Care Home: Kingsley Court

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What the care home does well Kingsley Court provides information about the services it provides so the prospective residents and their families are able to make an informed decision about residency before they move in. Robust pre admission procedures are in place to make sure that the home is confident that they can meet people`s needs before they move in. All residents have a plan of care detailing their health, caring social needs and these give clear instructions to staff on how such needs will be met. Residents health needs are identified and met by staff and visiting health care professionals such as district nurses or GPs. Appropriate risk assessments in relation to falls, moving and handling, pressure sores and nutrition were in place and had been reviewed regularly according to need. Staff are trained in how to administer medication safely and appropriately and medication practice is generally well run. Residents are treated with respect and their right to privacy and dignity is an established part of the care practice of the home. The routines of the home are as flexible as possible to support residents to exercise as much choice and control over their lives as they are able to. The activities meet the expectations of the people who currently live there. Residents are encouraged to maintain their links with family and friends and visitors to the home are made welcome. The home provides a varied menu and all the residents spoken to and surveyed said that they always liked the meals at the home. One resident commented that the food was` excellent`. Policies and procedures to protect residents including an adult protection policy, whistle blowing and complaints were in place to safeguard the interests of people living at Kingsley Court. People living in the home are confident that they are able to raise any concerns and that these will be taken seriously and addressed. The home was clean and tidy and free from odours and residents private rooms reflected their individual tastes, preferences and lifestyle. Robust recruitment processes are followed when employing new staff which make sure that residents are safeguarded from the risk of abuse. Residents spoke highly about the provider, manager and staff team and were confident that they were well looked after. One relative commented that` we couldn`t have picked a better home`. The registered provider and manager have many years experience in the care sector and have the skills and knowledge to manage the home effectively. Staff are committed to providing a good quality service to people who live there. A staff trainingprogramme is in place and staff are encouraged to undertake both induction and further training. One resident commented that` I am happy here and well cared for by attentive staff`. The health and safety of the residents of staff are generally protected and maintained by the policies and procedures in place. What has improved since the last inspection? Since last inspection Mr Fry and the manager have undertaken training in the protection of vulnerable adults that qualifies them to pass on this information and training to other staff. The ongoing maintenance and redecoration programme has meant that the dining room has been redecorated and re-carpeted since the last inspection. Worker has also continued in other communal areas and residents private rooms. What the care home could do better: Further improvements are needed in the way that medication is administered to make sure that the system is robust and safe. Further improvements in infection control measures such as the provision of foot operated bins and the removal of toiletries from communal bathrooms would reduce the risk of cross infection to staff all residents. The home has an ongoing training programme to staff which means that residents will be looked after by people who have the necessary skills. However, efforts need to continue with NVQ training so that the home can reach the national minimum standard of 50% of care staff holding this award. The home must consider how best to continue to support one resident with their personal finances in a way that safeguards their interests and meets the regulation. The temperature of hot water outlets should be regularly tested to reduce the risk of scalding and make sure the temperature is comfortable for residents when washing or bathing. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kingsley Court 28 Dorchester Road Weymouth Dorset DT4 7JU     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 Hale     Date: 2 9 0 4 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 30 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 30 Information about the care home Name of care home: Address: Kingsley Court 28 Dorchester Road Weymouth Dorset DT4 7JU 01305782343 01305786800 enquiries@kfcare.co.uk 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) : Mr Michael Anthony Fry care home 18 Number of places (if applicable): Under 65 Over 65 18 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Kingsley Court has been owned and managed by Mr M Fry since 1994. It is one of two homes owned by Mr M Fry, the other being Friary House and forms part of the family business. The home is established in a large detached house, which is situated on the Dorchester Road, a short drive away from Weymouth seafront and town centre. It is also close to local shops and amenities. Kingsley Court is registered to accommodate a maximum of 18 older people with single and double bedrooms available at ground and first floor level. Communal facilities include a lounge with a conservatory extension and a separate dining room. There are two assisted bathrooms in the home, one on each floor. A stair lift enables access to the first floor of the home for those residents who cannot easily use the main staircase. Three rooms are accessible up a further four stairs. The front entrance of the home comprises of a large parking area, with garden borders, while the back garden is small, enclosed and sheltered with lawns, rockery and flower borders.The home has both a web site and email address where prospective residents can view details or contact the home directly for information. Fees range from 450 pounds to 600 pounds, extra amounts are charged for chiropody services, Care Homes for Older People Page 4 of 30 Brief description of the care home hairdressing, daily papers /magazines. