Care Home: Littledale Nursing Home

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What the care home does well All of the comments made by people living at the home were positive. These included, "The staff look after us well. They do what they can for us". "I am satisfied with the home". "I`ve no worries, it`s fine". "Marvelous". The relatives spoken with made some positive comments. These included, "We`re always made to feel welcome". "I`ve no worries about my parents care". The staff said that they worked well as a team and they found the manager approachable and supportive. People`s health was monitored and access to health specialists was available to meet people`s needs. Medication was securely stored and administered safely. Relatives could visit the home at any time to maintain contact. People said that they had a choice of food and that the quality of food served was "Good". There was an adult safeguarding procedure in place to uphold people`s safety. People said that they felt safe living at the home. Staff training and recruitment practices promoted people`s safety. Systems were checked and serviced, to keep people safe. What has improved since the last inspection? Significant improvements had been made, as the manager had met all of the requirements and recommendations made at the last inspection where she had the control to do so. The statement of purpose and service user guide had been updated so that people were provided with up to date information. A system to audit medication on a monthly basis had been introduced to keep people safe. A full time activities worker had been employed to provide people with choice and improve leisure time.The menu board had been changed so that it was easier to read. People had been provided with accurate information on how to complain, to uphold their rights. Parts of the home had been redecorated and refurbished to improve communal and individual living space. A training programme had been developed so that staff skills were maintained. Staff recruitment files contained all of the required information to evidence that thorough procedures had been adhered to. A programme of staff supervision had been put in place to make sure staff were supported and appraised. A quality assurance system had been implemented. Questionnaires had been sent to people living at the home and their representatives to obtain their views and make sure the home was run in their best interests. What the care home could do better: The record used to carry out initial assessments was limited and restricted the amount and range of information obtained. It is acknowledged that the manager had developed a new assessment record and was in the process of introducing this to improve the assessment process. Care plans were difficult to navigate so that essential information could be missed. It is acknowledged that the manager was updating the care plan format so that they were easier to read. All risk assessments were not reviewed to make sure they contained up to date information. Staff were not always vigilant to respond to routine health care needs promptly. The complaints procedure on display in the entrance hall contained out of date details, which meant that people had not been provided with important information. The ground floor corridor carpet and some bedroom carpets were worn, old and stained. This did not provide pleasant and clean accommodation. The designated smoking area was in the entrance porch so that visitors to the home walked through a smokey environment. Access through the entrance porch was limited which restricted safe access and exit into the home. Monthly monitoring visits and reports had not been routinely undertaken. Copies of the report had not been sent to us to show that the running of the home was checked. It is acknowledged that one monitoring visit has taken place since this inspection. Practice fire drills were not undertaken frequently to make sure all staff participated in these. Key inspection report Care homes for older people Name: Address: Littledale Nursing Home 669 Prince Of Wales Road Sheffield South Yorkshire S9 4ES     The quality rating for this care home is:   one star adequate 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: Janis Robinson     Date: 0 2 1 2 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 30 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 30 Information about the care home Name of care home: Address: Littledale Nursing Home 669 Prince Of Wales Road Sheffield South Yorkshire S9 4ES 01142611644 F/P01142611644 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Abdul Majid Khan,Mrs Tahir Majid Khan care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Littledale is a 30 bed nursing home in a large detached property. It is situated on a main road and accessible to community facilities such as shops, pubs, parks and a post office. The home has a small garden and a car park. It is a three storey building and floors can be accessed by a passenger lift. There are eighteen single and six double rooms. Communal lounges, dining rooms and sufficient bathing facilities are provided. The weekly fees range from £369 to £479. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Care Homes for Older People Page 4 of 30 Over 65 30 0 0 3 1 2 2 0 0 8 Brief description of the care home Written information about the home, including the latest inspection report, is available from the home. Care Homes for Older People Page 5 of 30 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: one star adequate 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 one star. This means that people who use this service experience adequate quality outcomes. This was an unannounced key inspection carried out by Janis Robinson, regulation inspector. A visit to the home took place between 9am and 4pm on the 2nd of December 2009. The manager, Janet Cooper, was present during this visit. Prior to the visit the manager submitted an Annual Quality Assurance Assessment (AQAA), which detailed what the home was doing well and any plans for improvement in the next twelve months. Information from the AQAA is included in this report. On the day of the visit staff were observed interacting with people that live at the Care Homes for Older People Page 6 of 30 home. A partial inspection of the