Care Home: Lanrick House

What the care home does well The management and staff make the people who use the service and their visitors welcome. There are frequent visitors to the home. Staff demonstrated great respect for the people who use the service, and people were addressed in an appropriate manner. Discussions with staff were positive, and showed a clear determination that they belong to a committed team. People spoken with were very positive about the care that they were receiving. The home was clean, warm and comfortable. New care plans were in the process of being implemented since the previous inspection, these were more person centred, comprehensive and clearly written. Individual risk assessments were up to date. What has improved since the last inspection? The Annual Quality Assurance Assessment completed by the registered care manager told us about the following improvements made: "75% of staff have successfully completed the n.v.q. in customer care which has enabled us to give better customer care which in turn has created a more homely and relaxed home for the service user." "100% of staff have or are doing the n.v.q.2 in elderly care, we have incorporated a dignity care plan for each service user, We also have employed an extra member of staff on nights this has enabled us to give the service users the best possible care." "Continuing professional development, which includes all aspects of complaints and protection procedures." "New carpets have been laid in some of the bedrooms, two new flat screen televisions in the service users sitting areas, flat screen television in one of the service user bedroom. General paint up keep throughout the home." "Through continuing professional development the manager has successfully achieved up to date n.v.q.2 customer care, team leading n.v.q. level 2 and updated train the trainer manual handling. Senior carers have achieved n v q. customer care level 2 and currently on n.v.q. team leading." What the care home could do better: Controlled medication must be stored safely and appropriately in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973. Alternative bedroom floor covering should be used in line with our discussion about the named person and their continence management. A dedicated activities person would encourage and stimulate individuals, and ensure better variety and quality activities for people using the service. Regular minuted meetings should be held to enable people to have a say in the running of the service, and to give people more control over their lives. A shower should be installed to provide individuals with a choice of a shower or a bath. Staff training should be undertaken in regard to the Mental Capacity Act 2005 and Deprivation of Liberty guidance, to ensure the safety and protection of the people using the service. Key inspection report Care homes for older people Name: Address: Lanrick House 11 Wolseley Road Rugeley Staffordshire WS15 2QJ     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: Pam Grace     Date: 2 3 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Lanrick House 11 Wolseley Road Rugeley Staffordshire WS15 2QJ 01889577505 01889577505 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Hazel Mary Elizabeth Price,Mr Barry Price,Mrs Diane Isobel Britten,Mr Richard Charles Britten Name of registered manager (if applicable) Mrs Geraldine Mary Reid Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category of service only: Care Home Only (Code 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) 32 Dementia (DE) 18 Physical disability (PD) 6 Date of last inspection Brief description of the care home Lanrick House is a care home that can accommodate thirty-two older people with needs associated with old age and dementia related conditions. The home is located in Care Homes for Older People Page 4 of 28 Over 65 0 32 0 18 0 6 Brief description of the care home a residential area of Rugeley, is close to amenities and served by public transport. The premises are a large Victorian house that has been extended, is pleasantly situated with lawns and external sitting areas. Adequate car parking is provided. Accommodation is provided on three levels, the first and second floors are served with stairs and a shaft lift. There are 12 single occupancy bedrooms and 10 doubles, and no bedrooms have an en-suite facility. There are adequate bathroom and toilet facilities on each floor of the home. There are two separate lounges, and two separate dining rooms, located on the ground floor. Services and facilities including laundry, catering and hotel services are adequate with ongoing upgrading work taking place. The registered care manager, her deputy, and teams of care assistants provide care. Health service professionals such as district nurse, community psychiatric nurse, and physiotherapist are accessed when needed, and local General Practitioners and a pharmacist service the home. Some activities and entertainment take place and transport is provided when required. Families and friends are encouraged to take part, and have an involvement in the home. Information about the fees is not available in the Statement of Purpose and the reader may wish to contact the service directly for this information. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The overall quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection was carried out over one day, by one inspector. The inspection had been planned using information gathered from the Care Quality Commission (CQC) database, the Annual Quality Assurance Assessment (AQAA) document that had been completed by the registered care manager, comments received from people who use the service and their relatives. The key National Minimum Standards for Older People were identified for this inspection and the methods in which the information was gained for this report included case tracking, general observations, document reading, speaking with staff, people who use the service and their visiting relatives. A tour of the environment was also undertaken. Care Homes for Older People Page 6 of 28 The Statement of Purpose and Service User Guide were available for us to view. These had been reviewed and updated. The previous inspection report was available to read in the main entrance hallway of the home. At the end of our inspection, feedback was given to the registered care manager, outlining the overall findings of the inspection, and giving information about the requirement and recommendations that we would make. People spoken with were very positive about the care they were receiving. Comments have been included in this report. We observed people who were unable to communicate. Our observations showed that these people were well cared for, and were happy in their surroundings. There had been 2 complaints and two Safeguarding referrals made about the home, since the previous inspection, these were not upheld, and had been dealt with in a timely way under the homes complaints and Protection of Vulnerable Adults (POVA, SOVA) procedure. There was one requirement, and 5 recommendations made as a result of this unannounced inspection. The current fees for this service are not included in this report. The reader may wish to contact the service directly. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Controlled medication must be stored safely and appropriately in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973. Alternative bedroom floor covering should be used in line with our discussion about the named person and their continence management. A dedicated activities person would encourage and stimulate individuals, and ensure Care Homes for Older People Page 8 of 28 better variety and quality activities for people using the service. Regular minuted meetings should be held to enable people to have a say in the running of the service, and to give people more control over their lives. A shower should be installed to provide individuals with a choice of a shower or a bath. Staff training should be undertaken in regard to the Mental Capacity Act 2005 and Deprivation of Liberty guidance, to ensure the safety and protection of the people using the service. 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 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that willl meet their needs. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: New service users are encouraged to spend the day at Lanrick house free of charge to have their needs assessed. This gives the service user the chance to meet the other service users and the choice for them and their relatives to make the decision whether Lanrick house is appropriate for their needs. Surveys, staff and people spoken with confirmed that individuals wishing to use the service have appropriate information, and can visit the service to enable a decision to be made prior to moving in. Care Homes for Older People Page 11 of 28 Evidence: The Statement of Purpose and Service User Guide had been reviewed and updated to include contact details for the Care Quality Commission. The complaints procedure was included, and is also displayed on the wall in the main entrance to the service. We looked at three care plan pre admission assessments. These evidenced that people received an assessment prior to a decision being made to move into the service, and enabled the service to determine whether they could meet the individuals needs. Intermediate care is not provided by this service. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been positive changes made towards the person centred care plan format now being used. Robust medication systems ensure the health, welfare and safety of the people using the service. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: We generate a care plan with the involvement of the health care professionals, the service users and their relatives which enhances the service users quality of life. We looked at three care plans and spoke with staff, relatives and people using the service. Care plans were in the process of being changed over to a more person centred system, we were shown the format and an example of one new care plan. This showed a good improvement on the existing system, all care plans will be changed over during the course of time, and people newly admitted to the service will be given the new format. Care Homes for Older People Page 13 of 28 Evidence: Risk assessments had been reviewed and updated, with clear contingencies and actions in place to minimise risk, and to keep people safe. We highlighted and discussed one named person with the care manager, this person needed higher levels of support and assistance from staff. We advised that an assessment should be undertaken and documented in relation to their bed rest, tissue viability and nutrition. So that staff knew exactly how to care for that person. We also discussed the personal care needs and environment of a named person who needed additional support with their continence management. The room occupied by that person needed the carpet cleaning every day. We suggested that alternative floor covering could be used instead of the malodourous carpet. Staff, relatives and people using the service told us that they received the medical care they needed, and were able to see their General Practitioner if they wished. Staff told us that they are given enough appropriate information about the people they care for. Comments made included, I can see the doctor any time, I have no issues about the way the home manages my relatives health problems, they always let me know whats happening. We spot checked medication systems in place at the service. These showed one anomaly in that Controlled Medication is stored in a locked safe in the service, we require that controlled medication is stored in a cabinet that meets the Misuse of Drugs (Safe Custody) Regulations 1973. We subsequently highlighted and discussed this with the provider. An auditable trail for medication was in place, including ordering, supply, administration and returns of medication. We were told that senior staff had received appropriate update training via a college course undertaken in October 2009. We saw that health professionals visits are documented and recorded, evidence of this was contained within care plans seen. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life style, but should be supported to develop their life skills. Social, educational, cultural and recreational activities should meet individuals expectations. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: We have a full and varied activities programme. We have formed links with the local community which enables the service user to go on their organised day trips. We have a professional hairdresser who comes in once a week; leaders of the local churches come in on a regular basis. The menus are created with full attention being given to the service users requirements; this includes cultural and religious beliefs. If required the service users friends and family are given the option to have a meal in private or with other service users if they wish. All service users are encouraged to bring in their own personal possessions to create a personal environment of choice, Lanrick house also provides alcohol beverages under strict supervision to the service users at Lanrick house own expense. The manager also has an open door policy for all service users and their relatives We feel this makes the service user feel more at home. Care Homes for Older People Page 15 of 28 