Care Home: Kentwood House Ltd

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What the care home does well The service has a strong ethos of enabling residents to see this as their home, and staff work together to enable residents to follow their own preferences as much as possible. Staff provide a warm and friendly welcome to visitors; and residents said that they are kind, caring and competent at their jobs. Personal care planning includes an assessment for each resident in accordance with the Mental Capacity Act; and this assessment is reviewed every six months or more frequently if indicated. Medication administration is well managed. No errors were found with storage or documentation. Food is well managed and well prepared. The variety provides a balanced and nutritious diet. There are good processes in place for staff recruitment. All required checks are made, and interview processes are well recorded. The service has a high percentage of care staff with NVQ training. Ninety-five per cent have achieved NVQ level 2. The home is committed to ensuring that all mandatory training for staff is kept up to date; and there is ongoing staff training for other related subjects. What has improved since the last inspection? The range and amount of activities for residents has been increased. An activities assistant works five days per week to provide an increased range of group activities and one to one stimulation. An ongoing programme of redecoration around the home has improved the general appearance of communal areas and bedrooms. The providers have purchased new mobile and stand-aid hoists; and some new electric nursing beds. The nurse call system has been upgraded and all calls are recorded. The system changes tone after two minutes to alert staff; and if it has not been answered within four minutes, will change to an emergency tone. This ensures that residents do not have to wait a long time for call bells to be answered. It is also a wireless system which promotes safety as there are no trailing wires. The purchase and daily use of a steam cleaning machine for carpets enables the fast effective removal of stains, and prevents odours. The staff training programme has been increased to include additional training forsubjects such as palliative care, and a deeper understanding of infection control. The management have also developed the use of on line training programmes for staff, so that they can study at varying times which fit in with their own life styles, as well as having training sessions in the home. What the care home could do better: Documentation should demonstrate that residents (or their authorised representative) are consulted about their care planning, and are notified of any changes to care plans. Personal care plans should include consent forms for taking photographs for medication purposes, and for photographs of wounds or injuries. Minor concerns and complaints should be recorded, so that the home can provide evidence to show how they deal with these matters. Some of the carpets and furniture are becoming worn, and replacement of these would benefit the home`s environment. The deputy manager stated in the AQAA that there are already plans in place to replace carpets and some furniture items in the coming year. There are also plans in place to fit double glazing to all windows; and quotes are currently being obtained. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kentwood House Ltd Darenth Road South Darenth Dartford Kent DA2 7QT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hall     Date: 1 6 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Kentwood House Ltd Darenth Road South Darenth Dartford Kent DA2 7QT 01322279771 01322279131 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) : Kentwood House Nursing Homes Ltd care home 35 Number of places (if applicable): Under 65 Over 65 35 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Kentwood House is a large detached building set in two acres of landscaped gardens. It is situated near to the town of Dartford, and can easily be accessed via the M2 and M20 motorways. The premises are at the end of a small lane, and this gives a sense of being in the countryside. The nearest shops and other facilities are approximately one mile away, apart from a public house, which is within walking distance down the lane. The home is built with two storeys, and there is access to the first floor via a passenger lift. Communal areas include a large lounge and dining room, and a smaller lounge where residents can sit quietly. The home has mostly single rooms, but also has some shared rooms for residents who wish to share. All bedrooms except one have en-suite toilet and shower facilities. Care Homes for Older People Page 4 of 28 Brief description of the care home The extensive gardens can be accessed via two wheelchair ramps. The home is a family run business owned by Kentwood House Nursing Homes Ltd. The providers are Mrs. Sandhu, and her son Neil Sandhu. Mrs. Sandhu is also the registered manager. Neil Sandhu is the deputy manager and the finance manager, and is taking an increasingly active role in the general running of the home. Fee levels currently range from 540.00 to 700.00 pounds per week, depending on the assessed needs of each individual resident. 