Care Home: Ivy House Nursing Home

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What the care home does well People told us daily routines are flexible, for example they can choose when to go to bed and get up. Two people said they like the home and another said they feel "looked after". During the visit we saw that staff spoke to people in a kind and respectful way. Visitors told us they are satisfied with the care their relatives are receiving. One person said the home is "lovely, top class", another said the staff always make them welcome and another said the home is "alright, could be worse". The home makes sure that all the required checks are done before new staff start work and this helps to make sure people are protected. There is an ongoing programme of refurbishment to make sure the home continues to provide a pleasant and safe place for people to live. What has improved since the last inspection? There were no requirements following the last inspection. In the AQAA the home told us they continue to make improvements in response to feedback from people. For example since the last inspection they have provided a INTERNET access via Skype to help people keep in touch with relatives and friends. Improvements have been made to the way people`s personal clothing is managed. The home now takes responsibility for making sure clothes are properly labelled and this helps to reduce the risk of people`s clothing getting mixed up or lost. What the care home could do better: There are some activities for people to take part in but more needs to be done to develop a person centred approach to social care to make sure that everyone living in the home gets the right support to follow their personal interests and make the most of their abilities. During the visit we identified a number of concerns about the lunch time meal service. The meal time was disorganised and rushed and it was not a pleasant or social occasion for people. Since the visit the manager has informed us that action has been taken to improve this. This needs to be monitored to make sure the improvements are maintained. During the visit we observed that staff often missed opportunities to interact with people. More leadership and supervision is needed to guide staff on how they can improve people`s well being through positive interactions. More needs to be done to make sure staff, particularly those who may be in charge of the home in the manager`s absence are familiar with the local safeguarding procedures. This will enable them to take prompt and appropriate action in the event of suspicions or allegations of abuse and will help to make sure people are protected. Key inspection report Care homes for older people Name: Address: Ivy House Nursing Home Ivy House Nursing home 6 Hollin Wood Close Shipley West Yorkshire BD18 4LG     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: Mary Bentley     Date: 2 7 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Ivy House Nursing Home Ivy House Nursing home 6 Hollin Wood Close Shipley West Yorkshire BD18 4LG 012754591476 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Holberry Care Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Additional conditions: Date of last inspection Brief description of the care home Ivy House is a detached Victorian property, which has been converted and extended. The home is registered to provide care, with nursing, for up to forty people. The accommodation is provided in a mix of single and shared rooms some of which have en-suite facilities. There are communal bathrooms and toilets throughout the home. The communal rooms are on the ground floor and there is a separate dining room. The home is in a quiet residential area close to the village of Saltaire. The gardens and patio areas are well maintained and are accessible to people. The main entrance has a ramp and there is car parking to the side and front of the home. CCTV has been installed outside the home to improve security. In January 2010 the weekly fees started at 535.00. Each person is assessed before they move in and the fees vary according to the level of care required. Please contact 2 6 0 9 2 0 0 8 Over 65 Care Homes for Older People Page 4 of 28 Brief description of the care home the home for more detailed information about the fee structure. There are additional charges for chiropody and hairdressing. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was carried out 26 September 2008. Last year we received some concerns about the service and as a result we changed our inspection plan. This is what we used to write this report: The home had completed an annual quality assurance assessment (AQAA) for us in August 2009, we have used information from the AQAA in this report. The results of any visits that we have made to the service in the last 12 months. Surveys returned to us by people using the service or from people with an interest in the service. On this occasion we did not send any surveys to people. Care Homes for Older People Page 6 of 28 Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Relevant information from other organisations. A site visit carried out by one inspector over two days. The first day of visit was unannounced and we were in the home between the hours of 4:30 and 7:15 pm. On the second day we were in the home between the hours of 09.15 am and 5:30 pm. We were accompanied by an Expert by Experience from the organisation Help the Aged/Age Concern. An expert by experience is a person who, because of their shared experience of using care services, is able to help us get a better picture of what it is actually like for people using the service. During the visit we spoke to people living in the home, visitors, staff and management. We looked at various records including care records, looked at some parts of the home and observed staff as they carried out their duties. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely enforcement action will be taken. how we did the inspection Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: There are some activities for people to take part in but more needs to be done to develop a person centred approach to social care to make sure that everyone living in the home gets the right support to follow their personal interests and make the most of their abilities. During the visit we identified a number of concerns about the lunch time meal service. The meal time was disorganised and rushed and it was not a pleasant or social occasion for people. Since the visit the manager has informed us that action has been taken to improve this. This needs to be monitored to make sure the improvements are maintained. During the visit we observed that staff often missed opportunities to interact with people. More leadership and supervision is needed to guide staff on how they can improve peoples well being through positive interactions. More needs to be done to make sure staff, particularly those who may be in charge of the home in the managers absence are familiar with the local safeguarding procedures. This will enable them to take prompt and appropriate action in the event of suspicions or allegations of abuse and will help to make sure people are protected. Care Homes for Older People Page 8 of 28 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed and they are encouraged to visit the home before making a decision about moving in. Evidence: The home told us that people or those close to them are encouraged to visit before making a decision about moving in. Peoples needs are assessed before they move in and this helps to make sure that the home will be able to meet their needs. We saw completed pre-admission assessments in the care records. The home told us people are given written information about the service at the time of admission and this includes information about the complaints procedure. One person told us they had not received any written information and this had caused some difficulties as they were not aware of the complaints procedure. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, peoples health and personal care needs are met however more could be done to promote peoples individuality and dignity. Evidence: Visitors told us they are happy with the care their relatives receive. One person said they thought their relative has improved since moving into Ivy House. Visitors told us they are kept informed about changes in their relatives needs and condition. We saw that people looked clean however, we noticed that some of the ladies were not wearing stockings and several people were walking around in stockinged feet. We observed that a lot of people were wearing clothes that are easy to manage for example jogging pants. It wasnt clear if this was their choice or if this style of clothing had been chosen for them because it is easier to manage. We saw that some peoples hair did not seem particularly well groomed. Staff told us the hairdresser visits once a week, they said some people have their hair done weekly, others monthly and staff help people wash their hair in between visits to the hairdresser if necessary. Care Homes for Older People Page 12 of 28 Evidence: During the afternoon we saw staff cleaning peoples nails in the lounge. We looked at four peoples care records. The care records are computerised and there are lap tops around the home where staff can enter information about peoples care. Paper copies are also kept for reference. The records have assessments of peoples needs and care plans setting out how their needs will be met. The care plans are reviewed monthly and were generally up to date. In the majority of the records looked at we saw evidence that people or those close to them are involved in reviewing how their care needs are being addressed. There are risk assessments for areas of potential risk for example, falls, pressure sores and nutrition. When people are identified as being at risk there are plans to show how this risk will be managed. We saw that the home involves external professionals, for example in one persons records we saw that they were at risk of malnutrition and the dietitian had been consulted about this. The cook confirmed this. In another persons records we saw that the tissue viability nurse specialist is advising the home on the management of pressure sores. A new section has been added to the computerised records to record information about peoples capacity to make decisions and information relating to any deprivation of liberty restrictions that may be in place. The home has not started to use this section of the records yet but we saw evidence that the home arranges advocacy services for people when necessary. There was not a lot of information about peoples wishes with regard to end of life care and this was discussed as an area that needs to be developed. One person living in the home had recently had a bereavement and staff were supporting them to deal with this. Medicines are stored safely. There were some minor recording errors in the medication records and these were discussed during the visit. One person told us that the care staff sometimes give people their medicines, they were worried that people might be given the wrong tablets. We did not see any evidence of this during the visit. During the visit we heard staff talking to people in a kind and respectful way. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some activities for people to take part in but a more person centered approach to social care is needed to make sure people get the right support to follow their personal interests and make the most of their abilities. Evidence: People told us that daily routines are flexible and they can go to bed and get up when they want. The home does not have an activities organiser at present, the manager told us they are trying to recruit someone. The home told us that activities include karaoke and trips out. A visitor told us that someone brings in a pat dog which people seem to enjoy. One person has a computer with large keyboard in their room and the manager had put a train screen-saver on as the person is interested in trains. There were some therapy dolls available but while we were in the lounges the people they were given to didnt seem particularly interested in them. The manager seemed to know people well and had information about their past lives. One visitor told us they didnt think staff knew a lot about their relatives background. There are social care plans in peoples records but a lot of the information that was Care Homes for Older People Page 14 of 28 Evidence: available about peoples past lives and interests had not been transferred to the computerised records. This should be done to make sure all staff have access to information about peoples backgrounds. This was discussed. The home has a large selection of old black and white films. There are two large TVs in the lounges and there were films showing during the day, however, we saw that several people were sleeping and it wasnt clear how many people were actually watching the films. Our Expert by Experience talked to people about how they spend their time, comments included, no activities, dont do anything, just loll around but go out and look at the shops, dont do anything, just sit. Other people said they listen to music or play dominoes and several people commented that the staff are busy and dont seem to have time to just sit and talk. One person told us they were going to the cinema that evening and another said he had been asked but did not want to go. During the visit we saw some staff playing games with some people but we didnt see staff spend much time just sitting or