Care Home: Isard House

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What the care home does well Shaw Healthcare were felt to be a good employer who provided staff with training and the resources to carry out their role. The manager said she felt supported by the senior personnel in the company. The company have standard documentation, which is comprehensive and covers all aspects that are required to maintain records satisfactorily. There are systems in place for internal auditing and the role of the Quality Team ensures standards are maintained. Relatives are able to visit their family members when they want and are able to play an active role in their family members care if they wish. The majority of the senior staff team and many of the other staff members have been in post for some considerable amount of time, which ensures that residents receive consistent care form staff that are fully conversant with their needs and the workings of the home. What has improved since the last inspection? The quality of the information recorded on the care plans has improved since the last inspection and care plans were seen at this inspection to provide more useful information together with action plans that staff can implement to meet the residents identified needs. The newly introduced key working system has improved record keeping and staff accountability for maintaining these records. The development of the activities room has provided further choices in residents lives. The appointment of a permanent manager, who is experienced, is an asset. It was evident that she had worked hard at driving improvement in the service. What the care home could do better: The Statement of Purpose and Service User Guide need to be amended to reflect the correct Regulatory Authority and the new manager. Staff need to work to support the existing leisure and activities and spend time engaging with residents. Communal areas must be staffed at all times and sufficient cover organized in case of emergencies. Residents should be provided with comfortable seating and alternatives to wheelchairs. Wheelchairs need to be fitted with foot rests to ensure residents are transported safely. Key inspection report Care homes for older people Name: Address: Isard House Glebe House Drive Hayes Bromley Kent BR2 7BW     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: Rosemary Blenkinsopp     Date: 2 4 0 3 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: Isard House Glebe House Drive Hayes Bromley Kent BR2 7BW 02084626577 02084620952 isard.manager@shaw.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shaw Healthcare Ltd Name of registered manager (if applicable) Mrs Philomena Margaret Winterboer Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 45 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 45) Dementia - Code DE (maximum number of places: 45) Date of last inspection Brief description of the care home Isard House is a large two-storey building built around two secure quadrangles. The home is set at the end of a cul-de-sac with open fields bordering onto the rear and side of the homes grounds. Isard House is situated within walking distance of public Care Homes for Older People Page 4 of 29 Over 65 0 45 45 0 3 1 0 3 2 0 0 9 Brief description of the care home transport links and local shops. Parking is provided to the front of the building. Since April 2005 Shaw Healthcare have been responsible for the management and provision of this service. Referrals are made through the Local Authority Social Services Department. The home does have two bedrooms available for private purchasers. This home provides care and accommodation for 45 older persons who may or may not have dementia. All bedrooms are now single rooms converted from existing double bedrooms. . Residents accommodation is on the ground floor. There are grab and hand rails in corridor areas, stairs, toilets and bathroom. Specialised bathing and toilet equipment and lifting aids are available for residents use. There are various lounges and sitting areas available. Fees range from £495.00 to £690.00. The fees for Local Authority placement and those purchasing care privately are different as are the fees for those with Dementia. Items such as toiletries, hairdressing, and private chiropody are paid from individuals personal monies and not included in the fees. The home provides information on the service through a Statement of Purpose, which can be supplemented on request with a copy of the latest inspection report. 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: The inspection was conducted over a one and a half day period. The manager facilitated the second site visit, and the deputy assisted with the first day. The inspection covered all the key standards in the National Minimum Standards. Prior to the inspection the manager had completed the AQAA and forwarded this to the CQC. Two comment cards were received prior to the site visit, including one from a resident the other was from a staff member. During the site visit we met with several relatives, residents and one health professional. Periods of observation were undertaken on the units by us to see how residents spent their time. Staff were interviewed as part of the site visit. Care Homes for Older People Page 6 of 29 All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. The homes Registration Certificate with the Commission was seen displayed appropriately in the hallway. There have not been any changes in the ownership of this home since the last inspection, although the manager has changed. Feedback was provided to the manager at the end of the second visit. One requirement has been made as a result of this inspection. Care Homes for Older People Page 7 of 29 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. Care Homes for Older People Page 8 of 29 