Care Home: Knowle Park Nursing Home

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What the care home does well The home is effectively managed by a skilled and competent management team and its overall operation is in the best interest of people using services. There is a clear, accessible complaint procedure and people using services are protected from abuse by the homes policies and procedures. Staff are trained, skilled and in sufficient numbers to meet their needs. Provision includes quality accommodation with specialist equipment and aids. The environment is clean and hygienic and there is a planned maintenance programme. The home`s management responds to the need to provide sufficient information enabling an informed choice of home for people considering using the service. Admissions are well planned and managed. Comprehensive admission-assessment procedures focus on achieving positive outcomes for people using services. These ensure facilities, staffing and specialist services can meet their diverse needs. Feedback from people using services and their representatives has been mostly positive about the home. Personal support is usually responsive to individual needs and preferences. Though most people using services consulted were unfamiliar with the term `care plan`, they described an individualised, flexible approach to meeting their needs. Comments included, " They do nursing and personal care and laundry well, the furnishings, food and activities are good. They makes me feel it is my home. They feed me gently and patiently, respect my views and move me around with care." "Friendly atmosphere, look after us. Provide excellent care. Give comfort and support." "Since 2005 my mother has lived at the home. She has severe dementia but is always happy, clean, well dressed and receives excellent meals that she loves. I cannot fault her care and for the first time in many years I know that if I go away on holiday she is in the best possible place." "The laundry is excellent-very regular and very quick." People using this service are registered with a general practitioner (GP). A GP visits the home weekly and at other times, as necessary. Personal health care needs including primary and specialist health, nursing and dietary needs are clearly documented. A number of professionals are involved in the care and support of people using services. This includes a physiotherapist, chiropodist, dentist and optician. Records provide a comprehensive overview of health needs and how these are being met. Health and safety risks are assessed and regularly reviewed.Feedback received from health professionals was very positive. Comments included, " The home does everything well, they are what every nursing home should aspire to be. I can`t think of anything the service could do better, if I did I would speak to the manager who has an approachable manner and an open door policy. Excellent manager and deputy manager which filters down to staff". "Excellent nursing care, very good leadership."The expert by experience observed examples of good care practice by individual staff members. Staff expressed pride in the positive outcomes achieved by people using services since their admission. They spoke of significant improvement in the condition and independence of one individual admitted after a severe stroke. Another person we spoke with who was admitted following a stroke, credited the high level of improvement in her condition to the dedication, skills and care practice of the whole team. This person stated she did not wish for anything at the home to change, "Everyone has been really helpful, whether internal staff or visiting therapists." We sampled the medication records of four people using services. Compliance was evidenced with regulations for the safe storage, recording, receipt, administration and disposal of medicines, including controlled drugs. We observed the home`s atmosphere to be warm and friendly and visitors to be made welcome. People using services may pursue their interests and hobbies, individually and in small groups. Two part-time recreational therapy coordinators are employed. They offer opportunities for people using services to engage in social activities of their choice from a creative, varied and stimulating activities programme. This includes access to community resources, enabling community inclusion, organised outings and various entertainment. Links with community groups were evident and arrangements in place for meeting the religious and spiritual needs of people using services. A qualified head chef has worked at the home for many years. He meets with people using services soon after admission, establishing dietary needs, food preferences and times they would like breakfast served in their rooms.There is a choice of where they have their meals at other times. Menus offer an alternative dish for each course and are circulated daily, enabling people to select meals for the following day. Chefs are always willing to cook other dishes on request. There is opportunity for people using services to contribute to menu planning. The focus is on provision of wholesome, nutritionally balanced meals and use of fresh ingredients, providing freshly prepared meals. The head chef attends service users meetings, which is a new development. Here he receives feedback on the quality of food and suggestions for menu changes and improvements. The minutes of the last meeting he attended confirmed the collective view that most meals were of a good standard, varied and healthy. Areas for improvement were communicated to him. During the inspection visits comments from people using services about catering standards were mixed. Some people were very satisfied and complimentary about the meals and others identified specific changes they would like to see implemented. Direct observations included a varied, wholesome menu, an overall high standard of catering, presentation of food and of the dining room and good practice in the support people received to eat their meals. What has improved since the last inspection? Shortfalls in medication practice at the time of the last inspection had been rectified. The home implemented use of Caring Homes corporate assessment tools and care planning format when first taken over by the organisation. Assessment processes and the care planning format had been further developed since then and staff now used an accredited nutritional assessment tool. Gathering life history information for people using services was noted to be a further positive recent development. Records sampled evidenced effort had been made to obtain details of lifestyle preferences, though some records were incomplete. Diverse needs, interests and aspirations, cultural and religious backgrounds had mostly been established. Where there were shortfalls relating to this practice these had been identified through internal systems and were in the process of being addressed. At a recent meeting between management and relatives/representatives of people using services, which is also a new development, their cooperation had been requested in supplying the home with additional life history and lifestyle information for those unable to provide this themselves. It was explained how this enables a person-centred approach to meeting needs. The intention to implement a more inclusive approach to care planning was explained to those present at the meeting. Plans for review meetings, involving people using services and, as appropriate, their relatives and representatives were explained. Discussions with some visitors during the visits identified a formal review structure would likely be of benefits to them. Care planning, requests for life history information and proposed review meeting had also been discussed with those people using services who attended the last `residents` meeting with management, which is