Care Home: Leaholme

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What the care home does well People and a relative said that staff were friendly and attentive and welcomed visitors. The food is seen as tasty and well presented. There are a number of activities for people to take part in. Peoples independence is encouraged. No complaints have been made about the service for over two years. The Manager is sen as supportive of people and staff and efficient in how she runs the service. The environment has been looked into to make facilities better signed for residents with dementia etc so that they are helped to get around the home. What has improved since the last inspection? There has been a slight increase in domestic hours to keep the home clean and odour free. Staff references are taken up before employment commences to keep people safe from unsuitable staff. Management know that the safeguarding procedure must be followed to keep people safe from abuse. What the care home could do better: Residents welfare could be more effectively met by ensuring that: Assessments are fully detailed to contain all aspects of individual needs to make sure staff can meet those needs from day one of a persons admission. All aspects of care e.g. proper toileting programmes, improving nutrition if this is identified as a problem, pressure sore care, a full record of daily living wishes etc are detailed in Care Plans to assist staff to meet all residents needs, and that staff read all the Care Plans so as to be able to be aware of all the needs of people. The lift need to be renewed or refurbished so that it is totally safe for people to use, and that a bathroom is upgraded to make it attractive and usable for all people. That staffing levels are reviewed and in particular domestic cover is increased to cover seven days a week so as to free staff to provide more personal care to people, and that the Manager does not work as a member of care staff to give time to run the service. The staff training programme needs to become more comprehensive by including peoples health conditions ensuring all staff increase their skills in delivering good quality care for residents. The Company needs to review staffing practices to ensure that staff retention and morale is improved so that people have consistent care from staff they are used to. Key inspection report Care homes for older people Name: Address: Leaholme 8 Springfield Road Leicester LE2 3BA     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: Keith Charlton     Date: 2 1 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Leaholme 8 Springfield Road Leicester LE2 3BA 01162702665 01162702667 mandy@leaholme.co.uk www.yourhealth.ltd.uk Your Health Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 17 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: 17 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 - Code OP Dementia - Code DE and DE(E) Physical Disability - Code PD and PD(E) Date of last inspection Brief description of the care home The Manager provided information on the day of the inspection that the fees for 2009 are #345-#500. The latest inspection report can be found in the reception area of the home. Care Homes for Older People Page 4 of 29 Over 65 17 17 17 17 0 0 1 3 1 2 2 0 0 8 Brief description of the care home Leaholme is registered to accommodate up to seventeen older people and older people with physical disability and dementia. There are thirteen single rooms and two double rooms. The home is part of a national company called Your Health Limited. Leaholme is a large, detached three-story Victorian house. The home is situated in a quiet tree-line road, which runs off a busy main road, in the Stoneygate area. The home is tenminute bus journey from the city centre and close to the railway station. The home is clean, bright, with comfortable furniture and decor to match. There is a separate dining room and two large lounges. The bedrooms on the first and second floor are accessible via the passenger lift. There is a large mature garden at the rear of the property, which continues at the side and to the front of the home. The garden is accessible via a gradual slope and ramp for people requiring the use of walking aids. Care Homes for Older People Page 5 of 29 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 quality rating for this service is Two Stars. This means the people who use this service experience good quality outcomes. We, as it appears throughout the Inspection Report refers to The Care Quality Commission. The inspection process consisted of pre planning the inspection which included reviewing the Annual Quality Assurance Assessment (AQAA) which is self assessment tool completed by the Manager of the service. We have sent surveys to people who use the service along with staff and their comments are reflected in this Report. We received five surveys back from people who live in the service and four staff members. Overall there was a satisfaction with the care provided, though there were some adverse comments about the availability of staff and the need for a minibus so people can enjoy more outings. Care Homes for Older People Page 6 of 29 The unannounced site visit was on the 21st October 2009 and was carried out by Keith Charlton. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Leaholme. Three people who use the service were selected. Discussions were held with six people who use the service though this was limited as some had difficulties with communication due to their dementia, a relative, the Manager, and two members of staff. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Residents welfare could be more effectively met by ensuring that: Assessments are fully detailed to contain all aspects of individual needs to make sure staff can meet those needs from day one of a persons admission. All aspects of care e.g. proper toileting programmes, improving nutrition if this is identified as a problem, pressure sore care, a full record of daily living wishes etc are detailed in Care Plans to assist staff to meet all residents needs, and that staff read all the Care Plans so as to be able to be aware of all the needs of people. The lift need to be renewed or refurbished so that it is totally safe for people to use, and that a bathroom is upgraded to make it attractive and usable for all people. That staffing levels are reviewed and in particular domestic cover is increased to cover seven days a week so as to free staff to provide more personal care to people, and that the Manager does not work as a member of care staff to give time to run the service. The staff training programme needs to become more comprehensive by including peoples health conditions ensuring all staff increase their skills in delivering good quality care for residents. Care Homes for Older People Page 8 of 29 The Company needs to review staffing practices to ensure that staff retention and morale is improved so that people have consistent care from staff they are used to. 