Care Home: La Luz

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What the care home does well Residents continue to live in a clean and homely environment, which is decorated and maintained internally to a good standard. Comments about the environment included: "I have my own room a stair lift to get to my room which is lovely. The rooms are bright, warm and clean" "Environment lovely, nice homely place exceptionally clean no unpleasant odours at all" and "my room is kept spotless clean". There continues to be a wide range of residents being accommodated, this includes some residents who live independent lives and residents who have dementia, visual impairments and mental health needs. The home is now able to identify and meet the assessed needs of residents. All persons consulted about the home spoke positively about their experiences with consistent feedback about the positive aspects of the home being family run. A sample of comments included "Its as near as I can to living at home its family run it`s the same as being looked after by your own family its not too big which suites me" "Nicely homely place to live" "Relaxing place to live" "This is an excellent care home. The rooms are like home the food is superb and the owners and staff very attentive and friendly" and "Could not wish for anything more than they provide mum has really settled here we are very happy with the with everything mum looks as happy as if she was in her own home". Social activities and meals are well managed, creative and provide daily variation and interest for people living in the home. A sample of food made about the food included: "The food is all prepared in the kitchen using fresh produce. it is well balanced and appetising" "Home cooking fantastic you would just tell them if you didn`t like something and they would get you something else" and "nice food". Residents are helped to exercise choice and control over their lives with flexible routines being an integral part of daily practice at the home. Links with families and friends continue to be valued and supported by the home. A relative commented "no restrictions can visit whenever I like, make you feel welcome every time I visit I have had a meal here and I came to the Christmas party". Personal support is offered in ways, which promotes and protect resident`s privacy and dignity. A complaints procedure and appropriate adult protection policies and staff training helps to protects the rights and interests of residents. A relative said "If I had any concerns what so ever you could just tell the manager and his wife they would always do their very best to sort it out". Staff make a positive contribution in residents lives as they benefit from a trained and enthusiastic staff team that know them and who are employed in sufficient numbers as is necessary to meet their needs. Comments about staff included "The staff are always around and people don`t change every week as they do at some homes" "Staff alright" "Staff all good" and "Always friendly always someone around to give me a hand if I need it". Residents benefit from a manager who has significantly developed their understanding of their roles and responsibilities and who provides a clear sense of leadership and direction which enables staff to provide good quality care to residents. Comments made about the management included "Relatives Angel and Carmen are very attentive and have a good sense of humour" "The managers have a special rapport with service users they are really caring" "Carmen very strong and good hearted I feel I can ask Carman anything as if they are family" "Carman is very supportive like family" and "The owners are always on hand and ready to listen". What has improved since the last inspection? All of the requirements made at the previous inspection have now been address or are in the process of being addressed. This has helped to improve the practices at the home through better staff training. Comprehensive new care planning system is in the process of being implemented which helps to provide staff with the guidance they need to work consistently with residents. The internal redecoration of the home has now been completed which has resulted in a well decorated and maintained internal environment in which to live. The managers understanding of their roles and responsibilities under the National Minimum Standards and good practices in the care of older people has significantly improved. This has resulted in improved administration standards and practices at the home with a more relaxed atmosphere present. What the care home could do better: There are no requirements made at this inspection, where shortfalls in practices were noted the manager was in the process of addressing and agreed to address these areas promptly. This was in relation to the exterior of the building being in urgent need of redecoration. The manager confirmed that this would be completed by June 2009. New care planning documentation needed further review to ensure that when they were fully implemented that they were more person centred. Information about the home needs to include the full range of placements being offered and their aims to ensure that prospective residents and their representative were able to make informed decisions. Some good practices recommendations were made in order to further promote medication practices and residents safety. Inspecting for better lives Key inspection report Care homes for older people Name: Address: La Luz 4 High Street Tadworth Surrey KT20 5SD     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: Jane Jewell     Date: 1 6 0 1 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 27 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 27 Information about the care home Name of care home: Address: La Luz 4 High Street Tadworth Surrey KT20 5SD 01737813781 Telephone number: Fax number: Email address: Provider web address: asoto195@msn.com Name of registered provider(s): Mr Angel Soto,Mrs Maria Del Carmen Soto-Regueira care home 16 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 to be accommodated is 16. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home La Luz is a large converted domestic detached property located in a quiet residential area in the village of Tadworth. The home is registered to provide residential care for up to sixteen older people including people who have dementia. 