Care Home: Kings Acre

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What the care home does well Kings Acre Nursing Home provides an excellent level of nursing and personal care. Staff are dedicated, supportive and well qualified. People are happy living at Kings Acre and feel they are well cared for. People said staff are very kind and caring and make sure they have everything they need: comments included "staff are marvellous, really lovely" and "it`s a lovely home". Staff communicate well with people and their families and provide opportunities on a formal and informal basis to ensure their voices are heard and requests acted on. Staffing levels are constantly reviewed and the registered manager is able to increase the staff in line with people`s care needs. Care plans are detailed and provide very clear instructions to staff regarding how to support each person in a consistent and safe manner that respects their preferences and choices. Meal times are a pleasant experience for people. Meals are nutritionally balanced and attractively presented. People`s preferences are regularly reviewed and recorded. Planned activities provide interest and stimulation as well as the opportunity to socialise with others. The home benefits from having owners who are regularly in the home and who know people well and a consistent and well trained management, nursing and staff team. What has improved since the last inspection? No requirements or recommendations were made at the last inspection. The owners and registered manager said they are constantly looking for ways to improve the experience of people living in the home. For example, a befriending service has been invited into the home to provide the people living in the home with a greater opportunity to socialise with people independent of the home. Ongoing redecoration and refurbishment ensures the home is well maintained. What the care home could do better: No requirements or recommendation have been made as a result of this inspection. Key inspection report Care homes for older people Name: Address: Kings Acre Kings Acre Ermington Nr Ivybridge Devon PL21 0LQ     The quality rating for this care home is:   three star excellent 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: Jane Gurnell     Date: 1 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Kings Acre Kings Acre Ermington Nr Ivybridge Devon PL21 0LQ 01548830076 01548831470 kingsacre@tesco.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Michael Leaves care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: One named, physically disabled service user, aged 50 years and over can be accommodated. Date of last inspection Brief description of the care home Kings Acre is a 34-bedded care home set in its own grounds on the edge of Ermington Village. The house has been converted and extended but still keeps its original charm, with views of the local countryside. Mr and Mrs Leaves have owned the home for over 20 years and Mrs Linnell, the registeed manager, has worked in the home for over 16 years. The atmosphere within the home is warm and friendly; the owners make every effort to maintain a family feel to the home whilst providing nursing and personal care to the elderly, physically disabled people who live there. Registered nurses are available on duty 24 hours a day to monitor peoples health. The home admits people over the age Care Homes for Older People Page 4 of 28 0 0 Over 65 6 28 Brief description of the care home of 65 years of either gender. The statement of purpose and service users guide are provided in the office of the home and copies can be requested. The weekly fees payable range from £520 for those residents requiring residential care to £730 for those residents requiring nursing. 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: three star excellent 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: Kings Acre was previously inspected in February 2007 when the home was judged to be providing excellent outcomes to the people living there. This was an unannounced key inspection undertaken on Friday 18th December. The owners and the registered manager were available and they and their staff team provided clear information about the home. Many of the people living in the home were spoken with as were a small number of visiting relatives and the staff on duty. The care plans for three people living in the home were examined and these included one for someone newly admitted to the home and two for people who had lived in the home for a longer period of time. A tour of the home was completed and records relating to staff recruitment and training as well as health and safety issues such as the Care Homes for Older People Page 6 of 28 fire safety system and accidents in the home were inspected. 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: 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 8 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 9 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. People considering moving to Kings Acre are given enough information to make an informed choice about whether the home can meet their needs. They can have confidence that their care needs will be assessed and met by staff who are trained to do so. Evidence: The registered manager confirmed that she visits people considering moving to the home to provide them with information about the services at Kings Acre and to undertake an assessment of their care needs. These pre-admission assessments provided information about peoples health, personal care and social care needs and allowed staff to prepare for their admission. The assessments also provided clear information about peoples preferences and what was important to them. For those people who were supported either through social services or from hospital to seek permanent residential or nursing care, the home obtained an assessment from the social worker or from the nursing staff at the hospital and this supported be homes Care Homes for Older People Page 10 of 28 Evidence: own assessment process. People are invited to visit the home with their family members to meet the other people living in the home and the staff team before making a decision about whether the home is suitable for them. The Service User Guide was informative and is kept up-to-date with current information about the services provided that the home and copies were available during the inspection for residents and visitors. This gives prospective residents and their relatives the opportunity to make an informed decision about the home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care needs met by a competent and caring staff team. Staff are employed in sufficient numbers to meet the needs of those currently living in the home. Evidence: Many of the people