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 home is assessed as having a rating of good, 2 stars. This was a key inspection, which includes assessing information received by the Commission since the last inspection, as well as a visit to the premises. The manager and deputy completed an Annual Quality Assurance Assessment (AQAA) within the time specified by the Commission. This was well completed, with comprehensive information; and assisted in the planning and details of the inspection. We (i.e. the Commission) sent out survey forms prior to the visit, and received nine replies. These were from residents, staff and a Social Services care manager. All of the replies were positive about the life in the home, the care given, and the kindness and Care Homes for Older People Page 6 of 28 competence of the staff. Comments included the home provides a safe environment with caring staff, who alleviate my worries (from a resident); and the home has good, kind staff. I do not want for anything (another resident). The visit was carried out by one inspector, and lasted for seven hours. During this time, we talked with four residents, three relatives, an NVQ trainer, and five staff as well as the manager and deputy manager. Staff said that they are well supported with training in the home; and that it is easy to access the management to discuss any problems. The visit included viewing most areas of the home; reading documentation such as care plans and staff recruitment files; and inspecting medication administration. A safeguarding referral was raised by a health professional in March 2009, in respect of the management of wound care and pressure sores. We brought our inspection date forwards and looked specifically at wound care and pressure sore prevention as part of the visit, and informed the Social Services Safeguarding Adults Team of the outcome. We did not find any cause for concern with these aspects of care during this visit. There have been no formal complaints during the past year. What the care home does well: What has improved since the last inspection? The range and amount of activities for residents has been increased. An activities assistant works five days per week to provide an increased range of group activities and one to one stimulation. An ongoing programme of redecoration around the home has improved the general appearance of communal areas and bedrooms. The providers have purchased new mobile and stand-aid hoists; and some new electric nursing beds. The nurse call system has been upgraded and all calls are recorded. The system changes tone after two minutes to alert staff; and if it has not been answered within four minutes, will change to an emergency tone. This ensures that residents do not have to wait a long time for call bells to be answered. It is also a wireless system which promotes safety as there are no trailing wires. The purchase and daily use of a steam cleaning machine for carpets enables the fast effective removal of stains, and prevents odours. The staff training programme has been increased to include additional training for Care Homes for Older People Page 8 of 28 subjects such as palliative care, and a deeper understanding of infection control. The management have also developed the use of on line training programmes for staff, so that they can study at varying times which fit in with their own life styles, as well as having training sessions in the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out 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. The home provides suitable documentation for enquirers and prospective residents; and there are good processes in place to ensure that the home will be able to meet the individual needs of residents admitted to the home. Evidence: The homes statement of purpose and service users guide contain all the required information. The deputy manager was in the process of amending these documents. The statement of purpose was being altered to reflect a change in the registered providers for the home; and the service users guide was being amended to make it shorter and easier for prospective residents and enquirers to read. Prospective residents or their representatives are encouraged to visit the home where possible, and can stay and have a meal with existing residents if they wish to do so. A pre-admission assessment is carried out for all residents, to ensure that the home will Care Homes for Older People Page 11 of 28 Evidence: be able to meet their individual needs. These assessments are carried out by the manager or one of the trained nurses. Three pre-admission assessments were viewed, and contained sufficient information for the manager to make an informed decision that the home would be able to meet the identified needs. There is a trial period of four weeks, after which a review is held with the resident and their representative or care manager, to check that the placement is suitable. All residents are provided with a written contract, which clearly sets out the fees, and any additional charges. This is discussed and agreed prior to admission. The home ensures that residents receive the registered nursing care contribution. Care Homes for Older People Page 12 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. Care plans demonstrate that health and care needs are met in the home. Evidence: Care plans are implemented for each resident on admission to the home, and are evaluated on a monthly basis. We examined three care plans, and looked briefly at several others; and found that they contained sufficient information to enable care staff to carry out effective care. The manager and nursing staff stated that residents and their relatives or representatives are involved in discussing their care needs; however, no documentation was seen in care plans to confirm this. However, a recent service user survey given out by the home included a question asking if residents felt sufficiently involved in their care and treatment, so this demonstrated that staff are aware of the importance of discussing residents care needs and changes to treatment with them. All activities of daily living (such as nutrition, mobility, continence, personal care needs and communication) are evaluated