Care Home: Howards

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What the care home does well Prospective individuals are provided with information, including visiting the home in order that they can make an informed choice about using the services provided. People who may wish to use the service have a full needs assessment prior to using the service in order to ensure that the homes staff have the abilities to meet the individuals assessed needs. Residents care plans were up to date and the provision of personal care and support reflected a person centred approach. Care plans are electronic and staff update the care plans daily. This is undertaken by the manager and senior staff. Residents health care needs are well met and the members of staff have maintained good working partnerships with health care professionals. Support and care is provided in a way which promotes peoples dignity and privacy. Residents rights to choice about their daily routines and the range of activities offered is promoted. Visitors are made welcome to the home so that residents maintain contact with their family members and friends. The home provides a healthy and balanced diet in spacious and pleasant surroundings. The physical design and layout of the home continues to support individuals to live in a safe and well maintained and comfortable environment. The control of the spread of infection in the home and cleanliness is robustly managed. Communal and private areas of the home are of a high standard, well furnished and comfortable for individuals. Staff in the home are in sufficient numbers to support people who use the service. The induction and training practise of the home currently ensure that staff receive training to meet residents needs. The home is run in the best interests of individuals and their views and opinions are sought and acted upon. What has improved since the last inspection? The admission and assessment procedures have been improved to ensure that prospective individuals needs are consistently identified and documented to ensure staff have the skills and abilities to meet the persons needs. Intermediate care is not currently offered. The standard of recording, management, regular reviewing and documentation of the care plans had significantly improved to include a more person centred approach to wards the individuals health, medical, personal and social care needs. The documentation and monitoring of risk assessments has been significantly strengthened to ensure the safety and well being of individuals and staff in the home. The home has recruited a chef since the last inspection the menus had been developed by the chef who listens to what individuals would like to eat and their views about the meals provided are considered. The home has updated the complaints policy and procedure following the previous inspection and all individuals and their representatives have an updated copy in order that they are aware of how to raise any concerns or complaints they may have about the services provided by the home. The home has obtained the local authority multi agency safeguarding vulnerable adults policy and procedures 2008. The homes safeguarding policy complies with the local authority protocols in order to promote peoples rights to safety and protection from harm or abuse. The home has implemented well documented recruitment procedures for the safe vetting of staff. The environment in the home is being constantly up graded, some bedrooms have been redecorated, new floor covering and new furniture provided. The two lounge areas have been redecorated and two bathrooms on the first floor have been changed to shower rooms. The manager stated the ground floor bathroom is in the process of change as and when the bedrooms become vacant, these rooms will be decorated. The chef informed the inspector that a new fridge freezer has been purchased and will be delivered within two weeks. The home is comfortable, clean and homely and areas in need of upgrading are being changed as and when rooms become vacant. What the care home could do better: It is recommended that the manager spends more time on appropriate management duties to ensure records are kept up to date and documents are up dated and recorded to reflect and recognise their accountability in reporting factual and accurate records relating to the home are in place. Key inspection report Care homes for older people Name: Address: Howards 24 Rowtown Howards Addlestone Surrey KT15 1EY     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: Vera Bulbeck     Date: 0 7 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 29 Information about the care home Name of care home: Address: Howards 24 Rowtown Howards Addlestone Surrey KT15 1EY 01932856665 01932856665 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Greydales Limited Name of registered manager (if applicable) Nicola Crossley Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category sensory impairment Additional conditions: The age/range of persons to be accommodated will be 60 years and over The maximum number of service users to be accommodated is 21 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 needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Dementia (DE) maximum number of places 10 Sensory Impairment (SI) 4 Date of last inspection 0 0 0 Over 65 0 0 0 Care Homes for Older People Page 4 of 29 Brief description of the care home Howards is a care home providing personal care and accommodation for up to twentyone people of mixed gender aged from 60 years. Service provision includes dementia care. The home is situated in a quiet residential area on the outskirts of Addlestone village and is a few minutes walk from a small parade of local shops. It is within 2 miles of the M25 and readily accessible from Central London and the Home Counties. The building is detached with off road parking at the front. Bedroom accommodation is arranged on two floors, served by a full size passenger lift. Nineteen bedrooms are for single occupancy, fifteen with en-suite facilities and there is one twin bedroom. Communal facilities comprise of assisted bathroom, two shower rooms and toilet facilities, also two lounges and a conservatory, which is also the dining room. The conservatory overlooks a well-maintained garden with two fishponds. