Care Home: Humphry Repton House

What the care home does well There is detailed information about the home that can be provided to enable people and their families to make an informed choice about the home and what it has to offer. The pre-admission assessment process ensures that placement is only offered to those whose needs can be met. Each person is cared for as an individual and their health and personal care needs will be met, because care planning processes are person centred. Medication procedures are safe. People who live in the home have the opportunity to participate in a range of meaningful activities and are provided with a well balanced diet. Any complaints or concerns that people who live in the home or their relatives may have will be listened to and acted upon. The staff will ensure that people are kept safe because they are aware of safeguarding adult issues. Humphry Repton House is a comfortable, safe and well maintained home that is designed and furbished around the needs of people who have dementia. The people who live in the home will be cared for by staff who are familiar with their individual care needs, are well trained and have the necessary skills and competencies. The home is well managed, and is run in the best interests of the people who live there. It is a safe and secure environment. What has improved since the last inspection? We did not make any requirements following the last inspection, but we did make one good practice recommendation. We suggested that the home seek the advice of the safeguarding adults coordinator regarding the impact the behaviours of one person was having upon the others. This they did. There are currently no circumstances where this is a problem. What the care home could do better: We have made two good practice recommendations in this report. The staff will complete a number of risk assessments for each person as part of the care planning process. It would be best if they still recorded a judgement when no risk is present. When hand written entries are made on medication administration records, these should be countersigned by an other member of staff to double check the details. Key inspection report Care homes for older people Name: Address: Humphry Repton House Brentry Lane Bristol BS10 6NA     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: Vanessa Carter     Date: 1 6 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Humphry Repton House Brentry Lane Bristol BS10 6NA 01179592255 01179709301 debs@aspectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust care home 44 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Manager must be a RN3 or RNMH on the NMC register May accommodate one person aged 46 at the time of registration May accommodate up to 10 persons aged 50 years and over with dementia Date of last inspection Brief description of the care home Humphrey Repton House is a 44 bedded care home operated by Aspects and Milestones. Aspects and Milestones are a Bristol based, non profit making charity, with several other care homes and small group homes in the city. Forty three of the beds are for permanent placement, plus there is one room that the home use to offer a short-term respite service. The home is registered to provide both personal and nursing care for persons who have dementia. In addition the home is registered to take up to ten people between the ages of 50-65 with a dementia. Humphrey Repton House is set in large grounds and is a purpose built care home. The facilities have been extended to offer additional beds and a separate day care facility. It comprises four wings plus a service area where the kitchens and laundry are sited. Each wing has its own separate lounge and dining area as well as bathing facilities. Care Homes for Older People Page 4 of 27 Over 65 44 10 1 7 1 2 2 0 0 8 Brief description of the care home Although the home will retain its name, it will also be known as the Bristol Dementia Centre. Care Homes for Older People Page 5 of 27 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 last full inspection of this service was undertaken on 22 November 2007 and our overall judgement about the quality of the service provided for the people who live in Humphry Repton House was that people received a good service. After that inspection we planned to visit the service again within two years. In the meantime, we completed an annual service review on 11 November 2008 and were assured that the service was still providing good quality outcomes. Because we received a complaint about the service from relatives, we visited on 17 December 2008 to discuss with the home manager the issues that were being raised. We were assured that the home was dealing the matter appropriately. Prior to this inspection the registered manager completed the annual quality assurance assessment (AQAA). This is a self assessment document that focuses on how well outcomes are being met. The assessment had been completed in detail and told us about the improvements that have made over the last 12 months and identified those Care Homes for Older People Page 6 of 27 areas where they felt they could do better. During the inspection we looked at records kept by the home, including care records and those that are kept in respect of the running of the home. We spoke some of the staff on duty, the registered home manager and we observed the interactions between staff and people who live in the home. At the time of this report the fees for placement in the home range between 551 and 879 pounds per week. Additonal charges may be made for other services and these are detailed in the homes brochure. Care Homes for Older People Page 7 of 