held quarterly. What the care home could do better: Standard admission procedures include establishing and recording information about known allergies, including adverse drug reactions. A breakdown in the home`s system for carrying forward this information on medication records was fully investigated by the home manager during this inspection, following an incident and complaint. We are not aware of any previous similar incidents. Staff have learned from this event and a more robust medication audit has been implemented to minimise risk of a repeat occurrence. Survey feedback suggest some individuals, specifically those unable to engage in group activities, may benefit from increased opportunities for social stimulation. Discussions with a recreational therapy coordinator confirmed this was recognised. Effort is ongoing for the recruitment of a third part- time therapy coordinator to make this provision. The home`s management is aware of the need for care staff`s records to reflect their daily contribution to meeting social needs and provision of social stimulation for the people in their care. Information suggests the need to review internal communication systems for informing and reminding people using services of when their meetings with management are due to take place. Also of arrangements to enable those who wish to attend. Whilst the health and safety of people using services and staff is promoted it is necessary to ensure a more timely response from the organisation to requisitions for essential repairs. Key inspection report Care homes for older people Name: Address: Knowle Park Nursing Home Knowle Lane Cranleigh Surrey GU6 8JL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Collins     Date: 2 4 1 1 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 34 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 34 Information about the care home Name of care home: Address: Knowle Park Nursing Home Knowle Lane Cranleigh Surrey GU6 8JL 01483275432 01483267342 netra.longhurst@slnh.co.uk www.slnh.co.uk South London Nursing Homes Ltd care home 49 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 49 The registered person may provide the following category of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - DE Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Knowle Park is a converted country house built in 1823 and located within nine acres of scenic parkland near Cranleigh village,Surrey. Converted and extended over the years, the original period features of the building have been retained and tastefully combined with modernised facilities. Bedroom accomodation is mostly single occupancy, arranged on both floors and accessible by passenger lift and stairs. Specialist bathing facilities are available and a range of adaptations and equipment maximise independence. Communal areas include the entrance hall, reception area, spacious lounge and dining room, sun-lounge and conservatory. Access to the home is Care Homes for Older People Page 4 of 34 49 0 Over 65 0 49 Brief description of the care home by way of a long driveway and ample parking facilities are available. The home is surrounded by spacious gardens with some seating areas. Knowle Park Nursing Home is part of the Caring Homes Group which is a national provider of care services. It continues to operate under the company name of South London Nursing Homes since acquisition by Caring Homes in September 2007. Weekly fees for single bedrooms are from 853 to 1288 pounds and 765 pounds for shared accomodation. Additional charges are for private chiropody and pysiotherapy, hairdressing, for staff escorts and vehicle mileage. Care Homes for Older People Page 5 of 34 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: Date of last Key Inspection: 22 November 2007. Registered Manager: Mrs Netra Louise Longhurst. The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). We carried out two visits to the home, one unannounced and one announced over a total duration of eleven hours, as part of the key inspection process, using the Inspecting for Better Lives (IBL) methodology. The inspection was undertaken by one regulation inspector and facilitated by the registered home manager. The homes interim regional manager attended the feedback session. Engaging with people using services is an integral part of the inspection process. On this occasion we involved an expert by experience, which is one of a range of stakeholder involvement Care Homes for Older People Page 6 of 34 methodologies used for this purpose. Experts by experience are recruited and trained by support organisations. They visit homes with inspectors and because of their shared experience of using services and/or ways of communicating, assist inspectors in forming a picture of what it is like to live in or use that service. The expert by experience spent four hours at the home and her observations are incorporated within the report. All available information has been taken into account, informing judgments about how well the home is meeting the National Minimum Standards (NMS) for older people. This includes accumulated evidence, knowledge and experience of the home since the last key inspection. We surveyed stakeholders in this service as part of the process. Surveys were received from eleven people using the service, some of which incorporated feedback from their relatives and advocates. We also received two surveys specifically from two relatives, five staff and two health professional. Each year providers registered with the Care Quality Commission (CQC) must complete a self assessment called an Annual Quality Assurance Assessment (AQAA). They are required to send this to the CQC, providing quantitative and numerical information about their service. The AQAA requires assessment of the service against the NMS outcome areas, demonstrating both areas of strength and where improvements can be made. The homes AQAA was received on time and the content was clear, of good quality and validated by evidence. Care Homes for Older People Page 7 of 34 What the care home does well: The home is effectively managed by a skilled and competent management team and its overall operation is in the best interest of people using services. There is a clear, accessible complaint procedure and people using services are protected from abuse by the homes policies and procedures. Staff are trained, skilled and in sufficient numbers to meet their needs. Provision includes quality accommodation with specialist equipment and aids. The environment is clean and hygienic and there is a planned maintenance programme. The homes management responds to the need to provide sufficient information enabling an informed choice of home for people considering using the service. Admissions are well planned and managed. Comprehensive admission-assessment procedures focus on achieving positive outcomes for people using services. These ensure facilities, staffing and specialist services can meet their diverse needs. Feedback from people using services and their representatives has been mostly positive about the home. Personal support is usually responsive to individual needs and preferences. Though most people using services consulted were unfamiliar with the term care plan, they described an individualised, flexible approach to meeting their needs. Comments included, They do nursing and personal care and laundry well, the furnishings, food and activities are good. They makes me feel it is my home. They feed me gently and patiently, respect my views and move me around with care. Friendly atmosphere, look after us. Provide excellent care. Give comfort and support. Since 2005 my mother has lived at the home. She has severe dementia but is always happy, clean, well dressed and receives excellent meals that she loves. I cannot fault her care and for the first time in many years I know that if I go away on holiday