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Howards is a registered home, owned by Mr G Samuel and managed by Mrs N Crossley, and provides care services for up to 21 residents in the categories of old age and dementia. Accommodation in the home is arranged over two floors and includes communal lounge areas, dining room, one double bedroom and nineteen single bedrooms the majority with en suite facilities and adapted bathrooms and toilets. The nicely laid out garden is accessible for residents their friends and families and the home is located close to local shops and offers car-parking facilities in the front and back of the home. The Quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Care Homes for Older People Page 6 of 29 The previous key inspection on this service was completed on the 24th September 2008. This key inspection was conducted by Mrs V Bulbeck Regulation Inspector and lasted for six hours fifteen minutes commencing at 10.00 hours and concluded at 16.15. The registered manager represented the service. The inspector looked at and assessed how well the service was meeting all the National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. The service had completed the Annual Quality Assurance Assessment AQAA. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document was received by the commission was noted as being well documented and is referred to throughout the report. The information contained in this report was gathered from observation by the inspector, speaking with a number of residents living at the home, the care staff and information contained within the AQAA. Further information was gathered from records kept at the home. The commission received one written survey/comments from a resident. The information from the comment card has been added within the report. A full tour of the premises was undertaken and documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, some residents care plans, daily records and risk assessments, medication procedures, health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the registered manager about the findings of the visit. The commission received an anonymous complaint, which was investigated at the time of this inspection. The commission has not been made aware of any safeguarding vulnerable adults referrals since the last inspection. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The admission and assessment procedures have been improved to ensure that prospective individuals needs are consistently identified and documented to ensure staff have the skills and abilities to meet the persons needs. Intermediate care is not currently offered. The standard of recording, management, regular reviewing and documentation of the care plans had significantly improved to include a more person centred approach to wards the individuals health, medical, personal and social care needs. The documentation and monitoring of risk assessments has been significantly strengthened to ensure the safety and well being of individuals and staff in the home. The home has recruited a chef since the last inspection the menus had been developed by the chef who listens to what individuals would like to eat and their views about the Care Homes for Older People Page 8 of 29 meals provided are considered. The home has updated the complaints policy and procedure following the previous inspection and all individuals and their representatives have an updated copy in order that they are aware of how to raise any concerns or complaints they may have about the services provided by the home. The home has obtained the local authority multi agency safeguarding vulnerable adults policy and procedures 2008. The homes safeguarding policy complies with the local authority protocols in order to promote peoples rights to safety and protection from harm or abuse. The home has implemented well documented recruitment procedures for the safe vetting of staff. The environment in the home is being constantly up graded, some bedrooms have been redecorated, new floor covering and new furniture provided. The two lounge areas have been redecorated and two bathrooms on the first floor have been changed to shower rooms. The manager stated the ground floor bathroom is in the process of change as and when the bedrooms become vacant, these rooms will be decorated. The chef informed the inspector that a new fridge freezer has been purchased and will be delivered within two weeks. The home is comfortable, clean and homely and areas in need of upgrading are being changed as and when rooms become vacant. 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 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive pre admission assessments are undertaken to ensure the service provided can meet the needs of people using the service. The home provides up to date information for residents including a written contract. Evidence: The manager confirmed that pre assessments on each resident are under taken prior to taking up residence in the home by the manager. Pre assessments fully completed were seen on the files of residents. The pre assessment document needs to include all areas at risk to the resident. The pre assessment process encourages prospective residents to visit the home, they stay for tea and maybe stay overnight or for a weekend. This also provides the residents currently living in the home the opportunity to meet and find out about the prospective resident. This also enables the prospective resident to decide whether the home can meet their needs, and if the accommodation is to their liking. The manager also stated that care managers are very much involved Care Homes for Older People Page 11 of 29 Evidence: with the residents and undertake regular reviews. The homes statement of purpose was seen and is up dated on a regular basis, details are informative and clear. The service users guide was also seen and this has been recently up dated and the manager stated this document is up dated as and when required. Contracts were seen on residents files providing full details of accommodation, services and fees. The service does not provide intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are involved in decisions about their