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 29 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 29 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 living at Leaholme have had their needs properly assessed before moving into the home. Evidence: I was given information about the home before I came here, one person who lives in the home said. The AQAA stated that prospective residents are invited to the home and can stay for the day, relevant information is provided and assessments are carried out by the management. Most Residents were not able to confirm that they had been provided with sufficient written information about the home due to their dementia conditions but a person who lives at the service spoken with said she had enough information at the time of the admission in order to be able to make up her mind about what the home offered. We case tracked a person living in the home who had moved into Leaholme in the Care Homes for Older People Page 11 of 29 Evidence: past. We also checked that this person had her needs properly assessed prior to moving in, to ensure that the staff at the home could meet her needs. We found that the assessment system was detailed regarding residents needs, though past health checks had not been included, which is useful to prompt these checks and improve the health and daily quality of life for people. The Manager said this would be followed up. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Leaholme receive good health and social care practice. Evidence: People who live in the service said that staff provided excellent personal care: Staff could not be more helpful or friendly, one person said. The AQAA stated that the home has detailed information in Care Plans in terms of health checks, checking weights and nutrition to promote peoples health etc, and that staff are due to receive training in palliative care, nutrition, the Mental Capacity Act etc to promote peoples welfare. A person who uses the service could recall having a care plan and that the Manager had gone through it with her to ensure that the care given was right for her. We checked the care plans of three people living at the home who were case tracked. Plans showed detail regarding the support required by staff to ensure the physical health of people living at the home, and there was some information to inform staff of the residents personal history, though sparse information of the preferred daily living Care Homes for Older People Page 13 of 29 Evidence: routines of residents to ensure their social and emotional well being is fully supported. The Manager said that she had identified that there needs to be more information as to the individual history of people so that staff can fully appreciate peoples personalities and past experiences. The Plans we saw were not always complete, e.g. risk of pressure sores was identified in one plan but no action set out to prevent his, continence information was recorded though this assessment needed more detail to work out the individual needs of a resident so staff could prompt before they needed to go to the toilet. There were gaps on moving and handling recording insofar as the type of sling needed was not specified in the plan so that people may not have had their full needs met. Staff said they had not read all Care Plans - this is needed so that they can fully understand peoples needs. The Manager said that these issues would be followed up. People said that staff were quick to alert the GP if there was sickness. Accident records were checked and medical services were contacted when a resident had a potentially serious injury. We checked the medication records, and found that there was good recording of the administration of the medicines in the home except for controlled medications whereby a staff member had recorded medication had been returned when it was still in the cabinet. There was good information on medication sheets regarding photos of people and allergies, so that residents health is protected by staff having awareness of this information. Controlled medicines storage was in a secured cabinet. The Manager said this storage conformed to the latest legal requirements. Staff said that only Senior staff give medication to people and this was confirmed by the Training Matrix. We spent time watching staff interaction with people living at Leaholme. We saw staff being friendly and caring to people throughout the day doing their best to meet the needs of people living at the home and people confirmed that staff respected privacy. The SOFI inspection we carried out was positive regarding staff care to people but it also identified that whilst good attention was paid to one person, another person was largely ignored and another person was not encouraged to drink when he had been woken by staff for that purpose so that he left it and it was taken away without it being drunk. Staff were seen to assist residents in various ways - encouraging residents in activities and to eat their meal etc. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for people at Leaholme to take part in activities and have a stimulating or relaxed lifestyle. Evidence: People said that they were largely satisfied with the current activities. One person said: Yes, we have quite a lot of activities but it would be nice to have some more and more trips out, one person said. There were comments in surveys that there should be a minibus so that trips out can be regular and easily arranged. The AQAA stated that there is an Activities Programme, with an Activities person visiting every Tuesday to do various activities - reflexology, head massage, relaxation, arts and crafts etc. That people are encouraged to bring in their personal possessions, there are Residents meetings, good food is provided as per peoples preferences and that there is a weekly religious service. There were some comments that because staff had to do domestic duties they did not have enough time to spend with people. People can garden if they wish and are able though there are no raised beds, which Care Homes for Older People Page 15 of 29 Evidence: would help people with dexterity difficulties. Someone said that the garden was not tended with skill. The