16 0 Over 65 0 16 Care Homes for Older People Page 4 of 27 Brief description of the care home The home is presented over three floors with access to the first floor via stairs or a chair lift. The top floor provides staff accommodation and offices. Residents accommodation consists of fourteen single rooms and one shared bedroom, with three bedrooms providing en-suite facilities. Communal areas consist of a large combined lounge and dining area and a conservatory. The conservatory overlooks a large rear garden. The front is paved to provided off road parking. Care Homes for Older People Page 5 of 27 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 information contained in this report has been comprised from an unannounced inspection undertaken over six hours and information gathered about the home before and after the inspection. This is the second Key unannounced inspection of the home within twelve months. The inspection was facilitated by Mr and Mrs Soto (joint registered providers). Mr Sotto is also the registered manager. The focus of the inspection was to assess the progress made towards addressing the areas of shortfall noted at the previous inspection and to look at the experiences of life at the home for people living there. The inspection consisted of a tour of the premises, examination of the homes documentation and discussion with residents and staff and two relatives. Feedback surveys were sent to the home in advance of the inspection, Care Homes for Older People Page 6 of 27 four were returned from residents, nine from relatives, five from staff and one from a health care professional. The feedback and comments from these surveys were used to inform the inspection process and are included in this report. Small groups of residents were observed for signs of well-being/ill-being (terminology used for observing behaviour for people with dementia) and these observations are also included in this report. There were fourteen residents living at the home at the time of the inspection. What the care home does well: Residents continue to live in a clean and homely environment, which is decorated and maintained internally to a good standard. Comments about the environment included: I have my own room a stair lift to get to my room which is lovely. The rooms are bright, warm and clean Environment lovely, nice homely place exceptionally clean no unpleasant odours at all and my room is kept spotless clean. There continues to be a wide range of residents being accommodated, this includes some residents who live independent lives and residents who have dementia, visual impairments and mental health needs. The home is now able to identify and meet the assessed needs of residents. All persons consulted about the home spoke positively about their experiences with consistent feedback about the positive aspects of the home being family run. A sample of comments included Its as near as I can to living at home its family run its the same as being looked after by your own family its not too big which suites me Nicely homely place to live Relaxing place to live This is an excellent care home. The rooms are like home the food is superb and the owners and staff very attentive and friendly and Could not wish for anything more than they provide mum has really settled here we are very happy with the with everything mum looks as happy as if she was in her own home. Social activities and meals are well managed, creative and provide daily variation and interest for people living in the home. A sample of food made about the food included: The food is all prepared in the kitchen using fresh produce. it is well balanced and appetising Home cooking fantastic you would just tell them if you didnt like something and they would get you something else and nice food. Residents are helped to exercise choice and control over their lives with flexible routines being an integral part of daily practice at the home. Links with families and friends continue to be valued and supported by the home. A relative commented no restrictions can visit whenever I like, make you feel welcome every time I visit I have had a meal here and I came to the Christmas party. Personal support is offered in ways, which promotes and protect residents privacy and dignity. A complaints procedure and appropriate adult protection policies and staff training helps to protects the rights and interests of residents. A relative said If I had any concerns what so ever you could just tell the manager and his wife they would always do their very best to sort it out. Staff make a positive contribution in residents lives as they benefit from a trained and enthusiastic staff team that know them and who are employed in sufficient numbers as is necessary to meet their needs. Comments about staff included The staff are always around and people dont change every week as they do at some homes Staff alright Staff all good and Always friendly always someone around to give me a hand if I need it. Residents benefit from a manager who has significantly developed their understanding of their roles and responsibilities and who provides a clear sense of leadership and Care Homes for Older People Page 8 of 27 direction which enables staff to provide good quality care to residents. Comments made about the management included Relatives Angel and Carmen are very attentive and have a good sense of humour The managers have a special rapport with service users they are really caring Carmen very strong and good hearted I feel I can ask Carman anything as if they are family Carman is very supportive like family and The owners are always on hand and ready to listen. 