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. The pre-admissions procedures provide residents and their families with the information they require prior to any decision regarding placement being made, to establish whether the service is right for them Evidence: We inspected several residents files over the course of this inspection and found that for all these people their needs had been assessed before moving into the home. The assessments, we were told, are usually carried out by the manager or another senior members of staff. Standard assessment formats are in use and these identify the persons physical, mental and social care needs and any other useful information such as their current medication and possible side effects of the medication. Those which we viewed were well completed and provided good information about that individual. This would provide staff with a good base from which care could be delivered and an initial care plan developed. Care Homes for Older People Page 11 of 29 Evidence: Residents were unable to tell us about their experiences of moving in to this service although relatives did provide information. The relatives that we spoke with said that they had received information and had opportunities to visit the home. Two relatives had moved from other Shaw homes in the Borough. The felt they were supported and assisted during the transition period. There was a selection of information available including the Service Users Guide an the Statement of Purpose , both of which will need amending to reflect the correct Regulator, namely the CQC and the new manager. The AQAA told us the following : We carry out a thorough pre-admission assessment for all prospective residents to the Home whether they be funded or private residents and where the referral is made via a local authority that we receive a full report of the residents assessed needs. We inform them of our decision to admit as soon as possible. Prospective residents are offered trial visit to the home and make available to them reliable, accurate information so that they are able to make a decision as to whether the Home is suitable to them. We strive to provide a holistic approach to the care and support of our residents and relatives at what is usually a very emotional time. We ensure that the care plans are individual to the resident and that any identified needs which require the services of the multi-disciplinary team, this is arranged immediately. We do not offer an intermediate care service. 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 care needs are met by staff in the home supported by members of the multi disciplinary team. Care plans are in place, and these provide good information for staff to deliver the care. Medications were safely managed which provides protection to residents. Evidence: We observed staff delivering care during the site visit. Staff engaged with residents in a friendly and pleasant way showing patience and understanding when interacting with them. Overall positive comments were received by relatives about the home. Relatives said that they were happy with the care that their loved ones received and that staff were excellent and you cannot fault them . One relative told us that when their mother was ill, they requested she stay in the home instead of being hospitalized, and that was done. The care she received was very god and their mother had improved. Two points, which need to be actioned, that relatives raised, were the lack of foot Care Homes for Older People Page 13 of 29 Evidence: plates on wheelchairs and on occasions the absence of staff in communal areas. Both of these points were discussed with the manager during the feedback session. Residents files were selected a as part of case tracking. Those seen showed that for these residents a care plan had been drawn up and this set out how their individual needs were to be met. Standard format care planning documentation is in use as it is in all Shaw Healthcare facilities. Each resident has a night care plan that relates what they prefer their night routine to be . The quality of the information recorded on the care plans has improved since the last inspection and care plans seen provided more useful information about the resident. The actual care that the resident required was recorded in the interventions section, this stated the care that staff need to provide, and was to a good standard to address residents identified needs. Many of the people living in this home are unable to tell staff what they like or dislike, so it is essential that the quality of the care planning information and action planning is comprehensive,it needs to be maintained by regular reviews with all the key stakeholders involved in the residents life. It is equally important that staff have a thorough knowledge of the residents care plans with whom the staff are to provide care and support. Additional information is gathered by way of relatives communication sheets and a lifestyles and past interests sheet, as well as information obtained through the assessment process. Supporting risk assessments for skin integrity, nutrition, falls and manual handling were in place. Weight records showed resident were weighed at regular intervals. In one file the records showed a resident had significant weight loss, although no follow up was recorded. On asking staff about this they stated the scales were malfunctioning and the resident had no visible signs of weight loss, although food and fluid charts had been commenced and a referral to the dietitian made. In such cases records need to clearly show the action staff have taken, and if mechanical faults are suspected, this should also be included. Visits made by members of the multi disciplinary team are recoded on a separate sheet. this provides a brief summary of the visit and