Care Home: Lavender Lodge Nursing Home

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What the care home does well The manager leads a team who understand how to provide a calm and stimulating environment for people who have a dementia. Nursing care is provided and this is of a good standard with all staff having been recruited safely. Ongoing training provides staff with an increased knowledge and skills base. The environment is clean and tidy and ongoing quality assurance systems and reviews ensure the service continues to evolve and improve. What has improved since the last inspection? Since the last inspection a new registered manager has been appointed and the service has moved forward in terms of more person centered care and key workers for all residents . Residents finances are protected . All residents who have monies looked after by the service have received information to confirm their finances are managed in a way which ensures they receive their rightful share of interest accrued on the bank account their money is deposited in. What the care home could do better: While activities take place in both parts of the service a review needs to take place in the main part of the service to ensure all residents are able to participate in activities which are meaningful and purposeful and in smaller groups if this is their choosing. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lavender Lodge Nursing Home Bruntile Close Farnborough Hampshire GU14 6PR     The quality rating for this care home is:   three star excellent 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: Kathryn Emmons     Date: 1 1 0 3 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: Lavender Lodge Nursing Home Bruntile Close Farnborough Hampshire GU14 6PR 01252517569 01252375852 Lavenderlodge@highfield.care.com www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Care Homes No 2 Ltd care home 68 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 68. The registered person may provide the following category/ies 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: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home Lavender Lodge is a care home providing nursing care for older people and can accommodate 68 persons. The accommodation is situated over three floors and all rooms are single ensuite. The external accommodation consists of two patio areas where residents can sit in warmer weather. There is a unit on the first floor called Care Homes for Older People Page 4 of 27 Over 65 0 68 68 0 Brief description of the care home Jasmine House which is for residents who have Dementia type conditions..Fees at the home range from #500 to #825 per week . 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The visit to the service was undertaken by one inspector who spent five and a half hours at the home. The care received by three residents was looked at in detail. This is a method called case tracking. This included looking at their personal records a range of general records and staff details. This forms part of a key inspection and focused on the standards in the key areas that most effect the quality of life for the residents. Information already held such as a service history and the providers self -audit which is called an AQAA (Annual Quality Assessment Audit) were used to plan the visit. The commission is trying to improve the way we engage with people who use services, so that, we can gain a real understanding of their views and experience of social care services. We are using a method of working where the Expert by Experience is an important part of the inspection team and helps the inspector to get a picture of what it is like to live in or use a social care service. The Expert by Experience spoke with Care Homes for Older People Page 6 of 27 many residents, a few relatives, the manager and 5 staff on their own. They contributed to the inspection process and provided a separate report. Comments and observations are reflected in this report. During the visit the inspector spoke to the manager ,three staff , a relative and some residents. We also sent comment cards for staff and residents to complete and we also considered the comments these contained when writing the report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 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 9 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. Residents are provided with information to make decisions regarding living at the service Contracts provide residents with confidence that they will receive the services they were told about when they considered living at the service. Pre admission assessments ensure that the service available can meet residents needs. Evidence: We reviewed the records for a resident who had recently been admitted to the service. We could see that a pre admission assessment had taken place and information had also been obtained from the health care professionals who had been caring for the resident previously. As part of case tracking we looked at contracts and could see that these were in place.This means that residents sign to show they understand the services provided and the manager signs the contract so residents can be confident that the services offered are available and the resident can expect to receive them. We also saw letters confirming needs could be met, which are sent to the prospective resident after they have been assessed. Care Homes for Older People Page 10 of 27 Evidence: When people consider living at the service there are two documents in place which provide information to assist with the decision making. These are the service user guide and the statement of purpose. These documents are in place and the service user guide was on display in the main reception area with a copy of the most recent inspection report. Comment cards received indicated that apart from one resident all residents felt they had information available for them to make a decision to live at the service. Care Homes for Older People Page 11 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. Through care planning and reviews residents can be confident that their care needs are known and that staff are clear how to support them. Medication systems keep residents safe. Access to health care professionals is good and residents receive the services they need. Residents dignity and privacy is acknowledged and maintained. Evidence: We looked at the care records for three of the residents. We included one of the new residents file in the selection and a resident who lives in Jasmine House which is the unit for residents who have dementia type conditions. We were told by the manager that a lot of work had been carried out on care plans. We could see that all residents had a key worker who was responsible for writing an update each week regarding any time they had spent with the resident in a one to one situation. The care plans