premises was undertaken and records relating to care and the running of the home were checked. Six people living at the home and three relatives were spoken with about their experiences of the care provided. Two staff were interviewed about their roles and experience of working at the home. The cook and two domestic staff were spoken with about aspects of their jobs. The manager was spoken with about the running of the home. This inspection was supported by an Expert by Experience. An expert is a person that has experience and knowledge of the care system. The expert visited the home for three hours alongside the inspector. She spoke with the manager, the activities worker, a relative and several people living at the home. At the end of her visit the expert reported back to the inspector. Comments from her findings are included in this report. Verbal feedback was provided to the manager and the owners son, Rashid Khan, at the end of the visit. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? Significant improvements had been made, as the manager had met all of the requirements and recommendations made at the last inspection where she had the control to do so. The statement of purpose and service user guide had been updated so that people were provided with up to date information. A system to audit medication on a monthly basis had been introduced to keep people safe. A full time activities worker had been employed to provide people with choice and improve leisure time. Care Homes for Older People Page 8 of 30 The menu board had been changed so that it was easier to read. People had been provided with accurate information on how to complain, to uphold their rights. Parts of the home had been redecorated and refurbished to improve communal and individual living space. A training programme had been developed so that staff skills were maintained. Staff recruitment files contained all of the required information to evidence that thorough procedures had been adhered to. A programme of staff supervision had been put in place to make sure staff were supported and appraised. A quality assurance system had been implemented. Questionnaires had been sent to people living at the home and their representatives to obtain their views and make sure the home was run in their best interests. What they could do better: The record used to carry out initial assessments was limited and restricted the amount and range of information obtained. It is acknowledged that the manager had developed a new assessment record and was in the process of introducing this to improve the assessment process. Care plans were difficult to navigate so that essential information could be missed. It is acknowledged that the manager was updating the care plan format so that they were easier to read. All risk assessments were not reviewed to make sure they contained up to date information. Staff were not always vigilant to respond to routine health care needs promptly. The complaints procedure on display in the entrance hall contained out of date details, which meant that people had not been provided with important information. The ground floor corridor carpet and some bedroom carpets were worn, old and stained. This did not provide pleasant and clean accommodation. The designated smoking area was in the entrance porch so that visitors to the home walked through a smokey environment. Access through the entrance porch was limited which restricted safe access and exit into the home. Monthly monitoring visits and reports had not been routinely undertaken. Copies of the report had not been sent to us to show that the running of the home was checked. It is acknowledged that one monitoring visit has taken place since this inspection. Practice fire drills were not undertaken frequently to make sure all staff participated in these. Care Homes for Older People Page 9 of 30 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 10 of 30 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 11 of 30 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 were provided with information about the home so that they could make informed choices. Peoples needs were assessed prior to moving into the home to make sure these could be met. Evidence: A brochure had been developed so that full information was provided to people. The brochure contained a copy of the service user guide, which had been reviewed so that all of the information was up to date. The manager had also updated the homes statement of purpose, which was seen by us. The statement was available to people so that they had all of the information they needed. The manager stated that she visited people in their own homes, or in hospital, to carry out an assessment prior to admission to the home. This was to make sure all identified Care Homes for Older People Page 12 of 30 Evidence: needs could be met before people moved in. The manager stated that on occasions a qualified nurse from the home would carry out the initial assessment. Where available, social workers assessments were obtained so that full information was available. The information gathered at assessment would be used to draw up an individual care plan so that staff knew how to meet peoples needs. Three peoples files were checked and they all contained an assessment that had been carried out prior to admission. The assessment covered most areas of peoples lives, such as communication, personal care, mobilising, interests and eating. However, the assessment form used was limited, as there was only space to record one line against each heading. This meant that peoples full needs may not be identified. The manager was aware of the limitations of the current assessment record and had developed a new assessment tool so that full and accurate details could be recorded. Care Homes for Older People Page 13 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care was monitored and, on the whole, met. However, some personal care needs had not been routinely met which could pose a risk. Evidence: Three peoples care plans were checked. They contained a range of information that covered all aspects of daily living. All of the care plans seen had been reviewed on a monthly basis so that they contained up to date information. Qualified nurses were responsible for writing and reviewing the care