she is in the best possible place. The laundry is excellent-very regular and very quick. People using this service are registered with a general practitioner (GP). A GP visits the home weekly and at other times, as necessary. Personal health care needs including primary and specialist health, nursing and dietary needs are clearly documented. A number of professionals are involved in the care and support of people using services. This includes a physiotherapist, chiropodist, dentist and optician. Records provide a comprehensive overview of health needs and how these are being met. Health and safety risks are assessed and regularly reviewed.Feedback received from health professionals was very positive. Comments included, The home does everything well, they are what every nursing home should aspire to be. I cant think of anything the service could do better, if I did I would speak to the manager who has an approachable manner and an open door policy. Excellent manager and deputy manager which filters down to staff. Excellent nursing care, very good leadership.The expert by experience observed examples of good care practice by individual staff members. Staff expressed pride in the positive outcomes achieved by people using services since their admission. They spoke of significant improvement in the condition and independence of one individual admitted after a severe stroke. Another person we spoke with who was admitted following a stroke, credited the high level of improvement in her condition to the dedication, skills and care practice of the whole team. This person stated she did not wish for anything at the home to change, Everyone has been really helpful, whether internal staff or visiting therapists. We sampled the medication records of four people using services. Compliance was evidenced with regulations for the safe Care Homes for Older People Page 8 of 34 storage, recording, receipt, administration and disposal of medicines, including controlled drugs. We observed the homes atmosphere to be warm and friendly and visitors to be made welcome. People using services may pursue their interests and hobbies, individually and in small groups. Two part-time recreational therapy coordinators are employed. They offer opportunities for people using services to engage in social activities of their choice from a creative, varied and stimulating activities programme. This includes access to community resources, enabling community inclusion, organised outings and various entertainment. Links with community groups were evident and arrangements in place for meeting the religious and spiritual needs of people using services. A qualified head chef has worked at the home for many years. He meets with people using services soon after admission, establishing dietary needs, food preferences and times they would like breakfast served in their rooms.There is a choice of where they have their meals at other times. Menus offer an alternative dish for each course and are circulated daily, enabling people to select meals for the following day. Chefs are always willing to cook other dishes on request. There is opportunity for people using services to contribute to menu planning. The focus is on provision of wholesome, nutritionally balanced meals and use of fresh ingredients, providing freshly prepared meals. The head chef attends service users meetings, which is a new development. Here he receives feedback on the quality of food and suggestions for menu changes and improvements. The minutes of the last meeting he attended confirmed the collective view that most meals were of a good standard, varied and healthy. Areas for improvement were communicated to him. During the inspection visits comments from people using services about catering standards were mixed. Some people were very satisfied and complimentary about the meals and others identified specific changes they would like to see implemented. Direct observations included a varied, wholesome menu, an overall high standard of catering, presentation of food and of the dining room and good practice in the support people received to eat their meals. What has improved since the last inspection? Shortfalls in medication practice at the time of the last inspection had been rectified. The home implemented use of Caring Homes corporate assessment tools and care planning format when first taken over by the organisation. Assessment processes and the care planning format had been further developed since then and staff now used an accredited nutritional assessment tool. Gathering life history information for people using services was noted to be a further positive recent development. Records sampled evidenced effort had been made to obtain details of lifestyle preferences, though some records were incomplete. Diverse needs, interests and aspirations, cultural and religious backgrounds had mostly been established. Where there were shortfalls relating to this practice these had been identified through internal systems and were in the process of being addressed. At a recent meeting between management and relatives/representatives of people using services, which is also a new development, their cooperation had been requested in supplying the home with additional life history and lifestyle information for those unable to provide this themselves. It was explained how this enables a person-centred approach to meeting needs. The intention to implement a more inclusive approach to Care Homes for Older People Page 9 of 34 care planning was explained to those present at the meeting. Plans for review meetings, involving people using services and, as appropriate, their relatives and representatives were explained. Discussions with some visitors during the visits identified a formal review structure would likely be of benefits to them. Care planning, requests for life history information and proposed review meeting had also been discussed with those people using services who attended the last residents meeting with management, which is held quarterly. 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 10 of 34 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 11 of 34 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 using this service and their representatives receive the information they need to enable an informed choice of home. Comprehensive pre-admission assessment procedures ensure needs can be met. Written contracts or terms and conditions of the home are issued to all people using services. Standard 6 was not assessed on the basis the home does not offer intermediate care. Evidence: The homes management places a high value on responding to the need for information when choosing a care home. An informative brochure is available detailing services and facilities. This can be obtained by post, on the internet or when people make initial visits to view the home. On admission a personal copy of the homes service users guide is provided to people using services. This is produced in an easy read A to Z format which is easy to understand. These documents and a range of other useful information are available in a binder in the reception area. Care Homes for Older People Page 12 of 34 Evidence: The admission criterion is explicitly stated in marketing materials. The home offers permanent, short-term and respite nursing and personal care for older people for conditions associated with ageing and physical frailty. The statement of purpose states provision also includes palliative care and services for people with special needs specific to sensory impairment and dementia, from the age of 50 years. Owing to the building design and layout and open door policy, to ensure individual safety, dementia conditions on admission are usually secondary to physical nursing needs. A random sample of four files belonging to people using services established significant time and effort invested