lives and have an active role in planning the care and support they receive. Residents health care is promoted and the care residents receive is reviewed and changes recorded. The medication processes in the home are robust to protect residents from harm. Evidence: All care plans sampled evidenced that residents and their representatives had been involved in the development of their care plans which also demonstrated evidence of the residents equality and diversity. The care plans were person centred and included a range of information about the resident, for example their life experiences and social history, how they like to communicate, their skills and abilities, and how they like to make choices in their lives, be addressed and how their health care needs are met. The care plans were up to date and reviewed regularly to reflect the changing needs of the residents. These care plans are now an electronic version and the manager and senior care staff have access to the computer. The care plans are also printed in hard back copies to enable residents and staff to view the details. The care plans and risk Care Homes for Older People Page 13 of 29 Evidence: assessments which were relevant to the resident to reflect the hazards being presented in their daily life and the measures in place to reduce the hazards as far as reasonably practicable. The inspector advised the manager to produce a chart of residents having falls so that they can be monitored and where falls had occurred frequently residents should be referred to the falls clinic. The residents risk assessments had been reviewed and updated in order to ensure their safety as far as possible, it would be advisable to include on the risk assessment document the residents use of the stairs. During the tour of the premises it was observed that residents residing in the home do not hold keys to their door, only one room had a key . However some rooms did have a lock that can be locked from the inside, and the staff are able to open the door in an emergency. The senior carer explained that most of the residents do not go up stairs without a member of staff present. Only one written comment feedback sheet about the care people receive at the home was returned to the commission and details included The home is well run and cares for its residents overall the home does a very good job. A number of complimentary letters and cards were seen by the inspector, these were sent to the home by various people who have had relatives and friends living in the home. There was evidence to support that the home has maintained links with the local general practitioner who visits the home regularly. Health care professionals visits are arranged for residents who require specific referrals are made where necessary to maintain residents health and welfare. The home has a medication policy and procedure in place and uses a blister pack system. Medication records were well documented and accurate. The procedures for ordering, delivery and disposal of medicines were robust. Training records evidenced that trained staff who administer medicines had received appropriate training which was up to date. Whilst speaking with staff it was confirmed that people have a right to refuse to take medication and if the refusal continued advise would be sought in order to ensure the residents well being. The present cupboard used for the storage of controlled medicines does not meet the required standard and should any resident be admitted with prescribed controlled drugs in the future, the home would not meet the regulations. Throughout the day the inspector observed that people were addressed in a polite and courteous way by all staff and there was some evidence of meaningful professional relationships between staff and individuals at the home. It was also observed that the bathroom and toilet doors need to have signs so that residents know where the appropriate facilities are this would enable residents the dignity particularly for Care Homes for Older People Page 14 of 29 Evidence: residents who are able to use the facilities unaided. The inspector observed staff to be polite and courteous to residents and in general staff knocked on residents doors before entering their rooms. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents rights of choice about their daily routines and the range of activities offered is promoted. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet in spacious and pleasant surroundings. Evidence: The home has continued to offer meaningful leisure activities for individuals and these include staff having one to one time with residents, some individuals go on various outings to the theatre, Wisley, Brighton and shopping trips particularly before Christmas when two residents are taken by staff for shopping and stop and have tea and cakes. The home has an activity organiser four afternoons per week and she undertakes a number of sessions the residents enjoy for example bingo, bowling, skittles, painting, sewing and craft. As well as music for health, exercises to music and quiz sessions. The activity organiser was playing the guitar and singing with the residents on the day of inspection, and clearly the residents were enjoying the afternoon. The registered manager advised that when trips are organised she books a vehicle and the services of a driver which would enable individuals to go out for day trips during the summer months. Care Homes for Older People Page 16 of 29 Evidence: The homes communal facilities promote individuals to live in a homely atmosphere with a variety of areas where they can continue to take part in leisure and hobby activities. There were a variety of books and board games, jigsaws and music available for individuals to choose from if they wished to and it was observed that some individuals had made strong friendships in the home and helped each other during the course of the day. Residents are encouraged to be part of the local community and attend local fairs, seasonal occasions and events. The registered manager confirmed that a hairdresser and manicurist visit the home to offer beauty therapy. The landscaped garden has a summer house for individuals wanting to just sit and watch the wildlife who enter the garden including a