27 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 27 order line 0870 240 7535. Care Homes for Older People Page 9 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 10 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 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. There is detailed information about the home that can be provided to enable people and their families to make an informed choice about the home and what it has to offer. The pre-admission assessment process ensures that placement is only offered to those whose needs can be met. Evidence: The Statement of Purpose is kept under review and any changes to the document will be made as and when necessary. The document meets the standard required and enables people who want to know about the home, to decide whether the home is the right place for them. Any prospective person who wishes to live in the home is also provided with a copy of the homes brochure - this is also kept under review. Copies of the brochure and the last inspection report are displayed in the main reception area. Each new person is provided with a Licence Agreement or a statement of terms and conditions upon admission to the home. This sets out the terms and conditions of Care Homes for Older People Page 11 of 27 Evidence: occupancy and the fees payable. The pre-admission assessment process for new people ensures that only those people whose needs can be met will be offered placement in Humphry Repton House. The documentation that had been completed for the most recently admitted person was looked at to see how the assessor had made the judgement that the home was the appropriate place for the person. The assessment tool that is used covered a wide range of different needs. There was a summary of the care and social history of the person, along with other health information, mobility, nutritional needs, communication, medication, personality and well being, mental health needs and behavioural patterns. For this person we saw that the assessment had taken place in the hospital ward. The document presented a clear picture of the persons specific care needs. When local authorities or primary care trusts are involved in the arrangements for a placement, a care plan and health needs assessment will be obtained as part of the information gathering process. This nursing home is registered to provide placement for people with a dementia, who may also have challenging behaviour needs. The staff team are appropriately skilled to care for this client group. Most people are also frail and elderly, and therefore can also have a full range of other physical and sensory disabilities. Care Homes for Older People Page 12 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. 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. Each person is cared for as an individual and their health and personal care needs will be met, because care planning processes are person centred. The monitoring of healthcare status may not be consistently checked. Medication procedures are safe. Evidence: We looked at the care planning documentation for four people who live in the home. Detailed plans are prepared for each person based upon their assessed needs and information gathered from health and social care professionals and family members. We saw that for one person who had been admitted from hospital, a detailed summary of the persons Nursing Needs had been prepared by the ward staff. This provided details about specific care needs, behavioural patterns, measures that must be taken to safeguard the person and information about medications. The home plans each persons care based on individual needs. The plans cover a range of different aspects of health, personal care, mental and emotional health, mobility, eating and drinking, and social care needs. The likes, dislikes, strengths and needs are recorded for each person. It is evident that the plans are written in conjunction with other relevant parties and are reviewed and updated as often as necessary but at least on a monthly Care Homes for Older People Page 13 of 27 Evidence: basis. The plans are supported by a number of risk assessments, these are around mobility, use of bed rails, eating and drinking, aggression, skin viability, fire and bathing. Moving and handling profiles, showing safe systems of moving or transferring people are prepared, but for one person nothing had been recorded. This person was fully mobile - the document should reflect this as initially it appeared that the form had been over looked. The risk assessments for this same person needed final finishing as well and this was discussed with staff during the inspection. Daily accounts are recorded for each person who lives in the home - those that were seen were detailed and provided a clear record of care given and any other events that have occurred. We could track when healthcare was provided and how any events had been handled. Measurements of body weights are not consistently being carried out. Some people had not been weighed for a number of months The home has previously demonstrated that they have safe procedures in place for the ordering, receipt, storage, administration and disposal of medications, and we checked the current procedures in place with one of the team coordinators. No changes have been made to the systems in place, howevere we did note from looking at some of the medication administration records (MAR charts), that where hand written entries had been made, these were not countersigned by another nurse. This would be good practice to ensure that the entries being made are correct, and reduces the potential of errors being made. During the