in planning admissions. This process is evidently well-managed. Individual needs are fully assessed, generally before admission, to ensure these can be met. Pre-admission assessment tools had been further developed. Assessments are usually undertaken by the home manager or deputy manager who both have the necessary skills and competencies. The service is highly efficient in obtaining summaries of any professional assessments, including a medical history, prior to admission. Assessments are focused on achieving positive outcomes for people using services, ensuring the facilities, staffing and specialist services can meet their diverse needs. Whilst emergency admissions were stated to be rare, an emergency admissions procedure is in place. Though this does not incorporate a preadmission assessment it requires as much information as possible to be gathered before admission. Further comprehensive assessments are carried out soon after admission from which individualised care plans are generated. People using services are issued with a contract specifying the homes terms and conditions which they or their representative sign their agreement. Standard 6 was not inspected on the basis that the home does not offer intermediate care services. Care Homes for Older People Page 13 of 34 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. People using services receive personal and healthcare support in accordance with their assessed needs. Their rights of dignity, equality, fairness and autonomy, within individual levels of capacity, are respected. Medication practice is usually safe. Evidence: The majority of people using services consulted during visits were positive about their care experience, indicating they receive effective personal and healthcare support using a person centred approach. Survey comments included, They do nursing and personal care and laundry well, the furnishings, food and activities are good. They makes me feel it is my home. They feed me gently and patiently. Respect my views. Move me around with care. Friendly atmosphere, look after us. Provide excellent care. Give comfort and support. Since 2005 my mother has lived at the home. She has severe dementia but is always happy, clean, well dressed and receives excellent meals that she loves. I cannot fault her care and for the first time in many years I know that if I go away on holiday she is in the best possible place. The laundry is excellent-very regular and very quick. Care Homes for Older People Page 14 of 34 Evidence: Direct practice observations also feedback from people using services, staff and visitors indicated staff are usually attentive to the personal appearance of people using services, ensuring their dignity and wellbeing. It was evident this can at times pose challenges as staff endeavour to achieve an appropriate balance between their duty of care and respecting the rights and wishes of individuals, specifically in the area of dementia care. Records confirmed staff are guided by best interest principles in their practice in these circumstances. Feedback received from a visitor that her relatives clothes were sometimes stained with food was followed up. We observed staff encourage this individual and others to wear protective clothing at mealtimes during both visits. The home transfered to using a corporate assessment and care planning format when the organisation initially took over. The care plan format has since been refined and improved and staff were again in the process of transferring information to new documentation. The four care files examined contained a range of assessments and holistic care plans which were reviewed at least monthly. People using services and their relatives stated staff always respect their privacy and dignity. Staff were observed to be discrete and sensitive in their practice relating to person care delivery and when assisting people with meals. Gathering life history information for people using services is a new development and is ongoing. Whilst effort has been made to obtain information about the diverse needs, interests and aspirations, cultural and religious backgrounds of individuals further work in this area is necessary and the home is pro-actively managing this. At a recent relatives/representatives meeting with management, which is a new initiative, their cooperation was requested in supplying additional life history and lifestyle information for individuals unable to provide this themselves. The care planning process was also discussed at this meeting and at the separate quarterly meeting between management and people using services. The value of obtaining comprehensive life history and life style information for each individual had been explained in terms of enabling a person-centred approach to meeting needs. Whilst most people using services consulted were unfamiliar with the term care plan, they were evidenced to have one. One person said information had been sought regarding individual interests soon after admission and recorded on a form. Another said, It all works out for me. They described a flexible routine, mostly accommodating their wishes. People consulted said they get up and go to bed when they wish. A more inclusive approach to care planning and reviews was in the process of being implemented. This had been discussed at the relatives/representatives meeting at which they were invited to be more involved in the process. Minutes of this meeting Care Homes for Older People Page 15 of 34 Evidence: were said to have been circulated to all relatives/representatives of people using services. Feedback from the expert by experience following conversations with visitors highlighted the benefits of the proposed involvement of families/representatives in review meetings. This will aid understanding of how the home is meeting needs, providing a safe forum for issues to be raised and clarified and for information sharing. People who use this service are registered with a general practitioner (GP). A GP visits the home weekly and at other times, as necessary. Personal healthcare needs including primary and specialist health, nursing and dietary needs are clearly documented. A number of professionals are involved in the care and support of people using services. This includes a physiotherapist, chiropodist, dentist and optician. Records provide a comprehensive overview of health needs and how these are being met. Risks to the health and safety of people using services are assessed and regularly reviewed. These include risks associated with mobility and falls, pressure sores, use of bed-rails and nutrition. Use of a validated nutrition assessment tool is a new development. Aids and equipment support activities of daily living and the home is wheelchair accessible throughout. It was agreed the home manager would further explore access to specialist equipment to enable an individual to operate the call bell system. Feedback from health professionals was very positive. The home does everything well, they are what every nursing home should aspire to be. I cant think of anything the service could do better, if I did I would speak to the manager who has an approachable manner and an open door policy. Excellent manager and deputy manager which filters down to staff. Excellent nursing care, very good leadership. Nurses said they are supported in their professional development, enabling them to update their clinical knowledge and skills. Care staff receive relevant training enabling awareness and understanding of the health conditions of the people they care for. A programme of dementia training for staff was observed to be at an early stage of implementation. Observations verified universal infection control procedures are practiced. Staff are supplied with protective aprons and gloves and suitable disposal arrangements made for clinical waste. Staff were proud of positive