the action taken. We met with one visiting health professional who provided positive information about the staff and care delivery. Gender preference forms are completed to ensure residents receive care by male or female staff as they wish, where this is known. Daily records of care provided are made. Care Homes for Older People Page 14 of 29 Evidence: The AQAA told us the following : The care plans are easier to navigate which makes them easier to read and to document pertinent information. I ( the manager ) audit the care plans and medication monthly to ensure that they are completed to an acceptable standard and to ensure that residents care needs have been properly identified with the relevant medical input in place. I (the manager ) reiterate our policy on Privacy and Dignity during staff meetings and supervision. At this visit we reviewed medication administration practices, including inspection of storage facilities and records. This was carried out together with a team leader. Shaw Healthcare has a comprehensive medication policy and procedures for staff to follow. These were available in the medication file. These procedures cover all the necessary areas of practice to be followed by staff when administering medications to the residents. All those staff who administer medications are trained to do so and are subject to regular refresher training. Each resident has an individual medication administration record with a photograph attached. Any allergies that the resident suffers are recorded. There is specific information on how that individual resident takes their medication and this is a useful tool for staff, especially bank and agency workers. Records for medications received into the home and those returned to pharmacy were available and complete. During this site visit there were no residents who were able to self medicate nor any who were receiving controlled drugs. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged to maintain contacts with their friends and families and assisted to exercise choice and control in their lives wherever possible. The meals and food provided to residents is well balanced, healthy and varied. The lack of appropriate activities and engagement for some residents can have a negative impact on the individual and their well being. Evidence: Periods of observation were undertaken on two units. The manager has developed one area as an activities /reminiscence area and this was in use during the visit. Memorabilia and items from times gone by, such as an old sewing machine, postcards and books had been provided in the room. The area was a pleasant place to spend time. We met with several of the visitors during the inspection. Visiting is open and it was evident that the regular visitors felt comfortable, making themselves tea and engaging with staff and other relatives. Many we spoke to had been visiting Isard House for a number of years. Relatives told us that they felt welcomed, that staff communicated Care Homes for Older People Page 16 of 29 Evidence: any issues with them and they were satisfied with the services provided. One relative wanted more activities and felt the weekends needed more input. Another relative felt the TV was on too long and music would be a better substitute. It was evident in Keston lounge that the TV played continually regardless of what programme it was showing, some of which was inappropriate, such as childrens cartoons. The TV was put onto silent and the radio played, of the four residents in the area three were sat with their eyes closed, and two remained in wheelchairs. The level of engagement between residents and staff varied from unit to unit and throughout the day. In some units, staff were observed to be in the room supervising but not engaging with residents. The home employs activities staff who cover five days a week. Activities were taking place during parts of the day yet in some of the units residents sat with their eyes closed in front of the TV. There was evidence of increased signs of well being when activities or staff interactions were taking place. Whilst group activities are provided this needs to be supported by staff working in the home. Information about residents previous hobbies and past times are recorded in care plans and from this information staff could engage with residents on a more therapeutic level. Within the AQAA it was aknowledged that activities could be improved upon and more variety offered. The lunch was nicely presented and tables laid in preparation for the meal. The lunch was colorful and appetizing with good portion sizes observed. Staff assisted residents in an unhurried manner. Juice was offered serviettes and some condiments were used . Staff sat with residents whom they were assisting. Over the lunch period there was a lot of residents chatting to one another and more staff interaction and engagement . One resident wanted more Irish food such as bacon and cabbage although she had been brought Soda bread on St Patricks day. The cook bakes cakes daily which are served at tea time. These were traditional cakes such as bread pudding and lemon cake that residents would be familiar with. This is a very nice alternative to biscuits. Care Homes for Older People Page 17 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. Residents can be confident that the home will deal with complaints appropriately; information about the complaints procedure is readily available to all who may wish to express an opinion about the service. Residents can be assured that the processes in the home will protect them from potential abuse by staff or others. Evidence: Shaw Healthcare have comprehensive procedures for dealing with complaints. The complaints procedure was on display and incorporated into several documents such as the Statement of Purpose. We looked at the complaints