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place over the course of one day in May 2009 and was undertaken by one inspector. The focus of the inspection was to look at all the key national minimum standards focusing on outcomes for people who live in the home. The aim is to measure the quality of the service under four headings, excellent, good, adequate and poor in each of the seven outcome groups. The home completed an Annual Quality Assurance Assessment (AQAA) as required under the Care Home Regulations 2001 and information provided in this was used to inform the inspection process and is included in this report. We sent out surveys to randomly selected professionals who visit the home, staff and Care Homes for Older People Page 6 of 30 residents. Completed surveys were received from six staff, three professionals and seven residents, the responses are incorporated into this report. We also spoke to the registered provider, manager, four staff and seven people who were living in the home on the day the visit. Five of the residents who completed their survey described themselves as having a Christian belief, one person had no religious belief and for people describe themselves as having a physical disability. What the care home does well: Kingsley Court provides information about the services it provides so the prospective residents and their families are able to make an informed decision about residency before they move in. Robust pre admission procedures are in place to make sure that the home is confident that they can meet peoples needs before they move in. All residents have a plan of care detailing their health, caring social needs and these give clear instructions to staff on how such needs will be met. Residents health needs are identified and met by staff and visiting health care professionals such as district nurses or GPs. Appropriate risk assessments in relation to falls, moving and handling, pressure sores and nutrition were in place and had been reviewed regularly according to need. Staff are trained in how to administer medication safely and appropriately and medication practice is generally well run. Residents are treated with respect and their right to privacy and dignity is an established part of the care practice of the home. The routines of the home are as flexible as possible to support residents to exercise as much choice and control over their lives as they are able to. The activities meet the expectations of the people who currently live there. Residents are encouraged to maintain their links with family and friends and visitors to the home are made welcome. The home provides a varied menu and all the residents spoken to and surveyed said that they always liked the meals at the home. One resident commented that the food was excellent. Policies and procedures to protect residents including an adult protection policy, whistle blowing and complaints were in place to safeguard the interests of people living at Kingsley Court. People living in the home are confident that they are able to raise any concerns and that these will be taken seriously and addressed. The home was clean and tidy and free from odours and residents private rooms reflected their individual tastes, preferences and lifestyle. Robust recruitment processes are followed when employing new staff which make sure that residents are safeguarded from the risk of abuse. Residents spoke highly about the provider, manager and staff team and were confident that they were well looked after. One relative commented that we couldnt have picked a better home. The registered provider and manager have many years experience in the care sector and have the skills and knowledge to manage the home effectively. Staff are committed to providing a good quality service to people who live there. A staff training Care Homes for Older People Page 8 of 30 programme is in place and staff are encouraged to undertake both induction and further training. One resident commented that I am happy here and well cared for by attentive staff. The health and safety of the residents of staff are generally protected and maintained by the policies and procedures in place. 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 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 30 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 30 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. Robust pre admission assessment procedures are in place to make sure that peoples needs been assessed and they have been assured they can be met before they move in. Prospective residents and their families are given information about the home and encouraged to visit and spent time there when choosing where to live. Evidence: We looked at the care files of two people who had moved into the home since the last inspection. Records clearly showed that pre admission assessments had been undertaken before the person moved in to make sure that their needs are identified and could be met in the home. Prospective residents and their families are encouraged to visit the home and spend time there before they make a decision about residency. Two people spoken to on the day of the inspection confirmed that they had been Care Homes for Older People Page 11 of 30 Evidence: offered this opportunity. Six people who responded to a survey told us that they had received enough information about the home before they moved in. One resident commented that it was the sixth home in the area that they had visited before they decided that Kingsley Court was the right home for them. One relative who completed our survey said that they liked the general ambiance of the home when they viewed. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are involved in the compilation of a detailed care plan that is up-to-date and reflective of their current circumstances and needs. Appropriate risk assessments are in place and are regularly reviewed and updated as necessary. Medication practice was generally well organised but minor changes would mean it would be more robust. People are treated with respect and their right to privacy and dignity part of the homes practice. Evidence: We looked at three care plans in detail. All had assessments that have been updated in 2009 to make sure that they reflected individuals current circumstances. The assessment contain good details and gave clear instructions to staff and how identified Care Homes for Older People Page 13 of 30 Evidence: need should be met. Assessment and care plans are discussed with residents and if they are able to they are asked to sign their agreement to the care provided by the home. Seven residents completed our survey four of whom said they always receive the care and support they needed and three said that they usually did. A member of staff who completed a survey commented that all residents were seen as individuals and were fully involved in their care. Another member of staff commented that they thought that the home did well in promoting the independence and giving freedom of choice to people who live at Kingsley Court. The daily records contained good detail of the care given and gave a clear indication of the persons well or ill being. Daily records relating to the three residents were cross checked with the accident book and all incidents had been recorded in both documents. Risk assessments in relation to pressure sores, moving and handling and nutrition were in place on all files looked at and these had been reviewed and updated as necessary. It was clear on all records looked at that people have access to health and medical professionals whenever necessary and that the home works closely with other professionals to make sure that peoples health needs are met. Six residents who completed our survey said that they always or usually received the medical support they needed. One relative commented that they would appreciate an annual visit from their relatives GP as a way of keeping in touch and up-to-date with their health needs. One resident who completed our survey confirmed that they received regular visits from the district nurses. Three professionals who visit the home completed our survey, three of whom said that the home always sought advice and acted upon it. Three said that individuals health care needs were met by Kingsley Court and that the service always respected individuals right to privacy and their dignity. One person commented that the home communicates well with the district nursing service. Another professional commented that they thought that one way the home did well was to provide personal sensitive care. We looked at the way in which medication is managed in the home. Medicines were stored securely and all staff responsible for the administration had received appropriate training. Risk assessments were in place for people who self medicate and these were regularly reviewed by the manager. There were no gaps in medication records and a system was in place to make it clear who had given each medication. However, there was no photograph of residents on the medication administration record( MAR) charts, handwritten entries were not signed by two members of staff and opening and expiry dates were not evident on all creams and ointments. Care Homes for Older People Page 14 of 30 Evidence: Staff were observed throughout the inspection to knock on the doors of private rooms before entering and to treat people with respect. Relationships between staff and residents were observed to be friendly but professional. Care Homes for Older People Page 15 of 30 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. There is a range of social opportunities available which the current residents are satisfied with that. Visitors to the home are encouraged and made welcome. The routines of the home are as flexible as possible to reflect individuals choices and support residents to have some control over their daily lives. The dietary needs of residents are catered for and people were satisfied with the quality and variety of food served at the home. Evidence: The AQAA detailed that people living the home are supported to have as much control as possible over their daily routine and people spoken to during the visit confirmed that they were able to get up and go to bed at times to suit themselves. The AQAA also told us that the home employed an activities organiser and that the residents family and friends were invited to join in with the events at the home. The Care Homes for Older People Page 16 of 30 Evidence: manager told us that a PAT dog visits weekly and last month a visit was made to the home by a group that look after owls. There were no organised visits from local clergy but two residents are visited by clergy from their own churches.Six residents who completed our survey said that there was always activities available they could take part in and one person said that there usually was. One resident commented that the recent celebration for red nose day was great fun. Photographs of the red nose days celebrations were on display on the noticeboard in the hallway. The home is currently supporting residents with the change to digital television by providing appropriate receivers. The menu provided choice and a variety of home-cooked meals for the people living at the home. The cook was familiar with residents likes, dislikes and dietary needs. There was sufficient stocks of fresh, frozen and tinned food.One resident surveyed said that they always like the meals at the home and six people said that they usually did. Comments made by residents about the food included good food provided with plenty of variety and food is excellent. Residents spoken to during the visit told us that their visitors were made welcome and able to visit at any reasonable time. Care Homes for Older People Page 17 of 30 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. Systems are in place to make sure that people are aware of how to raise any concerns of complaints and residents have confidence that they are always listened too and