inspection, staff were observed interacting appropriately with people, being attentive and providing assistance as necessary. Because of peoples dementia, they were unable to express their opinions about how they were being looked after, but those we saw during the inspection looked contented and at ease. One person had periods of time when they became tearful (this was referred to in the information provided by the hospital and the care planning documentation) and staff were seen comforting the person. The home will continue to look after people whose health is deteriorating and are dying. They have produced an informative booklet for relatives that may help them with the grieving process. Staff representatives will always attend funerals and pay their respects to the families. Care Homes for Older People Page 14 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. 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. People who live in the home have the opportunity to participate in a range of meaningful activities and are provided with a well balanced diet. Evidence: The home has designated activity organisers, who arrange a variety of different activities to provide meaningful social interaction for people who live in the home. A number of different activities are arranged on a daily basis. Support workers are also responsible for engaging the person they are looking after in meaningful activities. Examples of things that we saw happening include the following - one person was having a foot massage, another was watching a sensory light show, others were watching television or exploring their environment. Some activities are provided by outside entertainers and during the summer months outings may be arranged. Activities include music sessions, a monthly church service, pets as therapy, birthday celebrations and other such celebrations. Alternative therapies such as aromatherapy and reflexology are available but there is an additional charge for these services. People will be supported to continue with activities and arrangements outside of the home, where this is possible - for one person this had previously been important so that they could meet with others of the same age and culture. Care Homes for Older People Page 15 of 27 Evidence: People who live in the home can get up or go to bed when they wish, and their individual preferences will be accommodated in to the daily routine. People are able to move independently around the home as they are able. People can choose where they want to sit and where they take their meals. This freedom means that at some times of the day the home can appear to be chaotic and messy. The midday meal arrangements are unchanged since the last inspection and people will be offered a visual choice at each mealtime. This is so that people choose what they would like to eat at that particular time. People will not be discouraged from eating whilst walking around if this is the only way in which they will eat. Better monitoring of peoples body weight is required to ensure that people are getting enough to eat and are not losing weight. We looked at the records kept in respect of five people and for only one person was the weight recorded on a monthly basis. We saw that one person had a significant weight loss however in this instance the person had been in hospital and was now gaining weight. Some people liked to wander around with their meal in their hands whilst others needed to be assisted to eat their meals. Many of the people needed regular prompting and encouragement to help themselves. Mealtimes are unhurried and would appear to be chaotic to an outside visitor, however the people who live in the home continue to receive the service that meets their needs. There was good interaction noted between the staff and the people who live in the home. This evidences that those who live in the home are cared for as individuals and this is good practice. Care Homes for Older People Page 16 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. 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. Any complaints or concerns that people who live in the home or their relatives may have will be listened to and acted upon. The staff will ensure that people are kept safe because they are aware of safeguarding adult issues. Evidence: The homes complaints procedure is included in the homes brochure and is displayed in the main reception area. We did not receive any completed survey forms back from people who live in the home or from relatives. There were no relatives in the home during the inspection to check that they are aware of the complaints procedure. Since the last inspection we have been contacted on just one occasion by relatives who had made a complaint and were not happy with the way the issues were dealt with. We visited the home and discussed the issues that had been raised and we found that the manager and the deputy were taking the complaint seriously and were addressing a number of areas where things could have been done better. The manager had a plan of action to ensure that the same issues did not happen again. The main issue to come out of this complaint was that there needed to be better recording of events and actions taken. In the AQAA self assessment document we were told that the home have received three complaints in the last year and has dealt with these to conclusion following their complaints procedure. The home has in past shown us all the compliments they have received from greatful relatives. We did not discuss these on this occasion. Care Homes for Older People Page 17 of 27 Evidence: The home has a policy on the protection of vulnerable adults (POVA) and this is in line with locally agreed protocols. Copies of the current Bristol City Council No Secrets Guidance is available for the staff. The manager has made one safeguarding referral to the local authority and has assited with the resulting investigation. Discussions with other staff evidenced their awareness of safeguarding adult issues and they confirmed that they have received training. Care Homes for Older People Page 18 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. 