living in the home were spoken with and all said that they felt very well cared for. Staff were described as kind and caring and comments included the staff are marvellous, really lovely and its a lovely home. People confirmed they were assisted promptly should they need help, indicating that there are sufficient staff available to meet peoples needs. The care plans for three people were examined in detail, including one for someone newly admitted to the home and two for people who had lived in the home for a longer period of time. Each of these care plans was found to be very comprehensive and detailed and it was clear they had been developed from further assessments undertaken on admission to the home. The assessments included a description of each persons abilities and any risks associated with activities of daily living, such as Care Homes for Older People Page 12 of 28 Evidence: mobility and the risk of falling; nutrition; skincare and continence management. Where a risk had been identified the care plan guided staff how to reduce this and identified whether aids or equipment should be used. The care plans set out very clearly the actions needed by care staff to ensure all aspects of the health and personal care are addressed. Each of the care plans had been reviewed monthly or sooner if the persons needs had changed. The registered manager said that where possible people or their families, if appropriate, are encouraged to sign their care plans and this was evident in two of the care plans examined. Peoples personal preferences and choices had been recorded and these included how they wanted to be addressed, their likes and dislikes for food and the sort of activities they enjoyed. For example, one persons care plan included information about how they liked to be dressed with a preference for pink clothes. The staff recognise the importance of having this level of detail in the care plans particulrly when people have lost the ability to share this information themselves. The care plans demonstrated how people had access to health care services to meet their assessed needs, such as speech therapists, physiotherapist and specialist nurses for skincare. Where these health professionals have made recommendations about the way health care should be delivered, the care plan had been changed to include this advice. High dependency pressure relief mattresses were seen in use for people at risk from developing pressure sores due to ill-health and frailty. A clear wound care planning system had been introduced and this provided the staff with information about the dressings used. The care planning documentation included psychological health care monitoring. Where this had been identified as an issue, the care plan guided staff how to care for this persons psychological needs. For example, one person became distresed if she didnt have a particular item with her at all times and this was detailed in her care plan. Staff were observed caring for people in a respectful and friendly manner that valued peoples personal preferences and choices. Medication is stored safely in a locked treatment room and lockable drug trolley. The records of medication given were seen and these had been completed and signed in line with good practice. The controlled drug record was checked against the stock held for three people and found to be correct. Where medication had been disposed of this had been recorded and signed by two staff. A record of medication received into the home was kept. None of the people currently living in the home were able to self Care Homes for Older People Page 13 of 28 Evidence: medicate however should someone wished to remain responsible for their medicines, an assessment was undertaken to assess a persons ability to do this safely. Care Homes for Older People Page 14 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 routines of the home continue to be flexible to try to meet peoples needs and preferences. Planned activities provide interest and stimulation for people as well as the opportunity to socialise with the other people living in the home. Evidence: People said the home arranges activities several times a week and these were advertised on the notice boards throughout the home. On the day of the inspection, a singer was in the home singing Christmas carols and hymns. Other events this month included a pantomime, a Carol Service and a Christmas party. One lady said the home had organised a wonderful party for her and her family the previous week to celebrate her birthday. A member of staff has the responsibility to consult with people living in the home and to organise the activities they would like to see provided. A photograph album available for everyone to look at included photographs of people enjoying a variety of activities throughout the year. Activities included exercises to music, painting and other craft work such as making Easter bonnets. Care plans included a record of their personal preferences and choices and what interested them. Two people said there had been a trip out of the home during the summer and they looked forward to more Care Homes for Older People Page 15 of 28 Evidence: of these for a change of scenery. The registered manager said a befriending service would be visiting the home each week from the New Year to involve people in a variety of activities such as card or board games and newspaper reading. Visitors were coming and going through out the inspection. People were seeing their relatives in the privacy of their own room or in one of the communal areas in the home. Visitors spoken to during the inspection were complimentary about the care and services provided at Kings Acre. People said the meals were very nice and they had plenty to eat. The lunchtime meal observed was attractively presented and nutritional balanced. People were eating their meals at their own pace and those people who needed assistance were being given this one to one by a staff member. The staff observed helping people to eat their meals were speaking to them as they assisted: this appeared to be making the meal time a pleasant experience for them. A food likes and dislikes questionnaire had recently been completed to identify peoples preferences regarding their meals and drinks and snacks. Where people had been unable to provide this information due to poor health or communication difficulties, staff had completed the form using their observations and trial and error with different food groups and drinks. The care plans also included an assessment of peoples mouths and whether there were any problems such as sore areas, difficulty with swallowing or ill fitting dentures that prevented people from eating well. It was evident in the care plans examined that issues had been identified and advise had been sought from a Speech and Language Therapist for swallowing difficulties and a dentist for sores and dentures repairs. The chef advised that all the meals are prepared from fresh produced, which is locally sourced where possible. Should some not wish to have the planned meal then alternatives were always available. 