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 27 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 27 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. Prospective residents and their representatives are provided with information in a form that is appropriate to them to allow them to make an informed choice with minor adjustments needed to this information to ensure that it fully reflects the full range of services being provided. The way in which prospective residents are assessed ensures that the home admits only those residents whos needs can be met by living at the home. The home is now able to identify and meet the assessed needs of the residents. Evidence: There is a range of information about the home and the services it provides, this includes a statement of purpose and service user guide which is included in an information Pack given to prospective residents, representatives and other interested parties. Although this information is detailed minor additions are needed to Care Homes for Older People Page 11 of 27 Evidence: the statement of purpose to ensure that it reflects the full range of placements available at the home and their aims. This is to ensure that prospective residents are aware of the full ranges of services and facilities in order to help make informed decisions. The manager agreed to ensure that this was updated promptly. A relative spoke of how helpful being given the information pack was when they were first looked around the home and how they felt comfortable to ask any questions they wanted to the manager. Residents are provided with a written contract of terms and conditions of residency with the home, which they or their representatives have signed. This helps to ensure residents and their representatives are aware of the placement arrangements and to clarify mutual expectations around rights and responsibilities. A new format for the assessment of prospective residents needs has been introduced this provides comprehensive information about their needs in order for the manager to make an informed decision whether their assessed needs could be safely met at the home. Advice is sought during the assessment process from health care professionals and others who know and understand the needs of the prospective resident. The needs assessment then forms the basis of their care plan. This helps ensure that staff are aware of the recorded needs of new residents prior to them moving into the home. There continues to be a wide range of residents needs being accommodated, which includes residents who live independent lives and residents who have mild dementia, physical needs, visual impairments and mental health needs. Improvements made in management, staff training and administration now ensure that there is evidence that the home is able to meet residents assessed needs. All persons consulted about the home spoke positively about their experiences with consistent feedback about the importance of the family run nature of the home. A sample of residents comments included Its as near as I can to living at home its family run its the same as being looked after by your own family its not too big which suites me nicely homely place to live and Relaxing place to live I love living here they are very supportive. I can relax here as if my home. Good atmosphere I am happy and This is an excellent care home. The rooms are like home the food is superb and the owners and staff very attentive and friendly. A sample of relatives comments about the home included La luz is fairly small I think but appears well run and organised friendliness amongst staff and residents is very good and is most noticeable Several homes were visited and this appeared best in most respects and Could not wish for anything more than they provide mum has really settled here we are very happy with the with everything mum looks as happy as if she was in her own home. Care Homes for Older People Page 12 of 27 Evidence: Residents and their representatives consulted with spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Most residents consulted said that it was their families that looked around the home on their behalf. Intermediate care is not offered at the home therefore this standard is not assessed. Care Homes for Older People Page 13 of 27 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. New care planning process enables residents assessed needs to be identified and appropriate guidance for staff provided with the manager aware of the further review needed to ensure that care plans are more person centred. The medication systems are generally well managed promoting good health. Residents receive prompt health care intervention from a range of health care professional. Personal support is offered in ways, which promotes and protect residents privacy and dignity. Evidence: Much work has been undertaken to improve the care planning process and address previous shortfalls. This has resulted in new care planning documentation being implemented which provides complex standardised assessments undertaken for each resident. As part of their implementation, the care planning format remains under review and the manager was aware of the need to further change elements of care plans to make them more relevant and personal to individual needs. Staff were clear Care Homes for Older People Page 14 of 27 Evidence: on the needs of residents but were aware of the need for them to become more fully involved in the development and review of care plans once the new format has been further reviewed. Although it was clear that there was a greater awareness of good practices in the tone of language necessary to preserve residents dignity when recording, some further minor work is still needed to ensure that this is consistent across all documents. The risks faced and posed by residents are assessed and any actions needed to reduce or manager risks are recorded in the care plans. Records of medical intervention showed that the home continues to work closely with health care professionals including GPs, specialist nurses, chiropodists, opticians and dentists to ensure residents receive a good range of health care intervention. Residents and relatives confirmed that when they have asked for medical input then this has been sought promptly by the home. The system for the administration of medication is generally well managed with arrangements in place to ensure residents medication needs are met safely. To further promote good practices and residents safety it is recommended that additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. This is necessary in order for staff to know when to administer these medicines. Hand written MAR charts should be signed and dated by the person recording and in order to fully eliminate the associated risk when copying prescribed instructions onto medication administration records, it is recommended that these records should be checked and countersigned for accuracy by a second member of staff. One example was noted whereby a prescribed instruction had been changed without there being details of who, when and why these were changed, this is necessary in order to ensure a clear audit trail of all prescribed medication. The manager agreed to address this promptly. Observation in the home confirmed that residents privacy and dignity is being respected, staff knock on doors and speak to residents in a courteous manner. Residents were