plans. However, the care staff spoken with said that they had full access to peoples plans so they could keep up to date. Care staff also said that they could influence care plans if they felt changes were needed, and these would be discussed in daily handover meetings. The three care plans seen had been evaluated on a monthly basis to ensure they remained up to date. The layout of care plans was confusing, which meant that information was difficult to find and the plans were difficult to navigate. This meant that essential information could be lost. The manager was in the process of updating peoples care plans so that access to important information was easier. Care Homes for Older People Page 14 of 30 Evidence: The plans contained relevant risk assessments to make sure all risks were identified and minimised. Those seen covered nutrition, falls, safety and skin care. However, one risk assessments seen was dated 2006 and there was no evidence to suggest it had been reviewed since that date. This meant that out of date information could be in place that could place people at risk. One further risk assessment seen had not been dated and there was no evidence to suggest it had been reviewed to keep it up to date. Peoples health was monitored and access to health professionals was provided. Records were kept of all health professionals contact so that peoples health could be maintained. The people spoken with said that they could see their doctor when they needed, and had access to a dentist and chiropodist. People had their weight checked regularly and their diet was monitored as part of maintaining their health. However, some concerns were noted during this inspection which evidenced that peoples health and well being was not fully met. On arrival at the home at 9am, one person was seen with protective dressings on their leg. One dressing was hanging loose and left the damaged skin uncovered. The dressing was only replaced by nursing staff when it was pointed out at mid day. Staff had not observed this, or had neglected to rectify. This left the person at risk of further infection. In addition, the expert by experience had noted that whilst people appeared well groomed in clean clothing, several people had very dirty fingernails. This evidenced that peoples personal hygiene was not routinely well maintained. One relative told the expert by experience that he had visited one day and found his loved one in wet clothes that had not been attended to. All of the people spoken with said that staff were polite and respectful. Staff were observed interacting with people living at the home and sitting chatting to them. The staff spoken with could describe ways in which they respected peoples privacy. People said that they were well cared for. Comments included, They (the carers) are smashing. We are well looked after here. Couldnt wish for anything more. Relatives said, (Our relative) is well looked after. We have no concerns. One visitor to the home told the expert be experience, Care Homes for Older People Page 15 of 30 Evidence: I dont come into the home without staff speaking to me, they are marvelous. As homes go, this is good. A policy on medication was in place. The staff spoken with confirmed that only qualified nursing staff administered medication. The nurses on duty confirmed that they had been provided with safe medication administration training, to keep people safe. Since the last inspection the manager had introduced a system to monitor medication procedures to reduce risk. Records of these were seen which showed that monthly audits were carried out to monitor safe medication systems. A pharmacist had also audited the medication in May 2009. Medication administration records (MAR) were checked. Those seen had been fully completed. The details recorded on MAR sheets were checked against the medication stored and all details corresponded. Care Homes for Older People Page 16 of 30 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 were provided with a range of social opportunities and choice so that they enjoyed daily life. Evidence: Significant improvement had been made to peoples leisure opportunities. A full time activities coordinator had been employed who worked five days each week to provide a range of activities. An activities poster was on display in the entrance hall which showed that activities were varied. They included arts and crafts, bingo, card games, baking and pampering sessions. Some trips out of the home were provided, and shopping trips had been planned for the near future. Some people had participated in the Care Home Olympics during the summer, and had won two medals. People said that they enjoyed the activities provided. Comments included, Its better to have something to do. Im not bored now. I enjoy the bingo and its nice to get together. The activities coordinator kept a record of all activities provided, and whether people had chosen to participate or declined to join in so that she could monitor this. One Care Homes for Older People Page 17 of 30 Evidence: person told the expert by experience, I watch television in my own room and I am happy with the care I receive. I like to play bingo but I also like the privacy of my room. People said that they had contact with their family and friends. Relatives spoken with said that they could visit at any time and were always made to feel welcome. One person told the expert by experience, The staff are very pleasant and make visitors very welcome. People said that the routines of the home were flexible. They could chose when to get up and when to go to bed, what to do with their day, what to eat, and whether to spend time in the privacy of their room or in communal areas. All of the people spoken with said the food was good. People told the expert by experience, The meals are very good. Alright. Plenty of vegetables. The menu seen showed that a varied diet was provided. People could have alternatives to the main meal provided, and records of meals showed that people regularly had something different, in line with their preferences and choices. Staff said that they had access to food at all times so that they could make a snack if people wanted this. The kitchen was clean and the cook said that all of the equipment was in working order. There were fresh vegetables in the store room and