taken seriously. Policies and procedures are in place to safeguard the people who live in the home from the risk of abuse. Evidence: The home had a clear complaints policy and procedure that was displayed for all to see. It included the contact details of the Commission. The home nor the Commission has received any complaints since last inspection. All the residents spoken to during the visit were confident that they could raise any concerns or issues with any member of staff or the manager.Four residents who completed our survey said that they always knew who to speak to if they werent happy in three said that they usually did. Six residents said that they always knew how to make a complaint if they wanted to. One relative commented that any problems are immediately dealt with. Two professionals who completed a survey said that the home always responded appropriately if any concerns had been raised. The home had an adult protection policy dated August 2008 but this was not reflective of current locally agreed procedures on how allegations should be investigated, (it Care Homes for Older People Page 18 of 30 Evidence: stated that the homes manager would investigate any allegation).However the manager told us that if an allegation was received then they would follow the locally agreed procedures and later forwarded a copy of the policy that had been updated to reflect locally agreed procedures. The provider and manager had attended a training course about how to protect vulnerable adults which qualified them to pass his knowledge on to other staff. The training matrix recorded that this had taken place and staff spoken to on the day of the inspection were clear that they would report any issues of concern. Care Homes for Older People Page 19 of 30 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. Kingsley Court provides a homely and safe place for people to live in. Infection control measures are in place but these need to be more robust to reduce the risk of cross infection. Evidence: The home was clean, tidy and free from unpleasant odours on the day of the inspection. Residents are encouraged to bring in personal items from home including furniture and are supported to personalise their rooms to reflect their own taste and preferences. Aids and adaptations are provided as necessary according to individual needs. The home has a programme of ongoing maintenance and was generally well maintained but we noted that some carpets needed cleaning or replacing ,a wallpaper border in one room was coming off , a wooden window frame on the first floor was in poor condition and the arms of some chairs in the lounge needed cleaning. Six residents who completed our survey said that the home was always fresh and clean. One resident commented that this had been the deciding factor in their choice of the care home. Care Homes for Older People Page 20 of 30 Evidence: The AQAA told us that since the last inspection most of the wooden windows have been re painted, improvements had been made in the garden area,the dining room has been redecorated and re carpeted and several private rooms have been redecorated.Carpeting in some communal areas has also been replaced. The home does not have a passenger lift but has a stair lift for people to be able to use the upper floors, this is made clear in the service user guide. Appropriate laundry facilities were in place with protective clothing, hand wash and paper towels readily available for staff. However, we observed that dirty washing had been left on the floor with the laundry while waiting to go into the machine contrary to good practice advice. Infection control measures were in place and staff provided with protective clothing including latex gloves. We observed that waste bins in communal areas were not foot operated to reduce the risk of cross infection. Residents toiletries and a bar of soap were seen in communal bathrooms. The training matrix recorded that all staff had completed training in infection control although four staff had not undertaken training since 2004 or 2005. Care Homes for Older People Page 21 of 30 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 were enough staff to meet residents needs and people living in the home believed that they were well looked after. Robust recruitment procedures were in place to protect residents from the risk of unsuitable people working in the home. The number of staff qualified to NVQ level 2 is less than the recommended level but the home is aware of this and making efforts to improve. A training programme is in place to make sure that staff have the skills and knowledge to do their jobs. Evidence: We looked at the staff rota which showed individual roles and demonstrated that there were enough staff on duty at all times. The AQAA told us that the home employed thirteen carers, five of whom (38 ) are qualified to at least NVQ two or above. The manager told us that a further two members of staff were registered on NVQ level 2 courses and that five staff are qualified to NVQ 3 with another one person currently undertaking NVQ 3. Care Homes for Older People Page 22 of 30 Evidence: Five staff completed our survey and they all said that there was usually enough staff to meet individuals needs. Two of them said that they always had the right support and experience to meet different needs, two said that they usually did and one said that they sometimes did.Seven residents who completed our survey said that there was always or usually staff available when they needed them. All seven residents said that staff listened and acted on what they said. One relative commented that the staff are great and keep me informed of whats going on. Two professionals who completed a survey said that they thought that the care staff had the right skills and experience to support individuals social and health care needs. We looked at the staff files of three people who have started work at the home since last inspection. All the necessary checks are being undertaken before people started work except a declaration relating to the persons mental and physical fitness to work at the home. All staff are given their own copy of the General Social Care Council code of conduct and a contract of employment. None of the files looked at contained a job description. The home has an ongoing training programme and provided us with a training matrix on the day the inspection. The manager told us that all staff complete a detailed induction record based on the common induction standards. Six completed our survey five of whom said that the induction covered all aspects of their job very well and once said it covered most aspects. Five members of staff said they had access to relevant training which kept them up-to-date. Four people said that the training helped them understand and meet individual needs of residents to people said that it didnt. One member of staff commented that there was regular training on whatever your training needs may be. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by a committed and competent registered provider and manager who have created an open and positive atmosphere whereby residents feel confident about the service provided and that they are well cared for. Robust internal quality assurance systems are in place to review the service provided. The health and safety of residents and staff are generally protected by the policies and practices followed at the home. Evidence: The home is run on a day-to-day basis by the registered provider Mr Fry and a manager. Both have many years experience in the care sector and of suitably qualified. Residents spoken to confirmed that they found Mr Fry and the manager approachable. Care Homes for Older People Page 24 of 30 Evidence: Six staff completed our survey and comments about the way the home was managed were very positive and included management are very approachable and are willing to solve any work problem you may have and the manager is always willing to discuss anything at any time.One relative who completed a survey commented that staff do their best and that management are approachable and react well to any requests. Six staff who completed our survey commented that the communication in the home always worked well, three said that it usually did come and one said it sometimes did. One person commented that they thought one way the home could improve would be better communication at times. In the homes own staff survey 29 of respondents thought that the communication was poor. The homes registration certificate was displayed in the hallway, both pages should be visible. The AQAA told us that the policies and procedures were regularly updated to make sure that they are up to date and reflective of current good practice. The home has a development plan which identifies work required, its cost and the timescale within which it will be completed. Detailed maintenance records were kept with issues identified and the record of when jobs had been completed. The home undertakes quality assurance work to seek the views of people who live there and take these into account in future planning to improve the service. The home undertook surveys of residents views about the home in July 2008. The results were collated and were generally very positive with the majority of responses rated as excellent or good.Surveys are also undertaken among the staff and the results collated and used as part of the management review. Monthly managers meetings are held with another care home owned by the same provider. Minutes of meetings are taken, these include person information about individual residents which may breach the requirements of the data protection act. Information was provided by the home would show that equipment was regularly serviced to make sure that it was safe to use. The manager told us that the majority of residents manage their own finances or that this is done for them by their families. However, one residents family paid their personal allowance into the homes business account contrary to good practice. We looked at fire safety records which showed that equipment was regularly serviced and appropriate checks were in place to make sure equipment was in good working order. The manager told us that a legionella check been done three years previously but that there were no regular checks on water safety and that no checks were in Care Homes for Older People Page 25 of 30 Evidence: place to reduce the risk such as running of the water in empty rooms. There was no system in place to check the water temperatures in outlets throughout the building. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 35 20 The registered person shall not pay any money belonging to any service user into a bank account unless the account is in the name of the service user. This is to safeguard the service users finances. 30/07/2009 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 9 Handwritten entries on MAR charts should be signed by two members of staff. A photograph of each residents should be kept with the medication administration records (mar) charts. 2 3 4 9 18 18 Opening an expiry date should be clearly recorded on all creams and ointments. The whistle blowing policy should include the contact details of Public Concern at Work. The managing aggression by residents policy should be reviewed and updated to reflect current good practice advice and be more person centred. Page 28 of 30 Care Homes for Older People 5 26 All clinical waste bins should be foot operated to reduce the risk of cross infection. All waste bins in communal bathrooms and toilets should be foot operated. 6 26 Residents toiletries including bars of soap should not be kept in communal bathrooms or toilets to reduce the risk of cross infection. Consideration should be given to the use of vinyl as well as latex gloves to reduce the risk of allergies to residents and staff. 7 8 37 38 The minutes of the managers meetings should not include personal information about individual residents. Checks should be made weekly on the water temperature of water outlets. Systems should be put in place to make sure that the risks from legionella are reduced and the water quality is safe. Care Homes for Older People Page 29 of 30 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. 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