Evidence: We spoke with staff, relatives and people using the service. We saw that the service records activities undertaken by individuals, and that they have a four weekly rotational programme of activities, which includes music, bingo, occasional trips out, keep fit, films and a visiting minister from the local church. The grounds of the home are well kept, and there is a small safe area where people can sit or walk in the summer months. We saw that the meals provided are varied, nutritious and well presented. Snacks are made available during the day, including biscuits with morning drinks and cakes for afternoon tea. Comments received included, the food is always nice, and we always have enough to eat. We discussed the quality of activities at length with the care manager and provider, and suggested that a dedicated staff member for activities would encourage more people to take part, and would free existing staff, enabling them to have time to talk and care for people. Some staff told us they were hard pushed to provide activities for people because they were too busy completing domestic and care tasks. We observed staff interacting with people using the service, and individuals enjoying conversation with each other whilst sitting in the lounges and dining areas. The atmosphere was relaxed and homely. We noted that there were no meetings held for people using the service, and therefore no forum for individuals to have their say. We were told by staff that they converse with people every day, and gain there points of view. There was no visiting library, and we made suggestions for activities, for example reminiscence box, newsletter, news group, arts and crafts group. A variety of books should be made available to people, including large print and talking books for people who have sight impairment. Two visiting relatives told us that their relatives could join in with activities if they wished to, but that they had observed some people do not want to do any, and prefer to sit and watch television. One relative said she thought they needed more encouragement and stimulation. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: We have in place procedures that are simple and clear for service users to understand. All complaints are dealt with promptly and effectively, all the service users human rights to be in a safe and secure environment is catered for. We had been notified of two anonymous complaints about the service, and two referrals were made to Social Services under the Safeguarding protocols since the previous inspection. Both complaints had not been upheld, and had been dealt with under the homes own complaints procedures. We spoke with staff and looked at three staff recruitment records, all three records evidenced that appropriate security checks had been made prior to their employment, for example Criminal Records Bureau (CRB), Protection of Vulnerable Adults (POVA, SOVA), Application form, Identification and two references. We noted that one of the three did not contain two references, we confirmed with the provider that these had originally been received, but had possibly been filed in the wrong place. We asked the Care Homes for Older People Page 17 of 28 Evidence: service to let us know when these had been located. Staff confirmed that they had sent in their references, and the provider confirmed that letters had been sent out to referees, and references received. A spot check of individual finances evidenced a robust system of managing personal monies for people using the service. Amounts held tallied with amounts recorded, and receipts made on behalf of individuals are kept. One person told us he did not need help with his money, and managed his own. Staff spoken with and the staff training matrix confirmed that staff had undertaken recent Safeguarding of Vulnerable Adults training. However, staff still need to undertake Mental Capacity Act 2005 and Deprivation of Liberty (DOLs) training. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Facilities provided should include a shower. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: Create a homely atmosphere which is safe and well maintained. It has been designed with reference to relevant guidance. The premises are kept clean, hygienic and free from offensive odours. We were told that the Environmental Health Officer had visited and inspected the kitchen area. No anomalies had been found, and the kitchen had reportedly been awarded four stars. We found the kitchen and laundry areas were clean and tidy, fully operational and fit for their purpose. Records pertaining to hot and cold food temperatures were all in order and up to date, and there was a daily cleaning schedule in place. The AQAA also told us that new carpets had been laid in some bedrooms, and new flat screen televisions had been installed in both lounges. Four bedrooms had been Care Homes for Older People Page 19 of 28 Evidence: redecorated and refurbished. Bathrooms were about to be decorated, and were next on the list. There is a very pleasant garden with covered area at the rear, and grassed areas to the front and side of the building that is easily accessed. Part of the garden with direct access from the dining room has an enclosed area where people can sit or walk in if they wish. The Garden area is well maintained and used when possible during the summer months. Comments received from staff, relatives and people using the service told us that the home is always fresh and clean. However, we found that one bedroom was very malodorous and discussed ways of dealing with this with the care manager, in relation to replacing the carpet with a washable non slip flooring. There is no shower facility at the service, apart from an over bath shower head for hair washing, which means that individuals do not have a choice of whether to have a shower or a bath. This was a previous recommendation made following our random visit in July 2009, and has still not been completed. This remains a strong recommendation, and was subsequently highlighted and discussed with the provider. There is an ongoing programme of redecoration and refurbishment in place at the service. They employ a full time maintenance person who works in liaison with the managers requests for necessary work to be done. Each task is listed, and then signed off when it is completed. We observed that the hoist is in place, and in operation. The hoist had appropriate sizes of sling in use, and we were told that staff were trained in how to use it. There is a servicing contract in place for this, thus ensuring the health, safety and welfare of the people using the service. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the serivce, in line with their terms and conditions, and to support the smooth running of the serivce. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: Provide continuing professional development for all staff. Three day induction for new staff members we have supervisions every six weeks and appraisals every six months for each staff member. Manager has an open door policy for all staff members which they are aware of. We looked at the training matrix and staff rota for June 2010. We spoke with staff, relatives and people using the service. Staffing levels had been maintained, and an additional member of staff had been recruited for nights since the previous inspection, this was following our random visit in July 2009 and had been a recommendation to maintain the health, safety and welfare of people using the service. The question of night staff needing to escort a person to hospital was discussed, and the care manager confirmed that there is always an on call person, as well as an extra member of staff at night on the duty rota, therefore an escort can be provided, whilst still maintaining a safe minimum of two night staff at the service. Care Homes for Older People Page 21 of 28 Evidence: Staff records evidenced a robust system of recuitment is in place at the service. However, we were unable to find two references from one of the three records we looked at. We asked the provider and care manager to inform us when these had been located. Staff told us they had attended regular staff meetings, received appropriate and regular supervision, as well as update and mandatory training, including customer care, fire, Safeguarding of Vulnerable Adults, Moving and Handling and first aid. However, we found no recorded evidence that staff meetings are taking place. This was highlighted and discussed with the care manager. We saw records that confirmed this. We discussed the need for staff to be aware of, and trained in regard to the Mental Capacity Act 2005 and Deprivation of Liberty guidance. This was highlighted and discussed with the care manager. We highlighted and discussed the need for a dedicated activities person to be employed at the service. This is to ensure the quality and variety of the activities on offer, and would free up the existing care staff to enable them to complete their daily tasks. We were told that activities do not run if the staff are having a busy day. A high proportion of staff had already completed their NVQ2 or above. Thus meeting the National Minimum Standard. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and adminstration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Evidence: The Annual Quality Assurance Assessment completed by the care manager told us: All procedures are followed to a high standard regarding record keeping. Feedback monitoring system is in place seeking the views of the service users to measure success in meeting the aims, objectives and statement of purpose of Lanrick house. The care manager confirmed that she had undertaken training in Safeguarding of Vulnerable Adults, Advice and Guidance, and approved training in regard to moving and handling as train the trainer in response to our random visit recommendation in July 2009. We recommended that the care manager should undertake Mental Capacity Act 2005 and Deprivation of Liberty guidance training as soon as possible, to increase staff awareness, and to enable the information to be cascaded down to all staff. The Care Homes for Older People Page 23 of 28 Evidence: care manager is aware of the importance of update and refresher training for staff. There were some shortfalls noted in regard to lack of minuted meetings held for people using the service, two references were missing from a staff record, there was a very malodorous carpet in one bedroom, an immediate requirement was made in relation to the storage of controlled medication, and a care plan review was needed in regard to a person needing more care and support from staff. There is no shower in the service,which severely limits the choice of people using the service. Recommendations have been made in relation to these matters. We noted that complaints are dealt with according to the homes policy and procedures and people know how to make a complaint. Safeguarding referrals are dealt with and referred appropriately. Relatives spoken with and surveys received supported the view that the care manager and staff work hard, and are very approachable. Comments received included, they do everything, and I am very pleased, I am very happy with mums care, we love all of the staff, As far as I am concerned they are looking after her on a day to day basis, and I do not think they can do any more than they are. Staff records told us that supervision is up and running, staffing levels are maintained, staff are trained and updated, and staff are robustly and safely recruited. Staff told us they were encouraged to do training, and that they are given the support and information needed to care for the people using the service. There is work in progress in regard to person centred care plans, these will all be changed over by the end of October 2010. The new format is a great improvement. People told us they are well cared for and that their health needs are being met. We observed that people were happy, comfortable and enjoying their leisure time. However, activities need a boost of more quality and quantity. A dedicated activities person should be employed, thus freeing up existing care staff and enabling them to focus upon their care tasks. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 Controlled Medication should 31/08/2010 be stored in a cabinet that meets the Misuse of Drugs (Safe Custody) Regulations 1973. Controlled medication must be stored safely and appropriately in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973. 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 1 7 Alternative bedroom floor covering should be used in line with our discussion about the named person and their continence management. A dedicated activities person would encourage and stimulate individuals, and ensure better variety and quality activities for people using the service. Regular minuted meetings should be held to enable people to have a say in the running of the service, and to give people more control over their lives. 2 12 3 14 Care Homes for Older People Page 26 of 28 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 4 5 22 30 A shower should be installed to provide individuals with a choice of a shower or a bath. Staff training should be undertaken in regard to the Mental Capacity Act 2005 and Deprivation of Liberty guidance, to ensure the safety and protection of the people using the service. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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