during the admission process, and care plans are Care Homes for Older People Page 13 of 28 Evidence: set up in accordance with the findings. The care plans generally show good attention to detail, such as: a personal care plan contained details for managing dentures and oral health; and a communication care plan contained very good details for ensuring a hearing aid is properly maintained and fitted for the residents benefit. Further attention to detail could be supplied in some care plans, such as specifying which hoist and sling is to be used for residents without mobility (some plans noted the hoist, but not the sling size); and the type of pressure relieving mattress in use for residents at high risk of developing pressure sores. Daily records are completed for day and night shifts. One of these included reports throughout the night for two hourly checks for a resident who had become confused, and this showed good practice. Some daily records were not very specific, with entries such as safety maintained but without identifying how this had been carried out. The manager said she would follow this up with further training for staff. Care plans contain evidence of meeting health care needs, such as weekly blood pressure checks for a resident with high blood pressure; and daily or weekly blood sugar monitoring for diabetics, according to the stability of the diabetes. Visits from health professionals such as GPs are recorded. Risk assessments are carried out e.g. for risk of falls. Wound care was specifically assessed looking at records for two residents. The care plans contained clear directions for nursing staff in regards to the type of dressing to be applied, and how often dressings should be changed. A written report is completed each time a dressing is changed, so that nurses can indicate if there has been any progress or deterioration in the healing of the wound. Admission details show if the resident has been admitted with wounds or pressure sores from the hospital or place of admission, and wound photographs are taken and dated to confirm these. There were no consent forms in place for these photographs, or for photographs taken for each residents identity for medication charts. Medication is stored in a clinical room which has sufficient cupboards and work surfaces. Storage cupboards and the medication trolley were seen to be in good order; and there was no over stocking, and no out of date items were found. One bottle was found without a label on it, but the pharmacy label was evidenced on the box. The nursing staff said that they would ask the pharmacist to label the bottle in future, and not just the box. Controlled drugs are correctly stored and the register is well maintained. The drugs fridge contained appropriate items, and the fridge and room temperatures are checked and recorded daily. All Medication Administration Records (MAR charts) were inspected, and were excellently completed, with no errors; and this shows good practice by the nursing staff. Care Homes for Older People Page 14 of 28 Evidence: Staff maintain residents privacy and dignity by knocking on doors and waiting before entering; by addressing residents according to their choice; and by using screening in shared rooms. Care plans confirmed that residents individual preferences are taken into account, such as their preferred times for getting up and going to bed; and if they prefer to socialise or stay in their own rooms. The home has a wireless call system in place, so that residents do not have to stretch for a bell and risk falling. This also promotes independence, as residents do not have to worry about moving out of reach of a call bell. The system ensures that if a call is not answered within two minutes, the tone changes to an emergency bell. All calls are logged, so the time for answering bells can be confirmed. Residents wishes in regards to end of life care are carried out by the home as far as possible. For example, respecting the wishes of residents who do not wish to go to hospital, but enabling them to be cared for in their own room, by staff who know them. Eight staff are currently carrying out further training in palliative care, so as to further increase their knowledge and skills in this area. Care Homes for Older People Page 15 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 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 residents with a range of stimulating activities. Food is well managed, and residents said that there is a good variety. Evidence: Staff discuss residents social preferences on their admission to the home, so that they know if residents prefer to mix with others, or stay in their own rooms. Relatives are invited to assist in this process by sharing details of the family background and life history. The home employs an activities organiser who keeps residents informed of activities available, and finds out the residents individual preferences. The activities organiser was observed playing games with a group of residents in the morning, and giving one to one time to residents in the afternoon. She maintains a separate record for each resident, showing their participation and enjoyment. Group activities include card games, dominoes (currently very popular), quoits and ball games, music and singing, bingo, and some craft activities. Residents enjoy sitting out in the gardens in fine weather, and being taken for walks in the extensive grounds. Many said that they enjoy viewing the local animal life, including horses, squirrels, rabbits and birds. A new large plasma screen television has been installed in the main Care Homes for Older People Page 16 of 28 Evidence: lounge, and residents sometimes watch sporting events together, or DVDs for popular films. Outings and entertainments