outcomes achieved by individual people using services since admission. They spoke of significant improvement in the condition and independence of one individual admitted after a severe stroke. Another person consulted also admitted following a stroke, credited the major improvement in her condition to the skills and care of the whole team. This person did not want anything to change, commenting, Everyone has been really helpful, whether internal staff or visiting therapists. We sampled the medication records of four people using services. Shortfalls in medication practice at the time of the last inspection had been rectified. We evidenced Care Homes for Older People Page 16 of 34 Evidence: compliance with regulations for the safe storage and recording, receipt, administration and disposal of all medicines, including controlled drugs. Prescribed medication is regularly reviewed by medical practitioners and efficient systems exist for the supply of medicines. Only qualified nurses are involved in the administration of medication and monthly medication audits are carried out by the home manager. People using services are able to take responsibility for administration of their own medication if they wish and have capacity to do so, within a risk management framework. The homes admission procedures include establishing and recording information about known allergies, including adverse drug reactions. This was evidenced by care records sampled also the system documenting and highlighting drug allergies on medication records. A breakdown in this system resulting in an incident in which nurses administered prescribed medication to an individual with a known allergy to the same, was fully investigated by the home manager during this inspection, under the homes complaint procedure. It was established this information had been obtained and recorded on admission but owing to an error was not carried forward on medication records which change monthly, when new supplies are received. The home has no previous history of such an incident. Staff have learned from this adverse event, implementing a more robust medication audit to minimise risk of a repeat occurrence. An explanation of what happened and an apology was given by the home manager to the individual concerned and relatives. Care Homes for Older People Page 17 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A wide range of social and leisure activities are offered and community inclusion is well promoted. Visitors are made welcome by staff, supporting people using services to maintain relationships with people important to them. An overall high standard of catering was evident, served in an attractive, spacious dining room. Evidence: The home was observed to have a warm, welcoming and friendly atmosphere. People using services may pursue their interests and hobbies individually and in small groups. Two recreational therapy coordinators are employed, one working five afternoons and the other, three afternoons. Efforts to recruit a third part-time therapy coordinator have not been successful. Feedback from surveys suggest some individuals would benefit from more social stimulation opportunities. Specifically, people nursed in their rooms and others with conditions preventing them from engaging in group activities. Discussions with a recreational therapy coordinator confirmed they are conscious of this need. They would like to extend the social care programme, offering one to one time for people nursed in their rooms. This provision dependant on recruiting to the third part-time coordinator vacancy. Discussions with management confirmed recognition that care notes written by care staff need to be more holistic. These mostly focus on physical care and do not reflect the contribution of care staff to Care Homes for Older People Page 18 of 34 Evidence: provision of social stimulation. Recreational therapy coordinators maintain clear records of those attending organised social activities. The autumn programme of social events was displayed on a notice board. Typical weekly activities include cinema afternoons, newspaper reviews and crossword groups, group exercises to music, word and boardgames, art group or flower arranging, discussion groups and music. Events in recent months included poetry readings, a Macmillan coffee morning, an anecdotal talk and a music and exercise workshop. External entertainers had provided shows and concerts, a Wear It Pink Day Tea Party was held in aid of breast cancer and a Chinese lunch outing was organised. A full and interesting programme of seasonal activities, concerts and parties was planned for Christmas. Reminiscence materials are available, enabling this type of activity. The home has an in-house library with large print books and has quarterly visits from a mobile library.Local and daily newspapers are delivered to the home and personal copies can be ordered at an additional charge. The homes equal opportunity admissions policy values diversity. At the time of this inspection none of the people using services were from ethnic minorities, though a wide ethnic mix of staff was employed. Effort is made to meet the religious and spiritual needs of people using services. Church of England and Baptist services take place monthly in the drawing room and a separate monthly Communion service. Arrangements can be made for people using services to attend local Churches of their choice. Roman Catholic service users may receive Holy Communion at the home every Sunday. Community inclusiveness is promoted involving community groups in the activities programme, children from local schools and visits from a PAT (Pets As Therapy) dog. Survey feedback from relatives confirmed staff are welcoming. The home is situated on the outskirts of Cranleigh village where there is a library, a weekly market and good range of shops. Transport assistance is arranged to facilitate off-site shopping and excursions. A hairdresser and beautician visit regularly and facilities include a hairdressing salon.Letters arriving by post are delivered to bedrooms unopened on the day of delivery. Key workers will assist people using services to write letters, on request. The home has just produced its first newsletter which had been distributed to all people using services. A copy displayed on a notice board contained items of interest about staff and people using services, information and photos of a recent excursion and about the homes fund raising events. This year these included various raffles, an annual garden party and a cream tea party and coffee mornings. The expert by experience reported that some people using services chose not to participate in activities, preferring to stay in their rooms. The social therapy coordinators were observed to organise and facilitate a group activity of art and Care Homes for Older People Page 19 of 34 Evidence: scrabble, after lunch, in accordance with the activities programme. An individual wheelchair user was supported by care staff from her room so she could engage in the same. Another, who was blind, said staff informed her of the activities, enabling her to choose those she wished to attend. This person sat with the group listening to the radio and appeared to benefit from the stimulating atmosphere. Four people played a game of scrabble and one person was painting a water-colour. Paintings from previous sessions were displayed on the wall during the activity. Other people using services were also in the area and several care staff were chatting with them. One individual was observed using the garden independently during the visits. The garden was overall well-maintained with seating areas. Others had bird-feeders outside their bedroom windows adding additional interest to the outlook. Discussions with a visitor highlighted the benefit of involving relatives in review meetings. This will enable them to be more