policy and procedures for Isard House. This policy covered all the essential areas required for a complaints policy, including a staged process with timescales and details of other agencies to contact in the event of dissatisfaction with the internal process of investigation. The manager operates an open door policy whereby any resident, relative or visitor may speak to her confidentially. The manager is on call and there is always a senior person on duty in the home as well as senior management on call through the company. Induction of new staff covers safeguarding and training on safeguarding is part of the mandatory training all staff must attend regularly. The manager said that nearly all Care Homes for Older People Page 18 of 29 Evidence: the staff group have received this training and that those who have not yet done so will be doing so in the near future. Records seen by us showed that a high number of the staff team, including ancillary staff had received POVA training. We interviewed four staff and asked about whistle blowing and safeguarding procedures. In relation to abuse the level of knowledge varied, some staff relayed the procedures correctly others less so, although staff had a basic grasp of what to do, some were less familiar with the external avenues to report such incidents. This was referred to the manager for action. The manager maintains a record of complaints book and we saw this. Standard documentation is in place for receiving and recording complaints or concerns. There have been three complaints received in the last year all resolved satisfactorily we were advised. The CQC has not been advised of any referrals made under safeguarding procedures. In the file there were many thank you letters from relatives expressing their satisfaction with the service. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with an adequate standard of accommodation. Sufficient equipment in relation to mobility aids and pressure relieving mattresses are provided to meet residents needs. Evidence: A tour of the premises was undertaken. The accommodation at Isard House is all on one level which accommodates three separate units. There is a garden area and parking is to the front of the building. Each unit has their own communal accommodation including sitting and dining areas. The main kitchen and laundry are all on the ground floor, as are the main offices. Residents bedrooms were generally clean and tidy and personalized with pictures, ornaments and other personal items. In several bedrooms the lights above the sinks were not working and needed attention. The environment is maintained to a satisfactory standard although due to the planned closure there have been no major works carried out in the home, although a new Malibu bath and flooring have been completed in one bathroom. Some areas had benefited from new carpets and redecoration. One area that has improved, was a disused room that had been turned into an Care Homes for Older People Page 20 of 29 Evidence: activities area and this is a great benefit to residents as it is a pleasant room to sit in. All areas were clean although there was an odour present in the hall which was referred to the manager for action. Throughout the home there was evidence of gloves, aprons, wipes and other infection control measures to prevent the spread of infection. Hand washing facilities were provided with soap and paper towels The home had been inspected by the contracts department of Bromley Council who found that improvements had been made in many areas and their findings were positive. The AQAA told us the following : I ( the manager) walk around the Home regularly to ensure that a good standard of cleanliness and maintenance is upheld. We have improved areas of the Home and now they are more presentable and brighter. Cleaning schedules have been reviewed to ensure that they are representative of the cleaning required for the home. We have employed two new domestic staff with another started at the end of March. Some toilet flooring has been replaced. New pictures and soft furnishings have been purchased. Care Homes for Older People Page 21 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 are provided in sufficient numbers with an appropriate skill mix to meet the residents needs. Ancillary and administration staff work to support the care staff. Robust recruitment procedures afford protection to residents living in the home. Staff are provided with training and induction to enable them to undertake the work they perform. Evidence: The home was fully staffed on the days of the site visits, with 2 team leaders, six support workers and a number of ancillary staff on duty. We met with staff throughout the day of our visit. Some staff who have been newly appointed were selected for interviewing. Some of the newest staff have limited experience in this type of work, although the manager was pleased with their progress so far. The staff we met confirmed that they had been subject to recruitment procedures including an interview and CRB clearance. They had received a four day induction which had included the statutory topics including fire, manual handling, health and safety and abuse. They felt that there was sufficient staff to provide care to residents. Some staff had transferred fro Sheila Stead when that closed summer 2009 including the manager . Comments were received about supervision of residents in communal Care Homes for Older People Page 22 of 29 Evidence: areas and this was raised with the manager. She told us that directives have been given to all staff about this topic and is monitoring the situation closely. Personnel files were sampled to check that records relating to recruitment were in place. Recruitment procedures are undertaken through head office. A pro forma form is retained in the personnel file to confirm items such as POVA /CRB clearance and references have been obtained prior to commencement of employment. Health questionnaires were available and completed. Once appointed employees are issued with job descriptions, terms and conditions and contracts. All new staff must complete the Common Induction Standards before their probation period is signed off. Copies of the company induction forms were in the files. Probation review forms were on file for the new staff, these are conducted at intervals of three and six months. Training was said to be available and encouraged. Staff told us that they did receive the mandatory topic and these were regularly updated. Shaw are in the process of introducing a new staff development initiative. This is a programme initially for senior staff that will run over a one year period. 