the service they require. Care plans should be up to date, accurate and clearly state what staff are aiming to achieve when delivering the care and how this will be monitored. This will tell staff what they need to do, why they need to do it and how they can assess if the care they give is meeting each persons needs. Advice and instructions given by health care professionals should be written in peoples care plans. This will make sure staff are aware of the advice and information is not missed. When staff handwrite instructions for the administration of medicines, these should be checked and validated by 2 people to reduce the risk of errors. Peoples social and recreational needs should be reviewed and opportunities to meet these needs made available. development of the key worker system should be considered to facilitate this. Further consideration should be given as to how peoples choice can be promoted at mealtimes. Menus should be reviewed to ensure they are varied and nutritious. Staff should be encouraged and supported to undertake further training in specfic topics related to the care they have to provide to people living at the home. This will ensure they have the most up to date knowledge of the care and treatment required for specific medical conditions. Further systems for quality monitoring should be developed, which include auditing (checking) that staff are following procedures correctly in respect of working practices such as care planning, medicines management and health and safety. The owner should carry out an unannounced visit to the home at least once a month and prepare a written report on the conduct of the home, which should be available for inspection at any time. 3 8 4 9 5 12 6 15 7 30 8 33 9 33 Care Homes for Older People Page 26 of 27 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. 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