are arranged throughout the year, for items such as shopping, and visits to places of interest. Photographs in the entrance hall showed residents taking part in the homes annual garden party last year. There is a strong emphasis on recognising this as the residents home, and visitors are welcomed at any time, and offered drinks. Residents bedrooms can be personalised according to choice. Food is well prepared and presented, and there is a good nutritional variety. The cook works to a prepared menu, but residents are informed of the choices of meals and desserts each day, to ensure that they can decide what they want on the day. An information sheet in each room provides residents with tea time choices. Fresh vegetables and fruit are used every day; and home made cakes are offered during the afternoons. Additional snacks or drinks can be requested at any time. The kitchens were seen to be very clean and well organised. Care Homes for Older People Page 17 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. Concerns and complaints are taken seriously and are acted on appropriately. Residents are protected from abuse. Evidence: The complaints procedure is on display in the entrance hall, and a form is kept available for anyone to use at any time. The procedure encourages people to talk to the nurse on duty or the manager, in the first instance. All complaints will be thoroughly investigated, and will be responded to within twenty-eight days. There have been no formal complaints in the last year. There is also a suggestions box in the front hall for anyone to use. The manager and deputy manager have a daily presence in the home, and any minor issues or concerns are usually dealt with immediately. It is recommended that the home keeps a record of these matters in a staff notebook, so that there is evidence to show how day to day concerns are dealt with, and confirming that appropriate action is taken in response. All staff are trained during the induction process in the recognition and prevention of adult abuse; and there is ongoing training for this each year. The manager and deputy manager are familiar with the protocols in place for referring suspicions of abuse or neglect to the Kent Safeguarding Vulnerable Adults team. One referral was made to Care Homes for Older People Page 18 of 28 Evidence: the team in the last few months in regards to the management of pressure sores; and the subsequent investigation is in the process of being completed. Care Homes for Older People Page 19 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 premises are well maintained, and provide a comfortable home for residents. Evidence: The home is situated in its own grounds at the end of a lane, providing a quiet location which is near to local towns and motorways. The entrance area is enhanced with flower tubs, and the indoor hallway includes a notice board with photographs of activities, and letters of thanks from friends and relatives. The home has a communal lounge at the front of the house, with an archway through to the dining room; and there is a smaller quiet room at the rear of the ground floor. The manager and deputy were in the process of re-locating the main front office to a room on the lower ground floor. The current office will then be set up as a reception lounge and additional quiet area. The home has large grounds, and there is a gazebo and a water feature at the front of the property. Bedrooms are situated on the ground and first floors, and all areas can be accessed via a passenger lift. All bedrooms except one are fitted with en-suite shower and toilet facilities, and most bedrooms are for single use. There are currently seven rooms which are large enough for two people to share, but the providers are in the process of Care Homes for Older People Page 20 of 28 Evidence: altering most of these into rooms for single use, and re-registering the number of bedrooms with the Commission. They intend to keep two rooms for shared use, for residents who wish to share. The home has five bathrooms with assisted baths, and these were seen to be well maintained and in good condition. There are assisted toilet facilities near to communal areas. There are two sluice rooms, with one on each floor. There are two mobile hoists and two stand-aid hoists, and all of these are new equipment which have been purchased during the last year, replacing previous items. The providers are also purchasing another hoist, which is for a specific room with a narrow door way, so that staff do not have to constantly struggle to get a hoist through the door. Some new electric nursing beds have also been purchased. There is an ongoing system of redecoration for bedrooms and communal areas. Bedrooms were seen to be personalised according to choice. Furniture is of an adequate standard; and soft furnishings include matching bedspreads and curtains in each room. Ongoing maintenance is provided by two maintenance men, one for outdoor work and gardening, and the other for indoor work. This includes steam cleaning of carpets as needed on a daily basis; and checking hot water temperatures, and fire alarm systems. The deputy manager also assists with day to day maintenance. The home was clean in all areas, and there were no offensive smells. There are two domestic staff on duty each day, who clean all areas; and a separate laundry assistant. All staff have completed training in infection control. The providers have plans to replace the carpets in the home during the coming year; and plans to fit double glazing to all windows before the Winter. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a stable and competent staff team, who are well trained, and deliver care with kindness and efficiency. Evidence: The home has two nurses on duty throughout the day time until 6pm, after which there is one nurse for the rest of the evening shift, and one nurse for night duty. They are assisted by four or five health care assistants during the morning, four care assistants in the afternoons and evenings, and two care assistants at night. Additional care staff are brought in if needed, for example, for escorting residents to hospital appointments. Staff said that the management are very supportive of them, especially in regards to training. There are 95 of health care assistants who have completed NVQ level 2, and two who are currently studying for it. This is an excellent percentage. We talked with an NVQ Assessor who was visiting the home, and she stated that the care staff are very willing to learn, and that residents cannot speak highly enough of the care given to them by the staff. We examined three staff recruitment files, and these included all required documentation, and certificates for confirmation of training. Files included well Care Homes for Older People Page 22 of 28 Evidence: completed application forms, showing complete employment histories; POVA First and Criminal Record Bureau (CRB) checks; two written references; proof of ID; and an interview record. Nurses PIN numbers are checked with the Nursing and Midwifery Council. All staff are provided with an employee handbook which contains key policies and procedures; a job description; and a contract. Work permits and residence permits are checked as applicable. A routine spot check was recently carried out by the UK Border Agency, and they wrote to state that the company were assessed as class A (i.e. top grade) for the way in which they check documentation for staff entering from abroad. A training matrix confirms that all mandatory training is kept up to date. The manager carries out all staff inductions, which are comprehensive, and in accordance with Skills for Care. Most staff choose to complete the induction and mandatory training programmes on line, and the management have provided a computer for staff to use for this purpose. Staff may also use their own computers at home if they wish to do so. This enables staff to carry out training programmes at their own speed. The training packages ensure that staff can demonstrate understanding and application of the subjects; and the manager ensures that staff are competent as well as knowledgeable. The manager encourages staff to carry out further training in subjects such as palliative care, nutrition, infection control and dementia care. Care Homes for Older People Page 23 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 good management systems in place, which promote the welfare and safety of residents. Evidence: The manager is registered with the Commission and has many years of nursing experience and caring for older people. She has been managing this home for over eighteen years, and is also one of the Providers. She is assisted by her son who is the finance manager, and is also the deputy manager. He has completed an NVQ level 4 in management and care in 2008. The home has clear management structures in place, and there are staff meetings every month. We read the minutes for the last three meetings, and these confirmed that all levels of staff are invited to share concerns and ideas. Three staff members completed surveys for the Commission, and they all included very positive comments such as We are given underpinning knowledge and continuing professional Care Homes for Older People Page 24 of 28 Evidence: development; and It is a good working environment here as a team. All staff have formal supervision every two months, and a yearly appraisal. Residents and relatives are invited to give feedback on a daily basis, and the manager or deputy are available in the home every day. This ensures that residents concerns will be dealt with very quickly. The home provides survey forms every six months, and these request feedback on different aspects of life in the home such as the standards of care, the food, and the environment. The results of these surveys are analysed, and used to produce changes in the home. Residents can have small amounts of pocket money stored in the home on their behalf. These are stored as separate amounts, and are documented individually. All receipts are retained, and the accounts are always available to the resident or their authorised representative. Staff are trained in understanding health and safety, and their responsibilities to report any concerns. The employee handbook contains a reminder of health and safety matters. All staff complete fire training, and fire systems are checked and kept up to date. Servicing records confirm that equipment such as fire extinguishers, mobile hoists, passenger lift and portable appliances are checked according to requirements and kept up to date. Care Homes for Older People Page 25 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 26 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 1 7 11 To improve documentation 31/07/2009 to show that care plans and treatment are discussed and agreed with the resident or their authorised representative. The registered person shall as far as practicable enable residents to make their own decisions in regards to the care they receive, and their health and welfare. 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 To obtain written consent for taking photographs of residents for the purposes of identification for medication administration; and for any other identified reasons such as wound care. To keep a record of minor concerns, with information providing evidence for how these matters are dealt with. 2 16 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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