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. Humphry Repton House is a comfortable, safe and well maintained home that is designed and furbished around the needs of people who have dementia. Evidence: Humphry Repton House is a purpose built care home that is able to accommodate up to 44 people, one of the rooms is used for planned short-term stays, whilst the other 43 rooms are for permanent placements. These rooms however will be offered for respite stays, when they have vacancies. On the same site there is also local offices of the Alzeihmers Society, a self-contained day care centre and offices for a domiciliary care service. The home is surrounded by pleasant gardens that are secure and are designed with sensory stimulation in mind. A Wall of Smiles is kept by the Friends of Humphry Repton where tiles are decorated and displayed to remember all previous people who lived at the home. The main entrance has comfortable seating, the visitors signing in book, a display of relevant information and photographs of the whole staff team. The main front door is secured out of hours and the doorbell is programmed into the deck-phones carried by qualified staff. The home is arranged as four wings, three being in the original part of the home and the forth being in the new section (referred to as the green wing). Each area has its Care Homes for Older People Page 19 of 27 Evidence: own communal areas, assisted bathrooms and toilets. The three wings are situated around a central courtyard, each containing ten bedrooms. All bedrooms have a wash hand basin and french doors, leading out on to the garden area. These bedrooms have either already been redecorated or will be once they become vacant. Each wing has its own communal area consisting of a lounge and dining room and these rooms have been refurbished and redecorated and are in keeping with the newer parts of the home. One of the lounges is set up as a sensory area with moving lighting. Easy-clean flooring has been laid throughout. The three wings in the original building link together and people are able to move between the different parts of the home freely. The forth wing is in the new building and has its own separate entrance. Each of the 12 bedrooms have en-suite facilities of a wash hand basin and toilet, and they are furnished with specialist nursing beds. A number of different types of armchairs are available to meet diferent peoples comfort needs, and there is a range of moving and handling equipment. The laundry room is equipped with two large washing machines and one tumble dryer, and all personal and home laundry is attended to in-house. The kitchen is fully equipped and has recently been inspected by the Environmental Health Department they have been awarded five stars for hygiene. Both facilities are located in the link corridor between the two areas of the home. The home was generally clean and tidy throughout. There were no unpleasant odours. 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. 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 people who live in the home will be cared for by staff who are familiar with their individual care needs, are well trained and have the necessary skills and competencies. Evidence: Nurses and support workers work within an established shift pattern. The 7am to 3pm shift is covered by two qualified nurses and eight support workers (two being allocated to each wing). From 1pm until 9pm there are two nurses and four support workers plus four who work between 3pm and 8pm. Over night there are two nurses and four support workers. The staff team alter between day and night duties. We have been in discussion with the home manager about support workers who have achieved a National Vocational Qualification (NVQ) in health and social care at Level 3, being given more responsibility in running shifts and organising care planning for example. No changes are planned as yet. The home has a team of approximately 43 employees made up of qualified nurses and support workers. Some work full time whilst other part time. Each wing has its own team coordinator and team leaders. Of the 33 support staff, 21 or 66 of them, have already achieved at least an NVQ at level 2. Five support workers are just about to sign up to start NVQ level 2. This evidences a real committment to provide well trained staff. Care Homes for Older People Page 21 of 27 Evidence: There is a continual process of staff recruitment going on although the turnover of staff is not as great as it has previously been. The home still uses a fair amount of agency staff however are now using just one agency. This helps ensure that the same staff are supplied to fill shifts and increases the chances of people being looked after by staff who are familiar with their care needs. We spoke with one agency worker who told us that they had been to the home on many occasions and knew the people they would be looking after for that shift. The management and care team are supported by administrative, housekeeping and catering staff, in meeting the daily living needs of the people who live in the home. The staff files of six newly recruited support workers were checked and evidenced