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. The staff at Kings Acre appear to have a genuine regard for the people living there and people can be confident that any concerns or complaints will be listened to and dealt with promptly. Evidence: People said they were very happy living at Kings Acre and had no concerns. When asked if there was anything that would make life more comfortable for them, no one could think of anything. People said they felt they could talk to any of the staff or nurses and the manager should they be unhappy about anything. The complaints policy and procedure was easily available in the reception area of the home. The registered manager advised that she operates an open door policy, which enables people and their relatives as well as staff to speak to her if they have any concerns. The Commission has not received any complaints since the previous inspection. The home maintains a register of concerns raised by people living in the home and this included the action taken by the registered manager to address the concerns. These records demonstrated that consideration had been given to whether these concerns had effected everyone else in the home and not just the person who had raised the issue. Policies and procedures are in place to guide staff how to respond to suspicions or evidence of abuse or neglect to ensure the peoples protection. Staff confirmed they Care Homes for Older People Page 17 of 28 Evidence: had received training in safeguarding vulnerable adults and certificates were seen in the staff training file. The staff records supported that the registered manager has a robust recruitment policy and practice that protects people from unsuitable staff. 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. Kings Acre provides a well-maintained and pleasantly decorated home to live in. There are sufficient facilities and equipment to meet peoples current needs. Evidence: People said they were satisfied with their rooms and the communal areas of the home. Those bedrooms seen at this inspection were pleasantly decorated and people had been able to bring personal items with them from home. Although some of the bedroom furniture was dated in style, it was in good repair. The registered manager confirmed that rooms were redecorated when they became vacant and the owners continue to upgrade the facilities. There is a large lounge room on the ground floor with a number of distinct seating areas, as well as a large conservatory and a dining room. When the dining room is not in use the tables are moved to one side to allow for peoples wheelchairs to be stored so the lounge room is not cluttered. The home is attractively decorated and reasonably well maintained, providing a homely environment for people. The toilets and bathrooms are easily accessible for the communal areas and individual bedrooms. Bedrooms are provided over the ground and first floors: 14 single and three shared bedrooms have en-suite toilets. People who require height adjustable beds have been provided with these. Several Care Homes for Older People Page 19 of 28 Evidence: pressure relief mattresses were in use during the inspection for those people at risk from developing pressure sores due to frailty and immobility. Hoist and raised toilet seats were seen in the bathrooms for ease of use for people with restricted mobility. Training records indicated staff have received regular up dates for manual handling. Central heating radiators are provided in peoples rooms that can be adjusted to meet individual preferences: some radiators were covered where a risk had been identified. The hot water temperatures in some bedrooms and in the bathrooms had been controlled to reduce the risk of scalding. Two housekeepers/domestic staff were working in the home during the inspection. The home was fresh and clean in all areas entered during the inspection and people confirmed this was always the case. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A competent, well-trained and caring staff team provide care for people in a way that respects and promotes their individuality. Evidence: People said the staff were very kind and caring with nothing being too much trouble. People said that staff came to assist them promptly when they rang their call bells indicating there were sufficient staff on duty. Staff were observed speaking with people in a respectful and friendly manner. A duty rota is provided which shows the number of staff on duty each shift and what role they have in the home. At the time of the inspection there were thirty-one people living in the home and six care staff on duty with a trained nurse. Staff confirmed that there are usually six or seven care staff each morning and often more than one trained nurse. Three care staff and a trained nurse were on duty in the evenings and two care staff and a trained nurse overnight. These numbers did not include the registered manager or the housekeeping and catering staff. The registered manager provided a copy of the monthly dependency tool she uses to plan the staffing levels for the home. The tool records the dependency of the people living in the home and the number of staff needed to meet their needs. The tool also enables the registered manager to review how well the home had been staffed over Care Homes for Older People Page 21 of 28 Evidence: the previous month and whether the staffing levels planned had been met. The resulting graphs provided for October and November 2009 showed that the staffing numbers were exceeded. Two members of staff spoken with confirmed that the staffing levels enabled them to provided good quality care for people. One staff member said she thought the staffing could be increased over the summer period to allow people to enjoy being out of doors either in the garden or on trips out of the home. Care staff are supported to undertake a National Vocational Qualification (NVQ) in Care: nine staff had completed a NVQ at level 2 or above and four staff were in training. In addition senior care staff were provided with NVQ training in Team Leadership and one staff member was undertaking a Management and Leadership course. The registered manager confirmed that the trained nurses support the staff team in specific areas of health care training such as infection control, care planning for terminally ill people, continence management, medication and wound dressing and safe moving and handling. Newly appointed staff are provided with in-house induction