are produced by the trained nurses with resident involvement. There is a copy of the care plan in the residents bedroom along with the key worker report and charts such as fluid intake and turn charts if these are needed. We could see the care plans contained a lot of information regarding residents personal likes and hobbies and things they didnt enjoy doing and food they didnt like . We could see that peoples personal Care Homes for Older People Page 12 of 27 Evidence: possessions were recorded and checked by themselves or relatives as being correct. We saw that care plans were individualized and signed by the resident if they had been involved. Reviews take place and we saw that changes had been made to a couple of care plans. There were relative contact sheets so there was a clear audit trial of communication between relevant people. We saw wound care plans and risk assessments which were regularly reviewed. Daily records were comprehensive and if there was a change in a residents well being there was a clear audit trail of how this had been addressed. Staff said they were aware of the care plans and daily notes and one said As a key worker we will write in the notes in the bedroom and check care plans to make sure we work safely and to the residents liking. We observed a medication round being undertaken by the nurse in charge. Medication is only administered by trained nurses and all receive training as part of their induction and we saw this happening for a new nurse during our visit. Nurses wear a red tabbard when administering medication with wording stating they are undertaking a drug round and if possible should not be disturbed. This means that there is less risk of a nurse making a mistake with medication. Currently no residents are able to fully self medicate. A couple are able to manage inhalers and one manages their own oxygen. Assessments are undertaken on admission and periodically reviewed. Medication sheets were seen and they had been completed correctly with a very clear audit trail of medication ordered and then whether administered or returned . A coding system is in use if medication is not given. Residents were assisted with their medication in an unhurried way. Records show that residents have good access to the local GP surgeries . Comment cards also evidenced that resident were always satisfied with the medical care they received.We were told by the manager that doctors would always attend when requested.If residents require an optician or dental treatment this is arranged by either a visiting service or residents are supported to go to Fleet. We saw notes in care plans which showed that the chiropodist visits every six weeks. During a tour of the home and for the few hours based on Jasmine House we were able to observe many interactions between residents and staff. Staff were aware of residents needs and worked hard to ensure that residents dignity was maintained even in every day activities such as assisting with taking meals, going to the bathroom and moving around the home with support. We noted that bathroom and bedroom doors were always knocked on and residents were asked discreetly if they needed help. If they were not able to make a decision verbally to receive help staff would guide residents to where they needed to go and would only carry out the task if the resident was willing to go with the carer. Examples Care Homes for Older People Page 13 of 27 Evidence: of this were seen in the dining room on the ground floor and assisting residents to do movement exercises in Jasmine house. Care Homes for Older People Page 14 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. Residents cultural needs and rights to have choice are known and met. Purposeful activities are provided but these need to be reviewed to ensure they meet the individual needs and preferences of residents.Residents dietary preferences are catered for. Evidence: During our visit to the service we spent time in the lounge of the main part of the home and time in Jasmine House. On the ground floor one activity coordinator was providing a light show for all of the residents. We found that some residents were saying they could not see as there are pillars in areas of the lounge. We could see an activities programme in place but many activities seemed to be for larger groups of people. The manager accepted this and said that he was looking into ways of providing activities to smaller groups and staff becoming more involved in supporting a group to ensure activities were purposeful and what the residents wanted.In the afternoon of our visit a visiting clothes shop attended the service so residents could buy clothing and shoes. Following our visit we spoke with the home and during the conversation we were informed that action had already been taken to provide activities in smaller groups and at the time of our call a group of residents were making Easter cards . All comment cards we received indicated that usually there Care Homes for Older People Page 15 of 27 Evidence: were activities to participate in except for one comment card which said the resident felt bored . We observed residents in various past time such as reading ,doing a cross word watching television and chatting with each other. In Jasmine house there is an activities coordinator full time for the 25 residents. Staff were able to provide support for all activities taking place. We discussed if residents went on trips out of the home and the activities coordinator said that these were being planned and were going to be discussed at the next resident and relative meetings. In Jasmine house residents were able to join in with an exercise DVD, while others were assisted to journey around the unit and reminisce with staff. Residents said they felt they had choice over all aspects of their care and could decide how to spend their days. We saw the residents making choices over lunch ,where they journey around the home and what support they received. We received a comment card indicating a resident felt they were not afforded choice over taking their medication. We looked into this and found this to not be a correct statement as when a resident choses not to take their medication this is recorded. The cultural and religious needs of residents are respected. A Communion service is held monthly and residents are able to express their religious and spiritual beliefs. Staff are from various religious denominations and this is acknowledged and respected . We saw that Christian festivals such as Easter and Christmas are celebrated . One resident does not have English as their first language, we saw that staff had received some training in the residents main language and were working with the family to learn more phrases. A list of phrases was on display to enable staff to better understand the resident and meet their needs. Comment cards received all indicated that food was good except