Manager said she had arranged a meeting between this person and the staff member who tended the garden to talk about this in the past and would do so again. We saw the staff going around with a box of activities and talking to a person about knitting, which the care plan stated that he had been very interested in doing in her life, and giving another person a magazine to read. The staff member spent useful time on a one to one basis with one resident though other people did not seem to receive very much staff time. The Manager said this would be followed up. Staff said that there were more activities in the afternoon and a choice of activities was displayed on the noticeboard in the hallway. Two people also confirmed that they had been taken out shopping in the morning and a person said to us that she was able to handle her own medication, do her own ironing and make hot drinks in her bedroom. All this proved that peoples choice and independence was positively encouraged by the management of the service. People also watched TV in the lounge though we observed no one watching it and people could have been given the option to listen to music of their choosing instead.The Manager said this would be followed up. The Manager said that she is also developing life history books for people so that staff can use them for one to one reminiscence sessions.It was clarified that memory boxes would only be provided for people with dementia to help them relive cherished memories. The relations between staff and residents were observed to be relaxed, positive and friendly. Staff said there were no rules. People can get up when they like, choose their clothes and food etc.The home supports residents with dementia with staff training on this having taken place for most staff and there was displayed information for the menu, though not for day, weather, place etc, which the Manager said would soon be provided.The only suggestions made were for more regular outings though some people said on the day that people changed their minds and then choose not to go out on the day of the outing. Visitors are welcomed at Leaholme and we were informed by a visiting relative that she could come at any reasonable time and they were always greeted in a friendly way by staff. People said that they enjoyed the food: The food cannot be faulted. It is always tasty Care Homes for Older People Page 16 of 29 Evidence: and filling, one person said. We observed lunch being served. There was a choice of starter and dessert and an alternative can be requested if a person does not want the meal provided. The Manager said there was always a choice though on some days people choose the same meal. Food records showed a good variety of traditional food served. There was evidence that the Environmental Health Officer had carried out an inspection in April this year and the service was awarded a high standard of food hygiene practice. Food was attractively presented though the fruit dessert was very hot and could have scalded peoples mouths. The Manager said she would look into this. Information regarding peoples weight is also kept though there was no recorded action on one Care Plan we looked at, to act on marked weight loss or gain. We observed staff assisting a person to eat to ensure that proper nutrition was supplied. Care Homes for Older People Page 17 of 29 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. Complaints are taken seriously and people are protected from abuse. Evidence: No one said that they had had a complaint though were confident if they took to management it would be quickly dealt with. A person said, Zelda (the Manager) would follow anything up. I am sure of that, one person said. The AQAA stated that there have been no complaints but if one is made this would be properly investigated and followed up. We saw in records that there have been no complaints since the last inspection. We talked to staff to find out how much they knew about protecting people in the home from abuse. Records showed they had received training about safeguarding adults from abuse, and they knew the in house procedure, and Agencies to whistle blow to if the in house procedure failed. The complaints Procedure was seen to be in place though needed to state that the Lead Agency was the Social Services Department, not the CQC.The Manager said she would rectify this. We looked at the staff recruitment records to see whether all the proper checks had Care Homes for Older People Page 18 of 29 Evidence: been made on staff before they started employment at Leaholme. We found records which showed staff had started work with legal checks in place to help management reach the judgement that people were safe to start employment. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Leaholme live in a homely and generally maintained environment. Evidence: My bedroom is nice and it is kept that way. I can have all my things there, one person said. All people spoken with said that bedrooms were clean and tidy. The AQAA stated that bedrooms are decorated following a persons individual wishes and that bedrooms will be all redecorated if people choose this to happen or when the room becomes vacant, that equipment is regularly serviced, and that the home is comfortable, safe, secure, homely, clean and tidy. The bedrooms of all people case tracked were looked at. All rooms had the individuals personal effects, and were clean and tidy. The communal areas were also clean and tidy and largely odour free though there was a slight odour by the main lounge and marks on the main lounge carpet and the corridor carpet by this lounge. The Manager said that the carpet cleaner had been broken but had been repaired and this would be attended to. A bathroom on the first floor had marks on the flooring, no toilet roll holder, no aids to help people use the toilet and rust on the arm of the bath hoist that could breach infection control. Care Homes for Older People Page 20 of 29 Evidence: The communal furniture was of good quality and lounges were decorated in a homely, attractive way. People confirmed their satisfaction with the homes facilities though there was one comment in a survey that people should have their own things, e.g. commode. The Manager should consider this comment. Facilities are signed for people with dementia - pictures on WC and lounge doors, photos on bedroom doors, though pictures that people can recognise would be clearer. During the inspection equipment was generally seen to be in good repair except the lift which one person aid was old and noisy and in need of repair. We tested this and the person was