dressed appropriately, in accordance with preserving their dignity and the prevailing weather. Care Homes for Older People Page 15 of 27 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. Social activities and meals are well managed, creative and provide daily variation and interest for people living in the home. Residents are helped to exercise choice and control over their lives with flexible routines being an integral part of daily practice at the home. Links with families and friends are valued and supported by the home. Evidence: There is evidence that residents are treated as individuals. Observation of the daily routines and discussion with residents continue to confirm that staff accommodate residents personal wishes with regard to meal times, going to bed, rising and bathing. During the inspection residents were observed to move around the home choosing which room to be in and what level of company they wanted to enjoy. It was clear that there is a improved awareness of appropriate occupations and activities for the needs of people at the home, this has resulted in more social opportunities and opportunities for engagement. Residents spoke of participating in music sessions, music for health dancing, and puzzles. Staff spoke of having the opportunity to go on short walks with residents to local amenities. The general census Care Homes for Older People Page 16 of 27 Evidence: of feedback received was that there are usually sufficient opportunities for occupation. Not all residents wished to be involved in organised activities and this was respected. Visitors commented upon how welcomed they are made to feel during their stay, this included being offered beverages or meals and staff being friendly and approachable. A relative commented no restrictions can visit whenever I like, make you feel welcome every time I visit I have had a meal here and I came to the Christmas party. A relative spoke of how they were enabled to use the homes phone in private to keep in contact with their family as they did not want to have their own phone line in their bedroom. For a few people living at the home, exercising their choice was difficult due to their level of dementia. The staff were seen to use their acquired knowledge of a person to help them make choices in regard to food drink and occupation. Relatives spoke positively about how staff ensured that there relative was always dressed in accordance with their lifestyle and personal preferences. Much effort has been made to ensure the cultural needs of residents whos first language is not English is respected. The manager spoke of the discussion that had occurred with placement authorities and relatives regarding the sharing of bedrooms, it was discussed that any agreements needs to be recorded in care planning documentation in order to evidence the process and the outcome. The inspector observed many signs of affection between the deputy manager/staff and some residents and it was clear that these residents responded and welcomed this affection and in some cases sought it. In order to promote the protection of all it was discussed that it should be recorded in care plans to ensure that all parties are aware of the boundaries and of physical affection for some residents being part of their cultural needs. Residents confirmed that the home continues to provide good quality homemade meals and that they are offered an alternative meal if they dont like what is on the menu. Residents who needed some support to eat were assisted discreetly and sensitively. A sample of comments made about the food included: The food is all prepared in the kitchen using fresh produce. it is well balanced and appetising Home cooking fantastic you would just tell them if you didnt like something and they would get you something else and nice food. In between meals residents were offered hot drinks and snacks including a fresh fruit bowl being on display in which residents could help themselves to. Care Homes for Older People Page 17 of 27 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. A complaints procedure and appropriate adult protection policies and staff training helps to protects the rights and interests of residents. Evidence: There is a written accessible complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. This includes the procedure being displayed in different languages. All residents and relatives consulted with said that they were aware of how to raise any concerns and felt comfortable to do so. A relative said: If I had any concerns what so ever you could just tell the manager and his wife they would always do their very best to sort it out. The manager reported that there have been no formal complaints made since the previous inspection. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff have received formal training in safeguarding adults and prevention of abuse and the staff consulted with showed an understanding of their roles and responsibilities under safeguarding adults guidelines. Care Homes for Older People Page 18 of 27 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. Residents continue to live in a clean and homely environment, which is decorated and maintained internally to a good standard. Residents private accommodation is personalised, safe and comfortable. The manager is taking action to improve the external of the building. Evidence: The home comprises of a converted domestic dwelling in a residential area on the outskirts of a village with a small parade of local shops a short walk away. Since the previous inspection the manager confirmed that the internal redecoration of the home is now complete, which has seen the redecoration of the remaining bedrooms and the fitting of some new sink vanity units. This has resulted in the internal building being decorated and maintained to a good standard with much effort made to create a homely feel. Consistent feedback was received that the home environment created was a significant factor in residents and their relatives choosing the home. The exterior of the building is in urgent need of redecoration and the manager agreed to ensure that this was completed by June 2009 therefore no requirement was made regarding this at this inspection. Residents bedrooms were observed to have been individualised to reflect their individual lifestyle and preferences with many of the residents saying that they were Care Homes for Older People Page 19 of 27 Evidence: able to bring small items of furniture and personal belongings with them. A resident feedback I have my own room a stair lift to get to my room which is lovely. The rooms are bright, warm and clean. There are sufficient number of toilets and bathrooms located around the building this includes assisted baths. There was a range of individual aids and adaptations to assist residents mobility and independence, including raised toilet seats, walking aids, chair lift and grab rails. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. A resident confirmed that they did not wait long before staff answered their calls for assistance. All areas inspected were observed to be cleaned to a high standard with many positive comments received regarding the cleanliness and hygiene a sample of comments included: Environment lovely, nice homely place exceptionally clean no unpleasant odours at all and my room is kept spotless clean. The inspection was undertaken on a cold winters day with all residents confirming that the home was always kept at a comfortable level. The use of portable radiators is used in a couple of bedrooms to provide additional heat. The manager had ensured that the appropriate safety considerations had been undertaken including risk assessments. Care Homes for Older People Page 20 of 27 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. Staff make a positive contribution in residents lives as they benefit from a trained and enthusiastic staff team that know them and who are employed in sufficient numbers as is necessary to meet their needs. Robust recruitment practices ensure that staff are suitable vetted before they commence employment. Evidence: Residents, staff and relatives consulted with all felt that there was sufficient number of staff on duty as is necessary to meet residents needs in a timely manner. Staff commented there is ample staff to do what needs to be done and Best thing is the individual care provided very feeling towards the residents we have time to spend individually with residents. All persons consulted with spoke positively about the staff , a sample of comments made about staff included there is enough qualified staff available in each shift. The staff are always around and people dont change every week as they do at some homes. Staff alright Staff all good. Always friendly always someone around to give me a hand if I need it and All very nice girls. Staff interactions with residents were positive, residents were observed initiating Care Homes for Older People Page 21 of 27 Evidence: conversations with staff, showing signs of recognising staff and showed relaxed body posture around staff. Some humour and laughter was observed in interactions with staff who had a good rapport with residents, which promoted a relaxed atmosphere in the home. The manager confirmed that they have more than 50 percent of staff having completed a National Vocational Qualification in care. In line with previous requirement much work has been undertaken to improve the administration of training and the training opportunities available for staff. This has resulted in staff having completed or are in the process of completing all of the mandatory areas of training necessary for staff to work safely with residents. Some areas of specialist training has also been undertaken including dementia, visual impairment and mental health. The manager confirmed that new staff confirmed undertake (skills for care) induction, which is the industry recommended minimum inductions standards. Two personal files of staff member were inspected and these showed that a more robust recruitment process is being followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. Care Homes for Older People Page 22 of 27 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. Residents benefit from a manager who has significantly developed their understanding of their roles and responsibilities and who provides a clear sense of leadership and direction which enables staff to provide good quality care to residents. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: The manager reported that they have completed the recommended management qualification in management. Both providers work in the home daily with a clear sense of leadership and direction being provided by them. It was evident that the managers knowledge and understanding of their role and responsibilities has significantly increased which has resulted in much improved administration and practices at the home. They demonstrated a continuing commitment towards improving services at the home and their knowledge of good practices in the care of older people. A sample of comments made about the management included: Angel and Carmen are very Care Homes for Older People Page 23 of 27 Evidence: attentive and have a good sense of humour The managers have a special rapport with service users they are really caring Carmen very strong and good hearted I feel I can ask Carman anything as if they are family Carman is very supportive like family and The owners are always on hand and ready to listen. Consistent feedback was received on the positive impact of the home now being owned by the current providers and how much more relaxed the atmosphere is and that decisions can be made much quicker as they do not have to be referred to several people. A staff member commented any problems can now be sorted out much quicker as dont have to ask permission from the other owners they listen to ideas more organised and better co- operation residents are much happier. Staff in the main continue to be supervised by the manager working along side them each shift and all staff consulted with felt supported by them to undertake their roles. Care staff spoke of receiving some formal supervision. The manager stated that they are involved in holding the personal monies for one resident and that social services monitor the records for this particular resident. Written guidance is available on issues related to health and safety. The manager undertakes regular health and safety checks. Systems were in place to support fire safety, which includes, regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that they have undertaken a fire risk assessment. This records significant findings and the actions taken to ensure adequate fire safety precautions in the home. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 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 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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