informed of the social activities their relative participates in and to contribute information that staff can use to further enhance this persons quality of life. Comments from people using services included, The home is clean, warm, well equipped, very comfortable and homely. It integrates with the local community in things such as Church services, Arthritis Support, Cancer Support. It is a happy place and the staff are always kind and patient. Fun things are arranged, such as a summer BBQ, tea and coffee mornings etc. They try to keep us entertained and interested in life and arrange outings. Two people sat in the lounge watching television said they were very happy with the home and that staff are very good. One added, They have a sense of humour, they keep our brains working with the activities which are very good. Nutritional assessments are carried out and weights are monitored. Professional dietary advice and swallowing assessments had been sought for individuals. The qualified head chef has worked at the home for many years and meets with people using services soon after their admission. He establishes their dietary needs, food preferences and times they would like breakfast served in their rooms.People using services have a choice of where they have their meals at other times. Some like to sit together in the dining room whilst others prefer or need to eat in their rooms. The catering team includes two other chefs, catering assistants and hostesses. A four week rotating menu offers an alternative dish for each course. Menus are circulated daily enabling people to select meals for the following day. There is opportunity for people using services to submit menu suggestions. The head chef emphasised his focus on provision of wholesome, nutritionally balanced meals. He stated fresh ingredients were mostly used. Fresh soups and desserts and home made cakes are prepared. Chefs are willing to accommodate other food preferences not on the menu, on request. The attendance of the head chef at service users meetings is a recent development. Here he can hear the views of people using services about the meals and any suggestions Care Homes for Older People Page 20 of 34 Evidence: for changes to menus or for improvement. Minutes of the last service users meeting confirmed only eight people attended. A person using services said others were not always aware these meetings are taking place to be able to attend.The collective view of those present at the last meeting was that overall the meals were of a good standard, varied and healthy. Some suggestions for improvement were made which were in common with those during the visits. A person using services said suggestions made to catering staff were not always acted on. Though most people consulted liked the food others were not fully satisfied. Some comments included, I would like more green vegetables, The vegetables are too al-dente. The meat is invariably tough. The food always comes hot, even in our rooms. The food is tasty. The menu is varied and the quality of food is excellent. Two people expressed the wish for the menu to rotate over a longer period to increase food variation and this feedback given to the head chef at the time. A relative said, The food is the only real pleasure my relative has (owing to medical condition).Its brilliant. The presentation of the dining room was of a very high standard, with crisp, immaculately ironed table linen, fresh flowers centre pieces, gleaming cutlery and glassware. A daily menu was on each table and record of individual menu choices by each place setting. Wine was served with the lunch -time meal or water. Lunch looked colourful and appetising. The presentation of meals, including those served in rooms, was also of a high standard. A choice of soup or smoked salmon was followed by beef stew with dumplings, mashed potato, spinach and a medley of diced root vegetables or macaroni cheese with salad. The macaroni cheese appeared dry however and cut like a cake. Desert was plum crumble with custard or ice-cream or fresh fruit salad. Hot drinks were served after the meal. There was sufficient space between tables though survey feedback from one person indicated this could sometimes be an issue. A carer was noted to take immediate action on observing individuals in wheelchairs on one table in need of more room, for their comfort.The atmosphere in the dining room was very calm and some social intercourse going on between people using services. A carer was observed to respond to an incident in which a service user choked on a piece of food in an effective, professional and calm manner. Observations confirmed drinks were regularly provided throughout the day. One visitor felt however that drinks might be offered more often. Care Homes for Older People Page 21 of 34 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 home has a simple, clear and accessible complaint procedure which includes timescales for the process. People using services are protected from abuse. Evidence: The complaint procedure is clearly detailed in the homes statement of purpose. It is also in the service users guide which is issued to people using services together with a personal copy of the complaint procedure. The procedure is displayed in the home and is summarised in the terms and conditions of residency. A relative whose complaint was under investigation by the home during the inspection requested that a more public and transparent complaint procedure be also advertised on the homes website. The procedure includes timescales, ensuring complaints are dealt with promptly. Survey feedback from people using services confirmed most were aware of how to make a formal complaint. They said they had someone they could speak with informally if they had concerns. Comments included, I and my family cannot think of anything they can do better. If we have a problem we see the matron or any of the staff and the issue is dealt with instantly. If I or my family ever need a care home then I hope there is a place available at Knowle Park. The home received eight complaints in the past year. Complaint records examined were comprehensive, including details of the investigation and any action taken. Observations confirmed the home learns from complaint and other than fee charges and catering, it is rare that a complaint about the same issue is made twice. Care Homes for Older People Page 22 of 34 Evidence: Policies and procedures for safeguarding vulnerable adults are available in the home. These give clear specific guidance to those using them and comply with Surreys local procedure and protocol. There is a clear system for reporting safeguarding incidents to Surreys safeguarding team. Also for staff to report concerns about colleagues and managers. Staff are trained to identify indicators of abuse and neglect and in the safeguarding procedures. This training commences during their induction and is ongoing. Conversation with staff confirmed awareness of the need to report any concerns they may have immediately, in the event of suspicions or allegations of abuse.They said that they would have no hesitation in doing so. Since the last inspection there had been one safeguarding referral which is now closed. Staff consulted said that there were always enough staff on duty to ensure the safety of people using services. This view was not shared however by two relatives who independently expressed concerns about the adequacy of staffing levels at weekends. Further comment on this is recorded in the Staffing section of this report. Observations during the first visit highlighted the need for a risk assessment to be carried out of building security. This was undertaken and with immediate effect measures implemented to strengthen security. The front door is now secure preventing unobserved access of visitors and strangers whilst not restricting people using