training staff which broadly follows the Skills for Care guidelines, a nationally recognised course to introduce staff to the principles and values of good care. Staff confirmed they worked alongside a more experienced member of staff until they felt confident and the registered manager felt they were competent to work unsupervised. The registered manager said she meets with new staff within their first week at the home to talk about their expectations and the principles and values of the home: she also confirmed she holds exit interviews with staff who are leaving to identify the reason they are leaving and to establish if there is anything the home could do better. The registered manager operates a robust recruitment policy, which ensures as far as possible only suitable staff are employed. Three staff files were examined during the inspection and all held the necessary pre-employment checks, including three written references, which exceeds the requirements of the regulations, and a Criminal Record Bureau check. Copies of staff contacts and terms and conditions of employment were seen in the staff files. Records indicated staff received an appraisal to discuss their work performance and training and personal development needs three times a year. Care staff said they had been provided with regular training to ensure they had the skills to care for older people and records indicated training in dementia care, care of people with terminal illness, medication, infection control and diabetes had been provided this year. The trained nurses were supported with their continuing professional development to maintain their registration with the Nursing and Midwifery Council. Reference material relating to the health care needs was available in the nurses office. The manager and Care Homes for Older People Page 22 of 28 Evidence: owner confirmed all mandatory training time is paid for staff. The registered manager confirmed that formal staff meetings are held about every three months to discuss the general running of the home and to share ideas for improvement: informal meetings are held as and when needed to discuss issues that have arisen since either in relation to a persons needs or regarding a management issue. Meetings for trained nurses are also held periodically to discuss nursing practice. Night care staff have their performance reviewed every six months by the night trained nurses. The registered manager said that formal one-to-one meetings with staff are generally not held due to the contact she has with the staff on a day to day basis and that ad hoc meetings were arranged when necessary to discuss any issues that need addressing immediately. The registered manager was advised to review this as not all staff may feel comfortable with approaching the manager about issues and planned individual supervision sessions would provide them with an opportunity to discuss their work performance and personal development needs more frequently than at the appraisal or staff meetings: the registered manager gave assurances that she would review this further. 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. People benefit from the registered managers clear leadership of the home, who tries to ensure that the home is run in their best interests. Evidence: The registered manager of King Acre has worked at the home in a senior management capacity for several years: she was the deputy manager prior to taking up the managers position approximately four years ago. She is a first level registered nurse who has an NVQ 4 in Management. She has also recently undertaken training in Management Mentoring to further develop her own skills and that of her staff team. Staff confirmed there are clear lines of accountability with in the home and care staff and the trained nurses work well together. The registered manager provided the results of the annual quality review for inspection. This showed that people living in the home, their representatives and others visiting the home on a regular basis such as the GP, chiropodist and hairdressers had been consulted over the quality of the services provided at the home. Care Homes for Older People Page 24 of 28 Evidence: The results indicated people had a high regard for the facilities and services provided at King Acre. The registered manager said that the results of any quality audit are shared with people and their families and staff. People are encouraged to manage their own financial affairs for as long as possible and for those who are unable their family retain responsibility. However, the home does provide safe storage for one persons money and records of money received and spent were kept. A system of billing people or their relatives for hairdressing, chiropody and other services has reduced the need for people to hold cash. The home has a safe for people to store valuable items but the registered manager confirmed that most families had chosen not to leave valuable items in the home. The registered manager provided information about the ongoing maintenance in the home. The home employs a member of staff to undertake day to day repairs and redecoration and the owners have a contract with a builder for more substantial repairs. Lifting equipment and the fire alarm system had been tested and serviced regularly to ensure they were maintained in safe working order. Staff had received fire safety training to ensure they knew what to do should a fire break out. As noted above radiators had been covered and hot water temperatures controlled where a risk to peoples safety had been identified. The windows above ground level had been fitted with opening restrictors to reduce the risk of accidents. The registered manager confirmed that staff received regular training in health and safety matters including manual handling, fire prevention, first aid, infection control and food hygiene and certificates were seen in staff files. Protective clothing such as gloves and aprons and liquid antibacterial soaps and paper towels for staffs use were seen to be available throughout the home to reduce the risk of cross infection. Accidents are recorded and these records were made available: where a risk had been identified the action taken by the home had been recorded. For example, one person was at risk of falling when getting out of her chair and advice had been sought from the falls assessment team to reduce this by using a pressure sensitive pad to alert staff when this person got up from her chair. This allowed staff to assist the person more quickly than they would have been able to do otherwise. 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 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 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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