two which said funny food and No variation and unimaginative. We looked at the menus and found that they were varied and that choices were always available . On the day of the visit there were three choices for the main meal and two hot puddings and fresh fruit is always offered after each meal.We saw residents choosing to have food which was not on the menu. The catering department use a system called Nutmeg when providing meals. This is a nutritional assessment system which means that residents receive meals which are nutritionally balanced and have the option always of hot and cold food. The Expert by Experience took lunch in Jasmine House and found the food to be well presented and served in the quantities desired but the residents. A record is maintained of all food provided so the manager can ensure that all residents have their choices and preferences catered for. We spoke to a relative regarding the meals provided and were told Mum cant chose but she always has something she likes and it always smells wonderful and she always eats it. Care Homes for Older People Page 16 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. Residents can be confident that their concerns will be listened to and acted upon. Staff are clear on how to deal initially with concerns raised.Safeguarding training , staff awareness and polices keep residents safe. Evidence: Since the last inspection two concerns were raised with the Commission .We asked both complainants to raise issues directly with the manager and that we would follow these concerns up on our next inspection. We looked at the complaint file and saw that one concern had been investigated by the manager. We could see a clear audit trail of how the issue had been investigated and who had been involved and also saw the response to the person raising the concerns. The other concern was not bought to the attention of the manager . This issue was in respect of the care a resident had received at the end of their life.We could not find any details of this concern and the care we observed was good . We looked at the care delivered to someone who was dying and found the care to be person centered and records were maintained of fluid and dietary intake and turn charts were in place. A complaint procedure is on display in the main entrance to the service and comment cards except one all indicate people knew how to raise concerns. We could see from staff records that safeguarding adult training had been carried out as part of induction training and on a yearly refresher. A copy of Hampshire county councils safeguarding adult policy was in place and this links into the services policy. Care Homes for Older People Page 17 of 27 Evidence: Staff we spoke with were very clear on what constituted abuse and one said because a lot of the residents are confused we have to be extra careful to keep them safe. We know we can without hesitation go to Amos with anything that we are not sure or happy about. Residents we spoke with and relatives all indicated they knew how to raise concerns and that the manager was always available to speak to them. All staff have received training in customer care which included how to initially deal with any concerns or complaints being made.We could see that one of the concerns made had been referred by the manager to safeguarding audits. This means that the manager knows how to keep residents safe and will work with other statutory bodies to ensure procedures are followed correctly. 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 live in clean and comfortable surroundings and have rooms which they are able to personalise. Training in health and safety and infection control means that staff work in a way which minimises risk to people at the service. Evidence: We toured the premises during our visit including Jasmine House and the main part of the home. We were given permission to speak with residents in their rooms so we were able to see the decor and layout of rooms. All comment cards except one stated people were satisfied with their rooms. We found there to be no adverse odours as we toured the building. Bedrooms were clean and tidy and we saw cleaning staff working throughout the visit. There is a large lounge on the ground floor and a conservatory area where residents can sit in smaller groups. Bedrooms are located on the ground and second floor of the service. There is a lift to all floors .The dining room was spacious with sufficient seating for all resident to dine together. We could see aids and adaptations such as hand rails, hoists and moving equipment. Staff we spoke with confirmed they received training in using this equipment and we could see from staff records that moving and handling , infection control and health and safety training has taken place.The manager confirmed he walked around the service each day and any hazards were noted and reported straight away. In Jasmine house all bedroom doors are painted a different colour and had a door Care Homes for Older People Page 19 of 27 Evidence: knocker and letter box plate. This helps residents have an understanding of ownership of their room which they can recognise by colour and decoration. A door knocker gives the impression that the bedroom door is a front door so that the resident may not feel as anxious when entering the room. The decor was decorated with pictures from a different era to be used as reminisce tools. Residents were able to journey around jasmine house freely. Cleaning staff were seen on the unit and it was noted that all cleaning materials were kept secure at all times. Since the last inspection a kitchenette has been fitted in Jasmine house so it is easier for staff to provide snacks and drinks to residents in Jasmine House. Residents indicated to us that they were happy with their rooms and we could see that generally decor was of a good standard. Infection control measures are in place and we saw staff wearing aprons and gloves when needed. Staff are provided with uniforms which they are responsible for keeping clean .A clinical waste contract is in place for disposing of continence products and clinical waste. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are cared for by trained and enthusiastic staff. Robust recruitment procedures keep residents safe.Ongoing training means residents will receive care which is in accordance with current care practices. Staff understanding the individuality of each resident means residents receive a more holistic approach to their care. Evidence: We looked at the most recent duty rota. We could see that dedicated staff worked in Jasmine House. This means that there is consistency for the residents who live in Jasmine House and they are cared for by staff who have experience of the different ways the residents express and communicate their needs. Residents said they felt their was enough staff on duty to meet physical needs and a couple said they felt their needed to be more staff to help with activities in the main part of the home. We spoke to a member of night staff and three day staff . Staff said they had time to spend with residents and were not rushed in their work. Comment cards indicated staffing levels were good. We could see that the staffing levels remained constant and that there was a good skill mix. We observed staff in their interactions with residents. We saw that staff had a very good rapport with residents in Jasmine House and understood how to reassure and communicate with residents. Relatives told us the staff are very good. they have all Care Homes for Older People Page 21 of 27 Evidence: worked here for quite some time and thats good for my mum and i think they are wonderful they really work hard to look after them all.We saw many interactions and these were valuing and respectful of the residents. Staff would remind residents of where they were, activities they liked and food they enjoyed. Staff understood that each resident was an individual person who had led a fulfilling life before they became in need of support and worked hard at promoting residents self worth and understanding their individuality. In the main part of the home we were told by residents that they had good relationships with the staff. We found staff to be approachable and responded to call bells very quickly. Since the last inspection new staff have been employed. Some of these were transfers from other services the organisation operates while others were employed directly by the manager for the service.We looked at three recruitment files . We could see that the necessary checks had been carried out such as written references, a CRB(Criminal records bureau check) and a written application form. We also saw evidence of an induction course and shifts where new staff had worked alongside established staff to learn the needs and care preferences of residents.This was further evidenced by speaking with a newly employed trained nurse who was receiving an induction from the deputy manager. The manager had also planned induction training for that afternoon in safeguarding adults. A training plan is in place and care staff are working to wards National Vocational Qualifications in Social and Health Care (NVQs) This means that they will have an enhanced skills and knowledge base which may provide a better quality of care for residents .The AQAA records that three staff are working toward NVQ 3 while seventeen of the 32 staff already have an NVQ qualification. We saw a training matrix which covered all mandatory training such as moving and handling infection control health and safety safeguarding adults and customer care.training is also provided in dementia care and staff are supported to attend relevant courses to further enhance the care they provide. Staff meetings take place every couple of months and these are minuted. Staff told us I enjoy my job i have been here for seven years, and I think we all enjoy it even though it is tiring sometimes. We really do care about the residents. Resident comments we receivedwe positive such as one resident who said staff could do no more to help me. Another said I cannot speak to highly of the care staff have given my mum , and the staff are friendly and caring. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is being managed by a person who residents and staff view as having improved the service and continues to move the service forward to consistently improve the residents quality of life. People have their finances kept safe and auditing ensures standards are maintained. Quality assurance systems enable the service to continually evolve and improve. Heath and safety arrangements ensure people who are at the service are kept safe. Evidence: Since the last inspection the service has recruited a new manager. The manager has many years experience as a Registered Mental Nurse and had attended very comprehensive training courses in dementia care. A relative told us they felt the service had Vastly improved since Amos has been here. We spoke to staff regarding the managers ethos and approach. All staff made positive comments which included Amos is open to new ideas and is always trying to make this home better for everyone We saw interactions between the manager and staff and residents. The manager was clearly open in his approach and staff said they could trust the manager Care Homes for Older People Page 23 of 27 Evidence: and felt he had good ideas to continue to evolve the service. We saw that resident and relative meetings took place every couple of months and actions were taken following these meetings. The responsible individual visits the service monthly and speaks with the manager ,residents and staff. A report is produced and these were available for us to view. The manager said they felt supported by the responsible individual and that the responsible individual supported the changes the manager had made. Following the last inspection a requirement was made to review how residents money were looked after as they were in one bank account and it was not clear how the interest from the bank account was allocated. Action has now been taken to ensure that interest is allocated depending on how much money each resident has in the bank. This is a system operated by the bank and a letter was sent to all residents. We saw a copy of this letter and the process was explained to us by the administrator. Staff supervision sessions take place which means that any training or development needs are identified and addressed so staff can provide a good quality service to residents. A cascaded system is in place with the manager providing supervision sessions to the trained staff and trained staff providing supervision to those people they directly manage. A quality assurance programme is in place and this consists of monthly audits of the services by the manager. This includes medication. environment, resident finances, health and safety issues , staffing supervisions and levels. These audits are sent to the head office of the organisation and then the responsible individual will randomly sample the audit on their visit to ensure the information supplied is correct. Questionnaires are also sent to staff ,residents and relatives . We could see from the information we hold about the service that we are informed about incidents in the service we need to know about such as when a resident goes into hospital or had an accident. The AQAA records that all safety records are kept up to date and we confirmed this by looking at a sample through the audit process the manager carries out. .This means that residents and staff can be confident that they are living and working in a service which is kept safe by health and safety arrangements being maintained. 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. 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