services from going out. The home manager stated her intention to request installation of a door-entry system. The home does not manage the financial affairs of people using services however does handle their money, on request. This is held securely and records of all transactions receipted and maintained. These individuals were stated to have access to their money at any time. It was evident that the manager keeps abreast of changes in legislation including the new legal framework and assessment responsibilities under the Mental Capacity Act. It was stated there are plans to cascade this training to the team.Work was stated to be in progress within the organisation to produce a related procedure and protocol. Care Homes for Older People Page 23 of 34 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. People using services benefit from quality accommodation, with specialist equipment and aids to meet their needs. The home is clean and hygienic and has a planned maintenance programme. Attention is necessary however to corporate systems for prioritising essential repairs. Evidence: Knowle Park is a converted, large, detached two - storey property with additional purpose built areas. Care has been taken in its conversion and refurbishment to retain the buildings original architectural character and features. Situated in a semi-rural setting people using this service enjoy scenic views of the Hanscombe Hills and of the homes extensive grounds and parklands from most windows. At the time of the visits the grounds were tidy and seating areas provided. Communal areas comprise of an entrance hall and reception area, large lounge and dining room, sun lounge and conservatory. Bedroom accommodation is arranged on both floor accessible by stairs and passenger lift. There are 42 bedrooms, most with with variable en-suite facilities, 7 suitable for shared use if required or available for sole use and 35 for single occupancy. Telephones are in all bedrooms, some of which have direct lines and all have a television providing terrestrial programmes and a radio. Emergency call bells are accessible throughout the building including bedrooms. A range of adaptations are in place to support people with mobility and sensory Care Homes for Older People Page 24 of 34 Evidence: impairments and specialist bathing facilities available on both floors. Fixed ceiling tracking hoists and mobile hoists are provided. Other facilities include office accommodation in the home and in a separate building, storage and staff facilities, a fully equipped large kitchen and laundry room. The inspection visits incorporated viewing all communal areas, the kitchen, laundry, clinical room and sampling bathrooms, toilets and bedrooms. Observations confirmed a high standard of decoration and furbishment throughout and of cleanliness, hygiene and odour control. A spacious laundry room is suitably equipped. Staff launder personal clothing and household linens are sent to an external laundry. The homes five year development plan includes ongoing refurbishment of rooms, provision of an en-suite facility for a bedroom and a new communal shower room. The maintenance person has specific areas of responsibility. These include health and safety checks, redecoration of rooms as required, wheelchair maintenance and other minor work, for example hanging pictures and shelves in bedrooms. His hours have been reduced and he acknowledged time-pressure created difficulties for him to manage his workload. At the time of the visits he was checking and recording the safety of water temperatures throughout the building. Feedback from staff in surveys and during discussions with them and records evidenced substantial delays in the past twelve months in carrying out essential repairs not within the remit of the maintenance person. This was outside the home managers direct control and specific details are recorded in the Management and Administration section of this report. At the time of the visit the home was waiting for a valve to be fitted to a hot water tap. This sink was in a corridor and the water temperature was a potential hazard. The home manager had implemented risk management measures to reduce the risk. Care Homes for Older People Page 25 of 34 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. People using services are protected by the homes recruitment policy and practice. Staff are trained, skilled and in sufficient numbers to meet their needs. Evidence: The inspection process included viewing the files of two new employees, sampling staff rotas, induction and training records. Also discussions with randomly selected staff and direct observation of practice.Staff were all in smart, clean uniforms, presenting a professional image. They created a happy friendly atmosphere in their interactions with people using services and each other. The expert by experience reported that all staff were courteous, friendly, calm and patient. They smiled readily and appeared to have a good rapport with people using the service. We were told by a person using services, They are very good staff, the nurses are all very good. I can ask any thing of these girls and they will do it for me. Everybody is most cooperative. A visitor said, The actual care has been very good. Other comments included, The staff are all very nice. The staff are very good and friendly. I love everyone here. They look after us very well. Records evidenced that people using services are protected by robust staff recruitment, vetting and induction procedures. Recently recruited staff had received copies of the General Social Care Councils code of practice and a staff handbook and Care Homes for Older People Page 26 of 34 Evidence: were working through the common induction standards workbook. A buddy system operates in which experienced staff support new staff when they first take up post. They receive accurate job descriptions and specifications clearly defining their roles and responsibilities and a contract of employment. There is a stable core group of staff which enables good continuity of care and services. In common with many care homes there are difficulties in recruiting nurses. Though nurses were stated to be flexible and adaptable with shift patterns it is sometimes necessary to use agency staff from an approved list to cover short -term absences. All visiting agency workers are required to evidence they have a current disclosure issued by the Criminal Records Bureau; also provide evidence of registration with the Nursing and Midwifery Council. Agency staff were stated to be fully inducted and to always work alongside a permanent member of staff for guidance. Staffing level during the day for nurses and care staff are one or two nurses and ten care assistants up until 6 p.m. thereafter until the night shift report for duty there is one nurse and six care assistants. Night staffing levels are routinely one nurse and five care assistants. The deputy manager, who is a registered nurse, works weekdays and is included in skill mix part of the week. At the time of the inspection two student nurses were on placements at the home, working supernumerary to staffing levels. Discussions with staff and survey feedback confirmed their opinion that staffing levels were usually adequate. Information received independently from two relatives whose perception was that nursing and care staffing levels were reduced at weekends was not evidenced.The home manager suggested an explanation might be because less administrative staff are on duty at weekends. Systems are in place to ensure staffing levels do not fall below the level necessary to meet the needs of people using services. A nursing sister has delegated responsibility for staff training with sixteen hours each week dedicated to this role. She is a registered general nurse, has a registered manager award qualification and is an accredited National Vocational Qualification (NVQ) Assessor and Verifier. There are five NVQ Assessors in total within the team. Staff training records evidenced an ongoing programme of statutory and service specific training and refresher training. The home has achieved the status of National Vocational Assessment (NVQ) Centre. 