chatting with people. Generally staff interactions were task led and brief and tended to focus more on people who were able to respond. For example one person in the lounge started to shout and bang the table, it was while a while before staff came to attend to this person. On another occasion we saw a carer making a bed while the person whose room it was stood by, there was no attempt to make conversation with the person. Visitors told us they are made welcome and we saw visitors being offered refreshments. One person said the lounge can sometimes be a bit noisy but said they said there is another room they can use if they want to. People can have breakfast when they want and cooked breakfasts are available from 7:30 am. Two people were having a cooked breakfast in the dining room at 11:00 am. One visitor wondered if people get enough to drink but said staff come around with cold drinks and fresh fruit in summer. One person told us they can have a cup of tea whenever they want. Tea and coffee are served during the morning and in the afternoon and people said they have drinks at supper time. Peoples views on the food varied, for example one person said the meals are lovely, another said food not as good as it was and another said the meals vary but said they could have soup and sandwiches if they didnt like the meals on the menu. There was information in the kitchen about peoples dietary needs and preferences. Care Homes for Older People Page 15 of 28 Evidence: During the visit we observed the meal service at lunch time. There was a choice of two hot meals and a choice of hot or cold pudding and after lunch we heard staff asking for choc ices for some people although these were not on the menu. People made their choice of meal during the morning. There were two sittings at lunch time and overall the meal service appeared rushed and disorganised. People were given their main course, pudding and drinks at the same time and we saw that for some people this made it difficult for them to know what to eat first. We did not hear staff telling people what the meal was or reminding people what they had ordered. We saw staff helping people to eat without speaking to them and some staff were standing over people while helping them to eat. We did not see any condiments on the table. People had cold drinks with their meal but we did not see tea or coffee served after lunch, however, one person asked for a cup of tea and was given it. There were no senior staff in the dining room to supervise lunch. During lunch one person became noisy and was shouting at other people, she was upset and upsetting other people but staff did not intervene. Our Expert by Experience had lunch in the dining room, the meat was hot but the rest of the meal was just warm. One person had food put in front of them and it was some time before staff came to help them eat. It is likely the food would have been cold as there was no warming lid. One person who had their meal in their room told us the food was not very hot and the tea was just warm. This was discussed and since the visit the manager has contacted us to tell us he has taken action to improve the meal service at lunchtime to make it a more pleasant and social experience for people. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place to make sure complaints are taken seriously and acted on and to make sure people are protected. More attention should be given to making sure staff are aware of these procedures and that they are followed consistently. Evidence: The home has a complaints procedure and written complaints are recorded. People told us they would complain to the manager or staff if they needed to. One person said they had never needed to make a complaint but felt confident that if they did they would be listened to and their complaint would be looked into. Another person said they had complained once that the bathroom was not clean. They said the manager had dealt with it and arranged for a checklist to be put in the bathroom to show when it was cleaned. When we looked the checklist was in place but had not been filled in. Since the last inspection we have received two concerns about the service. In both cases the people involved felt their concerns were not being taken seriously by the home. As a result both cases were referred to the local Adult Protection Unit and they have now been resolved. The home has taken action which has improved outcomes for both the people concerned and for other people using the service, for example by improving the laundry systems. Care Homes for Older People Page 17 of 28 Evidence: The home has procedures in place to safeguard people. The home told us 50 of staff have received training on safeguarding (adult protection) and more training is booked. The nurse on duty at the time of the inspection was not familiar with the safeguarding procedures despite having attended the training. This was discussed with the manager. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable place for people to live however more could be done to make it a more interesting and enabling environment for people. Evidence: Overall the home was clean. Our Expert by Experience commented that there was a slight underlying odour in some of the communal areas but not in peoples bedrooms. The communal rooms are on the ground floor, there are lounge areas and a separate dining room, there is a pleasant conservatory which is a quiet area, it does not have a TV. The communal rooms are suitably decorated and in most areas the chairs are arranged into small groups which helps to encourage people to socialise. There is a fish tank in one of the lounges and during the evening we saw staff talking to people about it and involving them in feeding the fish. There is a separate hairdressing room. When this room is not being used for hairdressing it provides a quiet lounge where people can have access to the INTERNET and Skype which allows them to have free voice and video calls with family and friends. Our Expert by Experience made the following observations about the environment. Whilst the toilets were marked the signs were not overly prominent and there were no Care Homes for Older People Page 19 of 28 Evidence: pictures etc indicating toilets/bathrooms or pictures on bedroom doors. Whilst there were one or two local pictures on walls there was no stimulating/interesting or olden days memorabilia/picture magazines, materials etc around or on the walls. There were two large clocks but there was nothing to remind people what day month or season it was. Peoples bedrooms were clean and suitably furnished. Some people have call bells, others, who are not able to use call bells, have pressure pads at the side of the bed so that staff are alerted when they get out of bed. The manager told us that some people dont have either a call bell or a pressure pad based on his assessment. Senior staff told that when this is the case people are checked every half hour. This should be clearly recorded to make sure all staff aware of it. Since the last inspection there have been concerns that peoples personal clothing was not being looked after properly and people were not always able to wear their own clothes. This has now been dealt with, the home has taken over responsibility for making sure peoples clothes are properly labelled. People confirmed that the laundry system has improved and one person said it is tons better. There are systems in place to reduce the risk of cross infection and hand cleaning gels are available throughout the home. The home has received a 5 star (the highest) rating from Environmental Health for its standards of food safety and hygiene. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are usually enough staff to meet peoples needs and people are protected because all the required checks are done before new staff start work. Evidence: We asked people about the staff and these are some of the things people said, fairly quick if needed, some more prompt than others, staff alright, anything you want or want doing, staff very obliging, some just put dinner down and dont talk, feel just doing a job. There are usually 7 care staff and a nurse on duty until 5:00pm. The manager, who is also a nurse works from 8:00 am until 5:00 pm Monday to Friday. From 5:00 pm to 9:30 pm there are usually 6 staff on duty, this includes one nurse. Overnight there are four staff, one of whom is a nurse. The home employs separate staff for catering, housekeeping and maintenance duties. The inspection was carried out over two days. During the visit there seemed to be enough staff on duty however at times staff appeared to lack supervision and leadership. For example, during lunch time there were no senior staff in the dining room and on other occasions we saw that staff seemed unclear about how to respond to peoples needs. Care Homes for Older People Page 21 of 28 Evidence: We looked at the files of three newly appointed staff and they showed that all the required checks are carried out before new staff start work. Information provided by the home shows that 17 out of 29 care staff (58 ) have achieved an NVQ at level 2 or above and 8 more staff are enrolled on NVQ training. The home has an ongoing training programme and topics covered include dementia care, palliative care, infection control and tissue viability. In response to concerns raised since the last inspection some staff have done training on supporting people with learning disabilities and more training on this has been arranged. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable systems in place to make sure the home is appropriately managed. The management team are committed to continuing to improve to make sure people experience good quality outcomes in all areas of the service. Evidence: The registered manager is a nurse with many years experience in caring for older people. The manager is aware that improvements are needed to some aspects of the service and responded positively to our suggestions as to how this could be achieved. Some people spoke very highly of the manager and one person described him as brilliant. Other people felt that while he was approachable and listened he did not always share information with the rest of the staff team and this sometimes caused problems. The home completed their annual quality assurance assessment (AQAA) when we asked for it. It was returned in good time and gave us the information we asked for. Care Homes for Older People Page 23 of 28 Evidence: The home sends questionnaires to people once a year to give them the opportunity to share their views of the service. The results are analysed and an action plan is put in place to deal with areas that are identified as needing improvement. The home told us they continue to make improvements in response to feedback from people, for example when people are moving in they are consulted about the choice of decor for their room. The management team should be more proactive about monitoring day to day working practices within the home to make sure staff are supported in applying their training to practice. The home did have a support group for people living in the home and their relatives but this has lapsed in recent months. The home told us they plan to start these meetings again. Staff meetings are held approximately every 3 months. There are policies and procedures in place relating to the Mental Capacity Act and the Deprivation of Liberty legislation. We saw in the records that when necessary the home has arranged advocacy services for people. The home told us they do not hold any money for people. There are suitable systems in place to make sure that installations and equipment are serviced and maintained at the required intervals. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The home should make sure that people or their representatives are given written information at the time of admission so that they have this information available to refer to a later date if they need to. Medicines should only be administered by staff that have been trained to do so to reduce the risk of mistakes being made. More attention should be given to making sure peoples dignity is promoted, for example by supporting people to maintain their personal appearance in a way that reflects their personal style. More attention should be given to developing a person centred approach to social care to make sure everyone living in the home is given the support they need to follow their personal interests and make the most of their abilities. The changes that have been made to meal times since the inspection should be monitored to make sure the improvements are maintained so that people can enjoy their meals in a more relaxed and social way. Page 26 of 28 2 9 3 10 4 12 5 15 Care Homes for Older People 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 6 16 All complaints should be dealt with in accordance with the homes complaints procedures. This will help to make sure that concerns can be resolved within the service. More attention should be given to making sure that all staff, particularly those who take charge of the home, are familiar with the local authority safeguarding procedures. This will help to make sure people are protected. More attention should be given to creating an environment that is enabling for people. For example by providing clear signage to help people find their way around. Senior staff should provide more direction and leadership to care staff to help them respond appropriately to peoples needs. 7 18 8 19 9 27 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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