correct in what she said. Repair sheets from the lift company regularly stated that the lift should be refurbished. The garden is attractive and maintained though one person thought that it would look better if proper gardening skills were applied to ensure weeds are cut back and flowers properly tended to. Care Homes for Older People Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples basic care needs are met by a caring staff group though staffing levels and training need to be reviewed and increased as needed to ensure all needs are always met. Evidence: There were a number of comments that the care staffing ratio is not always sufficient to meet peoples needs though the provision of direct personal care was generally good. Staff are really good and would do anything for you though they are very busy, one person said. There were also comments in the surveys that there should be more staff: We could do with more staff as we dont get to spend much time with the service users. If we did not do the cleaning then that would leave us to spend more time with the service users. A person that used the service said: The staff are so busy that those of us that are compus mentis often get forgotten and a bit neglected. Care staff are taken away from peoples care as they have to do domestic duties as the domestic only covers one floor and she only works three hours a day, five days a week. The rota showed that there are normally three care staff in the morning/afternoon until 6.00pm, when there are then two care staff in evening periods. The Manager is counted as being part of the care staff four out of five days a week and she also does the cooking on occasion, so she is only left one day a week to cover the management role, which means there is not sufficient time to carry out Care Homes for Older People Page 22 of 29 Evidence: management duties and if she is called to do them, as is inevitable on one of her care days, this also depletes the time available to supply care to meet peoples needs. We spoke with the Manager about the staffing and asked her to review this situation with her Line Manager. A staff member said that although she had only been working at the home for a year she had been encouraged by management to do the NVQ 2 course and had already completed a number of training courses and a thorough induction. We found that staff have been on a number of training events to help update their practice on areas such as Moving and Handling, Food Hygiene, COSHH, First Aid, Abuse Training, Medication for senior staff, Fire Safety, Infection Control and Dementia (though not for all staff,which is needed for a home that accomodates people with dementia)and some issues regarding residents health conditions were missing - e.g. Stroke, Parkinsons Disease, Mental Health conditions, Diabetes etc. The Manager said that these would be followed up and added to the training programme. Staff records showed that proper checks had been carried out to protect people from unsuitable staff. Care Homes for Older People Page 23 of 29 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. There are management systems in place to protect the health and safety of people that live in the service. Evidence: Zelda Lee is the Registered Manager of the home. Zelda has completed the NVQ 4 Award in management skills. People and staff confirmed that Zelda was very efficient and supportive and had peoples best interests at heart. Zelda runs everything in a caring way, one person said. Satisfaction questionnaires were sent around the home last year, and the results were seen to be very positive. They contained an analysis of the results to see if improvements in the service were needed. We recommended that questionnaires be provided to all interested parties - relatives, medical staff, social workers etc to get their views and suggestions as to improve the service. Written records regarding finances for residents are properly in place, and monies Care Homes for Older People Page 24 of 29 Evidence: were checked for two residents and totals were found to be correct. There was evidence of Residents Meetings discussing relevant issues - activities, food etc, which showed peoples involvement in the running of the home. Staff informed us that they were able to tell management of the problems they were facing and there were regular meetings and supervision to support them, which we saw as being detailed and well kept. This helps morale. However there were also comment that there was too much sickness, staff turnover and dissatisfaction about the way there were treated regarding no pay enhancements for working anti social hours (at night and at weekends) and having to pay for records checks. There was comment in a staff survey: We could do with more respect for what we do. The Company needs to review practices as this affects the quality and consistency of care to people who use the service. There are proper Health and Safety systems in place in the home. We saw risk assessments for safe working practices and COSHH assessments to keep residents and staff safe. Proper fire records were in place with regular fire drills. Staff were asked about the fire drill procedure and they all knew what to do except one staff member who missed out on the first step, which could put people at risk. The Manager said she would check that staff are fully aware of the fire procedure. Hot water is regularly tested to meet the National Standard so that people are not scalded. We found the dessert to be too hot on the day of the inspection as it could have scalded people. The Manager said this would be followed up. Care Homes for Older People Page 25 of 29 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care Plans ned to be fully detailed and read by care staff. So that peoples needs are fully met. 27/12/2009 2 19 13 The lift must operate efficiently and safely. To ensure that peoples health and welfare are fully protected. 28/12/2009 3 27 18 Staffing levels need to be reviewed and increased and Management hours be sufficient to fulfill this role. So that peoples needs are fully met and there is time to manage the smooth running of the service. 28/12/2009 Care Homes for Older People Page 27 of 29 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 19 Facilities need to be kept odour free and flooring clear of stains. The first floor bathroom needs to be attended to to ensure it is fully fit for use for people. Staff training should be extended to cover all the health conditions of people. 2 30 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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