60 per cent of care staff have achieved a relevant qualification in health and social care at NVQ Levels 2 or 3 or equivalent, exceeding the national minimum standard. 36 per cent care staff were working towards this qualification. Some ancillary staff have also achieved NVQ qualifications Levels 1, 2 and 3. Training was stated to be planned to ensure staff awareness of their duties and responsibilities under the mental Capacity Act 2005 deprivation of liberty safeguards. The training records evidenced the home was at an early stage of delivering dementia training and equality and diversity training to the team. Staff consulted felt they had received adequate training to fulfill their duties.One long- Care Homes for Older People Page 27 of 34 Evidence: serving care assistant demonstrated a good knowledge base of dementia care and management of behaviours that sometimes challenge services. She had a good knowledge of the people in her care. Several members of staff including a new employee were very good at explaining to people using services what they were going to do, when assisting them in moving from one place to another and with their meals. Care Homes for Older People Page 28 of 34 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 effectively managed by a skilled and competent management team, providing good outcomes for people using services. It runs in their best interest and ensures their financial interests are safeguarded. Whilst the health and safety of people using services and staff is promoted it is necessary for the organisation to ensure a more timely response to requests for essential repairs and equipment. Evidence: The home manager has worked at the home since 1989 and is registered with the Care Quality Commission. She is a qualified general nurse (RGN) with twenty years experience in the care of older people. She has achieved a National Vocational Qualification in management (NVQ) Level 4 combined with the Registered Managers Award (RMA).The deputy manager / senior sister has worked at the home since 1997, is a trained nurse with RGN qualification and also has the RMA qualification. Both were on duty at the time of the visits and observations confirmed their competent management of the home. Discussions with them confirmed their clear understanding of the key principles and focus of the service, based on organisational values and Care Homes for Older People Page 29 of 34 Evidence: priorities. They are evidently committed to the provision of good quality care and quality of life for people using services. They promote equality and diversity and human rights in the homes management and practice. The home manager was perceived to have good people skills and observed to know the people using services well. Communication systems include weekly inter-departmental management meetings, regular staff meetings, efficient record keeping. Meetings are held between people using services and management and with relatives. Relatives meetings and attendance of the head chef at service users meetings are new developments. The service has a wide range of up to date policies and procedures and systems to audit staff compliance. The Annual Quality Assurance Assessment (AQAA) completed by the home manager contained relevant information supported by a wide range of evidence. It demonstrated the homes management works to continuously improve services. Where there is still need for improvement the AQAA shows clearly how this is to be achieved. The manager is aware of current national and local developments related to the care sector. She has received training and is aware of the homes duties and responsibilities under the Mental Capacity Act 2005 deprivation of liberty safeguards. Though the home is not yet in receipt of the a related corporate policy and procedure which was understood to being developed, the home manager is familiar with local procedures.At the time of the visits there were no people using services subject to a deprivation of liberty authorisation or application. Two part-time administrators support the homes management and administration and undertake reception duties.People are supported to manage their own money. There is a safe for securing nominal amounts of personal money and valuables if required and receipts provided for anything deposited. The financial files relating to the sundry accounts of four people using services examined evidenced written records of all transactions. Information supplied in the AQAA confirmed a planned maintenance and renewal programme. Regular health and safety audits are carried out. A recent audit identified the need to fit a valve for controlling the hot water temperature to a sink in a public area. A risk assessment had been carried out and risk management measures implemented pending this work being carried out. Staff training includes moving and handling, first aid, infection control, COSHH, health and safety and fire safety. The deputy manager is a first aid trainer. The registered manager has budget control for the day-to-day running of the home. This includes food purchases, staff training, day-to-day maintenance and minor replacements. An electronic system operates for other repairs and maintenance requests which are authorised and prioritised by the organisations head office. Care Homes for Older People Page 30 of 34 Evidence: Survey feedback from staff raised concerns about delays in responding to essential repairs. Comments were numerous in this matter and included, Being part of a large group of homes at times it is difficult to get repairs done, everything has to go through head office which can be very frustrating and not satisfactory at times. The home itself does the best it can but lack of support from head office does not make things easy. They need to be quicker in responding to repairs as some can be a health and safety issue. The inspection evidenced lengthy delays in responding to essential repairs by the organisation. The kitchen had been without a hot water supply for forty days earlier in the year due to a faulty boiler. Catering staff had to boil water on the cooker. A fractured water pipe in the washing up area had taken twenty days to rectify. The report of the Environmental Health Departments inspection in June 2009 commented on a lot of flies in the kitchen and required fly screens which were five months on order. It is recognised the home manager had frequently followed up these outstanding repairs. It was noted more recently since the current service manager assumed interim line management responsibility for the home she had been more successful in expediting urgent repairs and replacement of equipment. Quarterly health and safety committee meetings were noted to be a new development. Caring Homes Ltd has clear policies and procedures for quality assurance. The organisation carries out regional quality audits that take into account the views of people using services, their representatives and staff. Since the last inspection professionals have been included in this survey. A representative of the company makes monthly visits to the home and reports in accordance with statutory requirements. Copies of these records demonstrated a thorough approach from which action plans are generated, ensuring continuous improvement. Care Homes for Older People Page 31 of 34 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 32 of 34 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 33 of 34 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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