75 of staff have achieved an NVQ qualification. NVQ training has improved as Shaw now employ there own NVQ assessors who are more reliable that the college based sessions. Training that staff had attended included Dementia care, nutrition, falls and catheter care. The domestic staff confirmed that she had received training in infection control and COSHH, both of which are important in her role. Staff recruitment is proving difficult as the home is due to close early 2011 and potential staff are reluctant to take up posts without any long term security. Recruitment continues although there are no major shortfalls as regular staff pick up overtime and regular bank staff are used. Care Homes for Older People Page 23 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 home has a competent and experienced manager in post, supported by an experienced senior staff team. Health and safety issues are addressed by regular servicing, staff training and on going monitoring to ensure the premises are safe. The homes quality assurance systems includes the views of all those who are involved in the service. Evidence: The home is now managed for Philomena Winterboer who previously managed Sheila Stead for many years. That home closed in 2009 and from that time she has managed Isard House. She started in this service August 2009. Ms Winterboer has completed the Registered Mangers Award ( RMA) and has a health and safety certificate as well as further training in Dementia. She is currently undertaking further mental health studies. Care Homes for Older People Page 24 of 29 Evidence: The deputy manager is in the process of completing her RMA. Senior staff have remained consistent for several years which provides continuity to the service and in residents care delivery. The manager told us that over the last year the frequency of staff supervision had increased and staff have had at least two supervisions. The staff files we inspected included supervision documentation and the records showed supervision sessions had been conducted on a regular basis. The manager showed us the service and maintenance records for the home which details all the maintenance requirements and how and when they have been resolved. Those files seen were well organized and information easy to access. The home is maintained to a safe standard. Certificates were checked and seen for a selection of health and safety topics. The fire risk assessment was carried out in 2010 and this is done annually. Records showed us that fire drills had taken place in February and March 2010. The fire alarm is tested weekly. Certificates were checked and seen for the following services that are installed in the home: Fire protection and alarm system Emergency Lights Electrical systems check including the portable appliances and 5 year hard wiring. The lifting equipment inspection under the LOLER regulations. The water risk analysis . The gas appliances had seen inspected 30 March 2010, although the certificate was not available. We were provided by the manager with certificates which state that these systems have been checked by appropriate professionals since the last inspection and found to be satisfactory. All staff are required to attend all statutory training and the home has prompts included in the computer programme to ensure that no staff member is missed. We found the employers liability insurance cover to be valid. The home was inspected by the Environmental Health Department and was awarded a four star rating for its food hygiene standards. Care Homes for Older People Page 25 of 29 Evidence: Quality assurance systems had improved. The Regulation 26 reports which must be conducted monthly unannounced were available and completed. Relatives now organize and co ordinate their own meetings an this has proved successful with better attendances. At each meeting a speaker is asked to attend - the last meeting had been a representative from Bromley Council to discuss the closure. There is a relatives questionnaire which is sent out quarterly and the results are collated into a summary report. In addition Shaw has a quality team who undertake their ow audits and internal inspections. The manager holds a monthly staff meeting and minutes are taken and circulated . Audits are undertaken by Shaw Healthcare on many aspects of the service including items such as care planning, medications, the environment and infection control measures. The results of the recent audits showed a high percentage of achievement . Checks made on residents money showed it was securely stored with supporting records for expenditure and receipts for purchases. A monthly audit of the finances is carried out by the manager or a representative. Head office also undertake regular financial audits. 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 1 12 12 More engagement with residents is needed. To promote residents well being. 30/06/2010 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. 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