duck seen on the day of inspection. People were seen to move around the home freely and the atmosphere in the home was was quiet and relaxed. It was observed that staff were calm and flexible to adjust to residents choices which indicated the service was led by the individuals living in the home rather than by the homes procedures. Residents are offered a choice if they wish to have their breakfasts in their rooms or in the dining area and most people have their breakfasts in their rooms. The chef confirmed that the menus had been developed with residents input. The chef and staff serve the meals to the residents. The menu available contained a varied and nutritious diet for residents. There was evidence to support that individuals with specific dietary preferences for example vegetarian diets were catered for. A choice of cereals at breakfast and at lunch time the chef stated he would cook something different for anyone who did not like the meal being served. Only one choice was on the menu which was roast lamb and all the trimmings, the meal was nicely presented. The chef stated that he knew all the twenty residents their likes and dislikes and if they wanted something different he would cook it. Residents were all clearly enjoying their lunch and residents stated the meals are very good. The chef stated they soon tell me if they dont like something. There was good communication between residents and the chef. The midday meal was served in an efficient manner in the dining area and the dining room contained small tables which had been had been set with appropriate condiments, crockery, tablecloths and napkins. The chef stated the Environmental Health Officer EHO had visited the home the previous week to the inspection, the chef had not seen the report that was left by the EHO. However he was informed that the fridge freezer kept in an out house in the grounds of the home had rust on the top. Management ordered a new fridge freezer Care Homes for Older People Page 17 of 29 Evidence: immediately and it will be delivered in two weeks time. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights are supported and protected by the homes complaints and safeguarding adults procedures. Evidence: The homes complaints policy and procedure has been up dated and reviewed on a regular basis. All residents and their representatives have an updated copy in order that they are aware of how to raise any concerns or complaints they may have about the services provided by the home. The inspector advised the registered manager to ensure regular resident meetings are held. The registered manager confirmed that no complaints had been received by the home and any complaints received would be fully investigated and that records would be kept by the home to evidence this. Several people told the inspector that they would talk to the staff or their family members if they had any concerns or were unhappy. There was evidence to support that the registered manager and staff have knowledge regarding peoples human rights with regard to the Mental Capacity Act and Deprivation of Liberty safeguards and the home have maintained access to an advocacy service as required. The home have, following the previous inspection been more mindful and have implemented risk and multi agency assessments regarding any actions by the homes staff that may constitute deprivation of liberty of individuals, and have ensured that appropriate advise is sought and agreed by the appropriate Care Homes for Older People Page 19 of 29 Evidence: parties to ensure any deprivation of liberty is lawful and individuals protected. The home has obtained the local authority multi agency safeguarding vulnerable adults policy and procedures 2008 and complies with the local authority protocols. The registered manager, was clear in detailing the process of reporting alleged harm or abuse and three staff records sampled indicated that staff had attended safeguarding vulnerable adults training. The home has a whistle blowing procedure in order that staff are aware of their duty of care to report any safeguarding incidents. The three staff files sampled evidenced that Criminal Record Bureaus checks had been obtained on all staff working in the home. Accident and incident records were sampled which indicated that events which affect the well being and welfare of individuals are reported to the commission without delay and this process must be maintained. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout continues to support individuals to live in a safe, well maintained and comfortable environment. The control of the spread of infection in the home and cleanliness is robustly managed. Evidence: It was pleasing to note that a number of bedrooms have been decorated and refurbished this includes, new floor covering and new furniture. All the bedrooms have a wash basin and eighteen bedrooms now have a toilet and some with shower or bath. There is only one bedroom that has a key lock the majority have locks which can be locked from the inside and are sliding locks which the staff can open in an emergency. The two bathrooms on the first floor have been refurbished and are now shower rooms, both rooms have been fitted with facilities for the residents needs. The Inspector suggested that signs need to be fitted on the doors to enable residents to be aware of the shower rooms and toilets. The large and small lounge have been re decorated and residents stated they think the home is very nice and like the new colours. The old style bathroom on the ground floor looks out of place in the newly furnished home, however the manager stated this bathroom will be up dated as soon as possible. A number of bedrooms on the ground floor need decorating and these will be redecorated when the rooms become vacant. It was noted that most of the bedroom doors had wedges. This was discussed with the manager who stated some of the residents do not like their door closed at night. The inspector informed the Care Homes for Older People Page 21 of 29 Evidence: manager that residents who require their bedroom door open at night must be assessed for appropriate fire prevention safety to enable the door to remain open and the door should be fitted to the fire alarm system to ensure residents are safe at all times day and night. It would be advisable to contact the fire officer for some advice to ensure the home is safe from potential hazards. The home was homely, clean and nicely presented. The garden is nicely laid out and residents are able to use the facilities there is a summerhouse for the residents to use and on the day of inspection the weather was reasonable and residents were sitting in the summer house chatting. The garden is a haven for wildlife a duck was using the garden and pond on the day of the visit. There was gel hand wash available in various places around the home for staff, visitors and residents to use to ensure cross infection is under control. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are in sufficient numbers to support the residents who use the service. The homes recruitment procedures for the safe vetting of staff and the management of recruitment practises have been strengthened to protect the welfare and safety of individuals at the home. The induction and training development practises of the home currently ensure staff receive training so that residents needs are appropriately met. Evidence: The home currently employs fifteen permanent care staff seven of whom have achieved their National Vocational Qualification NVQ Level 2 award or above. The staffing levels at the home during the inspection were considered to be appropriate to meet the care needs of the individuals residing at the home. The general atmosphere was quiet and orderly and staff were observed to undertake their duties in an efficient and professional manner. Staff relationships with individuals were professional and the use of terms of endearment supported trusting relationships between the individual and the staff member. Residents preferences on how they like to be addressed were documented in residents care plans. The homes recruitment and selection policy was sampled during this inspection. The Care Homes for Older People Page 23 of 29 Evidence: inspector sampled three care staff files. The documents regarding the safe recruitment and vetting of new staff was in place to ensure the safety and protection of people in the home. There was documented evidence that a Criminal Record Bureaus clearance had been obtained for all staff working in the home. The rota was checked and found to be well covered by the permanent staff particularly anyone who may be sick or on holiday. Staff confirmed they are happy to cover these duties. Therefore the home does not use agency staff, which means residents are happy to have staff attend to their needs by staff they know at all times. The registered manager confirmed that the home is committed to the ongoing training and development of staff and the staff files sampled evidenced that staff had attended induction, statutory training and specialist training including dementia training to support them to care for individuals with specific needs. The AQAA advises that the management ensures that staff can undertake training at their own pace and an external company will assess staff progress. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the homes administration needs to be strengthened. The home continues to be run in the best interests of individuals and their views and opinions and those of others associated with the home are sought and acted upon and residents general safety and welfare is promoted. Evidence: The registered manager has attained the Registered Managers Award and NVQ Level 4 in Care and continues to offer leadership and stability in the home. It was evident during the inspection that the homes staff have open and professional relationships with individuals living in the home and peoples views about the care and support their friends and relatives receive is listened to and acted upon by the registered manager and staff. The management of the home has been consistent and continues to be based on the principles of being open and respectful. The registered manager, demonstrated Care Homes for Older People Page 25 of 29 Evidence: throughout the inspection a knowledge and understanding of the day to day running of the service for the benefit of the residents living at the home. The manager needs to spend more time undertaking administration duties, there are a number of records that need up dating particularly around staff supervision, the format used is very basic and needs to be more user friendly and detailed. Staff meetings need to be more proactive and encourage staff to be involved with the home. The home has maintained an internal Quality Assurance process and there was evidence to support that the views from residents living in the home had been instrumental in changing some of the aspects in the home, which have included changes and increased number and type of activities. The fridge, freezer was well stocked. Fresh fruit and vegetables were available for individuals. Records of food temperatures, storage of food in the fridge in compliance with food hygiene standards to ensure residents health and safety. The Environmental Health Officer has recently visited the home and made a recommendation that the fridge freezer located in one of the outhouses had a rusty top. Management of the home immediately purchased a new one which will replace the old fridge freezer and delivery will be within two weeks. The storage of chemicals in the home were appropriate to ensure the safety and welfare of all residents in the home. Fire safety measures were in place and documents were sampled. The homes fire procedures confirmed that records were kept of fire tests and equipment checks and signage was available within the home to show residents, staff and visitors fire exits. The AQAA advises that the home does not have the responsibility for individuals money and relatives safeguard individuals financial interests. However the manager stated small amounts of money is kept for residents hairdressing and chiropody for example if requested. Details of the financial administration procedure was observed and found to be well documented. The home has a current certificate of registration and insurance indemnity certificate displayed within the home. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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