that the home follows safe vetting procedures. An application form has to be completed by all applicants, they are interviewed and they will only start work once two satisfactory written references from previous employers have been received, POVAfirst clearance and CRB disclosures have been confirmed. All new staff will complete an induction- training programme at the start of their employment, to ensure that they are aware of the homes procedures and are competent in all areas of their work. Corporate induction will take place at the Aspects and Milestones head quarters whilst competency in the job role, is confirmed by home staff. The programme to be completed has been formulated in to a booklet where competency has to be signed off. Assignment books based upon the five day induction programme have to be completed. The programme includes core values, safeguarding adults alerter, food handling, first aid, health and safety, fire awareness, manual handling and COSHH (care of chemical substances). The home maintains a staff training file for each staff member and examples of other training that staff have attended includes, positive behavioural management and dementia care. The manager told us about new dementia care training that has just been launched - this provides information on the different types of dementia, the changes that can occur, and how to deal with different situations. A relative was also included in the training and gave their perspective of handing over the care of their loved one to the home and being included in the ongoing care. Staff spoken with during the inspection said the training had been good. Care Homes for Older People Page 22 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. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, and is run in the best interests of the people who live there. It is a safe and secure environment. Evidence: The Home Manager, Mrs Deborah Stone has been in post for six years. She is a registered nurse in mental health and has completed the NVQ Level 4 in Management and Registered Managers Award (RMA). Mrs Stone works Monday to Friday, along with a deputy manager. Each wing has a team co-ordinator, team leaders, registered nurses and support workers. There are on-call arrangements for the weekends and out of office hours,provided by the manager, the deputy or other home managers. Staff meetings are held on a regular basis and records are kept of all meetings. Previous meeting notes were displayed on the staff notice boards. Support groups for relatives are currently on hold but it is hoped that these will restart and be held on a regular basis. Care Homes for Older People Page 23 of 27 Evidence: The home completed a relatives satisfaction survey in June 2009 and a summary report was prepared. The report was based upon 23 out of 30 surveys that were sent out. Relatives were asked about the standards of care, care planning, the home environment, food, and concerns and complaints. The area manager from Aspects and Milestones completes quality assurance monitoring visits (called Reg 26 reports). Copies of these are kept in the home and available for inspection. Care plans are reviewed on a regular basis and meetings are held regularly to capture relatives and staff views and where appropriate, the views of the people who live in the home. It is evident that the home has a number of processes in place to monitor the quality of their service and to ensure that the service remain appropriate to the needs of the people who live in the home. The home looks after personal money for people who want this facility. There are safe systems in place to account for all transactions in and out of the accounts. The accounts will be auditted by their finance department on a regular basis. Staff supervision is arranged for the staff team and is undertaken by a number of different people. The home manager will supervise team coordinators, the activity staff and the housekeeping team. The deputy supervises the team leaders who in turn supervise the support workers. Supervision is generally held on a two monthly basis. Sometimes group supervisions will be held if time constraints or peoples shift patterns have resulted in some sessions being missed. Staff spoken with during the inspection said that they were well supported and supervised. The manager completes regular audits of the home in respect of health and safety. The fire records were all in order and the fire risk assessment was in the process of being reviewed and updated. Fire drills are held on a regular basis. Portable appliance checks on electrical equipment had been completed. Loler checks on moving and handling equipment are undertaken on a six monthly basis. The maintenance team visits the home on a weekly basis and completes any repairs that are needed in a timely manner. Risk assessments are carried out for all safe working practices (moving and handling tasks) and records are maintained when any restrictive measures need to be taken to secure each persons safety (bed rails). There were no health and safety concerns raised as a result of this inspection. Care Homes for Older People Page 24 of 27 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 25 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 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 8 All standard risk assessments should be completed and evidence where this has been judged to be no risks should be recorded. Hand written entries on medication administration records should be countersigned by another member of staff. 2 9 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). 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