Care Home: Leighton House

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What the care home does well People who are considering moving into the home are provided with helpful information about what life is like there to enable them to make an informed decision. People can be confident their needs will be fully assessed and they will be able to visit the home to ensure the home will be suitable for them. People who live in the home can be confident their needs are understood and will be met in line with their individual wishes and expectations. Support is provided in a way that promotes people`s dignity and privacy. People are protected through the safe handling of medication. They are provided with a range of activities. Routines in the home are flexible and relevant to enable people to choose how they wish to live their lives. People are encouraged to have a say in how the home is run. They are supported to remain as independent as possible. Mealtimes are enjoyable and food is well presented. People who live in the home are listened to and are encouraged to offer comment or complaint. There are policies and procedures in place and staff receive training to understand how to protect people from abuse. They benefit from the clean and comfortable environment. People also benefit from the support of the well trained, caring and committed staff team. There are sufficient numbers of staff on duty during the day to meet their needs. People are protected from harm through robust recruitment procedures. People can be confident the home is being run in their best interests taking account of their views and expectations. There are effective quality and assurance systems in place to ensure people continue to receive a good service. The health and safety of people is promoted. What has improved since the last inspection? The service user guide and statement of purpose have been updated and a new information pack is now available to provide helpful information for people who are considering moving into the home. Improvements in the induction process ensure staff are better equipped to provide appropriate support to residents. People are provided with greater opportunity to be involved in the way the home is run through regular residents meetings and periodic relatives meetings. Menus are now provided in pictorial form to promote greater choice and understanding. People are benefiting from improvements in the environment including bedrooms, bathrooms, central heating and hot water systems. What the care home could do better: Recording and reporting systems must be improved to ensure compliance with current legislation and effective management of risk to ensure people are protected and their health and wellbeing is promoted. A review if night staffing levels must be undertaken to ensure there are sufficient staff on duty at night for the adequate supervision and protection of all residents in light of recent incidents. Key inspection report Care homes for older people Name: Address: Leighton House 59 Burgh Heath Road Epsom Surrey KT17 4NB     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: Ruth Burnham     Date: 0 9 0 4 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: Leighton House 59 Burgh Heath Road Epsom Surrey KT17 4NB 01372720908 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): a.hashmi@leighton-house.com Mr Azher Hashmi Name of registered manager (if applicable) Mrs Karen Crosby Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 26 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 Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Leighton House is a large detached property that has been converted to provide accommodation for twenty-six service users. The home is located in a residential area Care Homes for Older People Page 4 of 28 Over 65 0 0 26 26 26 0 Brief description of the care home of Epsom. Access to shops, church, public transport and other local services is short distance from the home. However, the home is situated on the top of a hill and this can cause some difficulty for service users especially those who use a wheelchair. Accommodation is provided over two floors with twenty single and three shared bedrooms. Eighteen of these rooms are provided with en-suite facilities. There is a passenger lift access to the first floor. The home provides two lounges, a dining room and a large garden and patio area. The home has car-parking facilities at the front of the house. The main office and some staff accommodation are provided on the top floor. Fees at this home are in the range of 556 to 890 pounds per week. 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: This unannounced site visit, which forms part of the homes key inspection was undertaken on 9 April 2010. We were in the home for six hours from 09:00 to 15:00. We asked the owner to complete and return the Annual Quality Assurance Audit (AQAA)before our visit. This was returned to us and contained all the information we asked for. Evidence for some of the information provided was looked at during our visit. There are 26 people currently living in the home. We spoke with 3 people who live there and observed and spoke to the other residents during the day. We also spoke to members of staff, the manager and the provider. We looked at most areas of the premises. We examined a number of records including staff employment records, daily records, incident records, risk assessments, medication records and care plans. Care Homes for Older People Page 6 of 28 Before the visit we sent ten surveys to people who live in the home and ten to members of staff. Sixteen surveys were returned: 9 from people who live in the home or their relatives, and 7 from members of staff. Responses were largely positive. The last inspection took place on 30 April 2007. There are 2 required developments at the end of this report. Feedback was given to the provider during the visit. 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: Recording and reporting systems must be improved to ensure compliance with current legislation and effective management of risk to ensure people are protected and their health and wellbeing is promoted. Care Homes for Older People Page 8 of 28 A review if night staffing levels must be undertaken to ensure there are sufficient staff on duty at night for the adequate supervision and protection of all residents in light of recent incidents. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home are provided with helpful information about what life is like there to enable them to make an informed decision. People can be confident their needs will be fully assessed and they will be able to visit the home to ensure the home will be suitable for them. Evidence: People who are considering moving into the home are provided with helpful information about what life is like there. There is a detailed service users guide and the homes statement of purpose has been updated. Some discussion took place about providing a simplified version of the service user guide to ensure the information is more accessible to people who are experiencing dementia. An information pack is provided to enquirers which covers basic information about the home that is useful to take away and reflect on. Before anyone moves into the home a thorough assessment is carried out, usually by Care Homes for Older People Page 11 of 28 Evidence: the manager who recognises the need to understand support needs and also individual opinions, likes and dislikes. The manager or another qualified member of staff visits the person to carry out the assessment. This is done by talking to the person and to their current carers, and obtain information from other written sources such as health and social care professionals if available. Documents used during the process have been improved to capture as much information as possible to ensure peoples individual needs and preferences are understood and can be met before a place is offered. People who are considering moving in are encouraged to visit the home wherever possible. If the person has been unable to visit the home they are shown information about the home, the support and activities on offer and given the option to ask questions. People may come for a short amount of time, for a meal or for the day. The home does not provide intermediate care. 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. People who live in the home can be confident their needs are understood and will be met in line with their individual wishes and expectations. Recording systems need some improvement to ensure compliance with current legislation and effective management of risk to ensure people are protected and their health and wellbeing is promoted. Support is provided in a way that promotes peoples dignity and privacy. People are protected through the safe handling of medication. Evidence: People who live in the home can be confident their needs are understood. Observation throughout our visit demonstrated that staff support people in a way that promotes their dignity and privacy. Ways to further enhance dignity were discussed with the manager in respect of the way in which laundry is managed. Each person has a detailed plan about how they wish their personal care to be provided, what support they need and how much they can attain for themselves. This is agreed with the person or their family, and is reviewed monthly by their key workers in consultation with them. We examined three care plans in detail and found Care Homes for Older People Page 13 of 28 Evidence: them to be up to date, person centred and well maintained. One person who responded to our survey made the following comments about what the home does well; Personalised care. nutrition, assessment of status, provision of nutritional needs. An excellent home. Far above all others I have come across. Excellent management and care. Peoples wellbeing and health is continually monitored through daily records and regular reviews. There was some concern that all records are not being maintained in compliance with current legislation. There is a communication book which all staff utilise, this is being used as a handover record where personal information is recorded rather than in individual files. The manager agreed to review this practice and ensure more appropriate recording practices. People know who to ask for help. On moving in the home identifies who the named nurse and key worker are going to be, and introduces them to the person. The named nurse, in association with the person and their family draws up the care plan which also identifies areas which require further care planning and risk management. Care plans cover support needs in all aspects of daily living, social requirements, medical issues and medication, nutritional status and food likes/dislikes, communication requirements, continence and mental state and cognition. Where risks are identified these are generally managed effectively. Examples were seen where each person is assessed regarding their risk of developing pressure sores. Where this shows that the person is at risk in this area, the key worker ensures that a care plan is put into action which highlights preventative measures which need to be taken. Pressure relieving mattresses and cushions are provided as required. If necessary referrals are made to external health care professionals for additional support and advice. There was some concern however where one persons behaviour posed a risk to other people who live in the home. Although this risk had been identified it had not been managed effectively to ensure the safety and wellbeing of people who live in the home. Some discussion took place about staffing levels in the home at night and advice was given that these should be reviewed to ensure adequate supervision and protection. The manager told us that the situation had improved following interventions by the GP and other professionals. The home has a good relationship with the GP who visits the home weekly. They support the home to refer residents to other specialists where necessary. Regular chiropodist, massage therapist visits occur, domiciliary dental services and vision and hearing tests are arranged. The home supports residents to attend appointments. Care Homes for Older People Page 14 of 28 Evidence: People are protected through the safe handling of medication. The home informs us should medication errors occur and takes appropriate action in such circumstances. All medication is stored securely. The home has been working with Surrey County Council to improve the safety of medication ordering, administration and disposal. The manager told us they had been commended for the way the home orders and manages medication and the relationship with both GPs and local pharmacist. A relative told us how their relatives condition had improved since moving to the home. My mum was in a poor agitated state, unwell and poor outlook. Within 6 months her medication had been reduced, she felt safe and had a better outlook on life. The home is working towards achieving the Gold Standard in palliative care. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are provided with a range of activities. Routines in the home are flexible and relevant to enable people to choose how they wish to live their lives. People are encouraged to have a say in how the home is run. They are supported to remain as independent as possible. Mealtimes are enjoyable and food is well presented. Evidence: People who live in the home have opportunity to take part in a range of activities. Information is recorded in care plans about their backgrounds and social histories to enable staff to provide activities to suit their individual interests and abilities. Routines in the home are flexible and relevant. Likes and dislikes and individual preferences are recorded in care plans. Activities were the only area where responses to surveys identified the home could do better. One person commented, more activities, Im sometimes bored. Maybe more activities to stimulate my brain. Another said, A wider variety of activities for some more mobile people but I find them adequate for me. The manager told us the activities coordinator had recently left and they are in process of appointing a replacement. The range of activities on offer includes group quizzes, knitting groups, music and sensory sessions. Care Homes for Older People Page 16 of 28 Evidence: A range of entertainment is provided in the home; some weekly like buttons the PatA-Dog, other entertainment has included singers, dancers, magicians, local historians and pantomimes. The home has recently purchased a new, adapted minibus which is well utilised for trips out into the community, residents have been asked what type of things that they would like to do or see. Residents requested to be more involved in gardening and last summer they grew different vegetables and plants. The home has links with the local church who come in each month to conduct a service for those who wish, they also visit people individually. All religious needs of residents are documented. Families and friends are welcome to visit at any time and the manager has an open door policy. Regular resident meetings have been introduced. The manager said that these meetings have proved really valuable and many points and suggestions have been made by the residents, also feedback and preferences are ascertained. The minutes from the residents meeting are brought to staff meetings so that changes can be implemented as a direct result of resident requests. People told us they enjoy the food in the home. A simple food preference questionnaire has been introduced which is filled in by residents with either the help of their key worker or one of the cooks, and this is regularly reviewed as peoples tastes change. Food is often discussed at the residents meetings with feedback given to the cooks. The menu offered reflects changing tastes and offers person centred choices. To improve peoples choice pictorial menus are provided to help people who have difficulty in reading words and enable them to decide if they would like to try the meal. Care Homes for Older People Page 17 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 who live in the home are listened to and are encouraged to offer comment or complaint. There are policies and procedures in place and staff receive training to understand how to protect people from abuse. Evidence: People who live in the home are listened to and are encouraged to offer comment or complaint. There is a suggestion box and robust complaints procedure to enable residents and relatives to share their views and raise any concerns. The manager told us she plans to provide the procedure in a more accessible format for people who find it difficult to read and understand. The complaints procedure is included in the service users guide and a copy is readily available on the wall in the hallway. This outlines the process and the timescale. Complaints and concerns are documented in the complaints book and these are reviewed monthly by the manager. This book was examined, the manager was advised that all complaints should be recorded individually. Further discussion took place about the need to record complaints and concerns from residents as well as external sources. The home has not recorded any complaints in the last year and the commission has not been contacted with any concerns about the service. The manager and owner have attended training on the mental capacity act and deprivation of liberties to ensure peoples legal rights are upheld. This training has Care Homes for Older People Page 18 of 28 Evidence: been cascaded to other staff in the form of advice documents. There are clear policies and procedures to ensure people who live in the home are protected from abuse. Staff receive training in safeguarding issues in their induction and later in training and updates and in supervision. The home works within a multiagency framework for protecting residents from abuse, and the policy identifies when to contact external support, and the procedures to be followed in the event of suspicion of abuse. Some improvement is needed in the recording of incidents to ensure prompt and appropriate action is taken when incidents occur. Care Homes for Older People Page 19 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. People who live in the home benefit from the clean comfortable and safe environment. Improvements in the furnishings and facilities have enhanced the quality of life for people who live there. Evidence: People benefit from the comfortable and clean environment. Cleaners are on duty each day and there are no unpleasant odours. People enjoy access to the well laid out garden and some people were enjoying sitting in the sunshine during our visit. The manager told us the garden is well used in summer for residents to play outdoor games, get involved with gardening or just sit and enjoy the sun. Residents are accommodated on two floors which are accessible via a passenger lift. Accessibility is further improved through the provision of grab rails and hoists are readily available. If residents require additional specialist equipment this is facilitated. Communal space available to residents includes two lounges and a separate dining room. Inadequate storage space means space in lounges is restricted and there is no room in the main lounge to provide for tables between chairs where people can place their personal items or drinks. The manager told us there are plans to extend to the side of the home to provide additional storage space. People are benefiting from improvements in the environment since our last visit. Bathrooms and shower rooms have been refurbished, a formerly disused bathroom has been refurbished and fitted Care Homes for Older People Page 20 of 28 Evidence: with an adapted bath. A new wet room shower facility has also been created to provide more choice for residents. People are being supported to find their way around the home more easily through new picture signage. Bedroom doors have been fitted with memory frames for people to furnish with memorable pictures, providing a reference point and ownership of their space. Discussion took place about how to further improve orientation for people who live in the home. The home is generally well maintained to provide a safe and pleasant environment for residents through a process for reporting faults and general maintenance tasks. The environment and facilities for residents are being continually improved. The home has been undergoing redecoration which is ongoing. People are encouraged to personalise their own rooms and make them more homely. An automatic door closing system which is compliant with fire regulations have been fitted to bedroom doors to allows the residents to leave the door safely in any position they choose. A programme of updating all bedroom furniture is in process. Bedrooms are being provided with new home style electric profiling beds. New bedroom furniture is specially designed for use in Nursing Homes. It incorporates rounded edges, robust drawers and hinges and locks. Approximately seventy five per cent of rooms have already been completed. The central heating and hot water system for the whole home has been renewed since our last visit. Two industrial boilers have been installed, a pressurised hot water system and new radiator valves to most radiators. There is a small laundry room which is well equipped to provide efficient laundry facilities for residents. Care Homes for Older People Page 21 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. People who live in the home benefit from the support of the well trained, caring and committed staff team. There are sufficient numbers of staff on duty each day to meet their needs. However a review is needed to ensure night staffing levels are appropriate to ensure the adequate supervision and protection of all residents. People are protected from harm through robust recruitment procedures. Evidence: People who live in the home benefit from the support of the caring and committed staff team. One relative who responded to our survey told us, My husband says staff are very helpful and kind. they could not be any better. Interactions observed throughout our visit were respectful and friendly. There are sufficient staff on duty in the home each day to provide appropriate support to people who live there. Some discussion took place about staffing levels at night and the manager agreed to review this to ensure residents are adequately supervised and protected in light of a number of recent incidents. There is a first level trained nurse on duty at all times. There are two qualified nursing staff on duty each morning in addition to care staff. The home also employs domestic staff, chefs, maintenance and laundry staff. There is a cleaner on duty every morning and a cook on duty each day. People can be confident staff are suitably qualified to carry out their roles. All care Care Homes for Older People Page 22 of 28 Evidence: staff are either working towards, or have achieved their NVQ 2 or 3. Other NVQ training has been sourced for individuals, such as team leadership for the senior care assistants. The manager is an NVQ assessor and can give advice and feedback to staff to support them through their NVQ programme. People are protected through the implementation of robust recruitment procedures. We examined three staff files which show that staff are thoroughly vetted before they begin working in the home to ensure that they match the criteria in the job description. Files seen included two written references; a full employment history; documents proving identity including a photograph and evidence of appropriate checks through the Criminal Records Bureau. People who live in the home can be confident the staff team are well trained and supervised and have the necessary skills to support them. All new staff receive induction training in their first week and are given the opportunity to shadow an experienced member of staff for the first week. There is a training manager who provides all statutory training, either in house, using training packages, or through external trainers who come to the home and supply training in specialist areas such as fire evacuation and moving and handling. Additional training essential to the skills of the team such as dementia, person centred care and behaviour management is also arranged to ensure staff understand the specialist needs of people who live in this home. There is a training matrix which helps identify training needs. Training requirements are addressed in supervision. Staff receive one appraisal each year and six supervision sessions. Most of the nursing staff have now received training in supervision. Care Homes for Older People Page 23 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. People who live in the home can be confident the home is being run in their best interests taking account of their views and expectations. There are effective quality and assurance systems in place to ensure people continue to receive a good service. The health and safety of people is promoted. Evidence: People who live in the home can be confident the home is being run in their best interests taking account of their views and expectations. The manager is well qualified and has an open door policy. She works closely with the staff team. The manager undertakes regular training to improve and update her knowledge. Some discussion took place about the need to ensure that the balance between time spent with residents and management duties allows sufficient time to ensure effective operation of the service taking account of current regulations and guidance. There are clear lines of accountability within the home; each member of staff spoken Care Homes for Older People Page 24 of 28 Evidence: to on the day of the inspection was clear about their role and responsibilities. In discussion with various staff members it was evident that there is a strong ethos of transparency and openness in the home There are effective quality and assurance systems in place to ensure people continue to receive a good service. People who live in the home are encouraged to get involved in the decision making processes of the home through regular surveys, residents meetings and day to day contact with the owner and manager. The annual quality assurance survey is distributed amongst residents and other stakeholders who have an interest in the service, and this forms the basis for the homes development plan. The home does not become involved in service users finances. The health and safety of people is promoted through training staff in safe working practices. However some risks to people who live in the home were noted during our visit. Chemicals were being stored in an unlocked sluice room on the ground floor and a number of toiletry items were found in communal bathrooms. This was drawn to the attention of the manager who agreed to take immediate action to ensure these issues were addressed. Staff receive regular training including first aid, health and safety, basic food hygiene, moving and handling, fire safety and infection control. People are protected from harm through effective environmental risk management processes and regular servicing and maintenance of equipment and installations. Care Homes for Older People Page 25 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 26 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 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 13 The registered person must ensure incidents are properly recorded and risk assessments updated. To ensure people are protected from harm and their health and well being is promoted. 31/05/2010 2 27 12 A review of staffing levels at night must be made to ensure there is adequate supervision and protection for people who live in the home To ensure the safety and welfare of residents. 30/04/2010 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 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. 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