the fridge and freezer had plentiful supplies. However, there were very limited supplies of fresh fruit. The manager acknowledged that people were not routinely offered this. The days menu was displayed on the dining room door in large letters so that people could read it. Since the introduction of further activities, some people had become more active. As a result they had an increased appetite and had gained weight, which improved their health. Care Homes for Older People Page 18 of 30 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 and adult safeguarding practices protected people. Evidence: A written complaints policy was in place so that people had access to important information. A copy of the complaints policy had been included in the service user guide. It contained relevant information and informed people how to contact us, should they wish to do so. The manager kept a record of all complaints received. The record detailed the actions taken in response to the complaint, and the outcome, so that these could be monitored. There was a complaints procedure on display in the entrance hall. This contained out if date information about our contact details and needed updating so that people had correct information. All of the people spoken with said that they had no complaints, but could talk to staff or the manager if they had. A written policy on adult safeguarding was in place so that staff had access to important information. The training records checked showed that all staff had been provided with safeguarding training since the last inspection. The staff spoken with could describe indicators of abuse and were clear of the steps to take if an allegation was made or if they suspected abuse. All of the staff spoken with were confident that the manager would take appropriate action if they shared any concerns. All of the people spoken with said that they felt safe living at the home. Care Homes for Older People Page 19 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home was generally well maintained, further refurbishment would improve peoples comfort and well being. Evidence: Since the last inspection some improvements had been made to the environment so that people had a more comfortable and pleasant place to live. The large lounge and dining room had each been reorganised to create two smaller lounges and dining rooms. This created a more comfortable communal space and provided the opportunity for people to watch different television programmes if they chose. The manager said that the lounges had been redecorated and thirty new lounge chairs had been purchased to improve the environment. Three new profile beds and nine bedrooms had been refurbished to provide people with pleasant individual space. A tour of parts of the environment was undertaken. Individual rooms appeared well decorated and, on the whole, well maintained. People had personalised their rooms, which showed that they had some control over their personal space. A minority of bedrooms seen had worn and stained carpets, which detracted from the appearance of the room. Communal areas were, on the whole, well decorated. Pictures and ornaments were provided to create comfortable living space. However, the main ground floor corridor carpet was old and worn. This did not create a positive first impression of the home. One lounge and corridor area had an unpleasant odour, which Care Homes for Older People Page 20 of 30 Evidence: detracted from peoples comfort. Some people living at the home smoked cigarettes and cigars. The designated smoking area was the front entrance porch. This meant that all visitors to the home had to walk through this area to enter the home. One smoker used a wheelchair which meant that when they occupied the smoking area space became very limited for people entering and leaving the home, which could pose a risk. Some towels seen in the storage cupboard were old and worn, which could detract from peoples comfort. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment and training practices protected people. Evidence: The staff rota was checked. This showed that levels of staff were maintained. The manager stated that she very occasionally covered shifts so that sufficient staff were always available. The staff spoken with said that they were a good team and worked well together. National Vocational Qualifications (NVQ) were provided to staff to enhance their skills. Of the thirty two care staff, seventeen had achieved NVQ level 2 in care. This is over and above the recommended fifty percent of care staff trained to NVQ level 2 in care, and will benefit people living at the home. Three staff recruitment files were checked. They contained all of the required information and included an application form, full employment history, two references and proof of identity. The files also included evidence that a Criminal Records Bureau (CRB) check had been completed to show that full and safe procedures had been adhered to. The training records checked showed that a programme of staff induction and training was provided to staff to maintain their skills. The staff spoken with confirmed that Care Homes for Older People Page 22 of 30 Evidence: they had been provided with induction training. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed, which benefitted people. Evidence: The manager was a qualified nurse and had many years experience of managing a care home. All of the people living at the home and staff made positive comments about the manager, these included; She is approachable and listens to us. Her door is always open. She cares about the residents. Throughout this inspection the manager was able to evidence that she had met all of the requirements and recommendations set out at the last inspection, where she had control to do so. Verbal feedback was given to the manager at the end of this visit. Care Homes for Older People Page 24 of 30 Evidence: The manager telephoned us a week after this inspection to inform that the majority of recommendations fed back had already been responded to. The manager had developed a quality assurance system to obtain and act upon peoples views. Questionnaires had been given to people living at the home and their representatives. The manager was advised that these needed to be audited and a report produced outlining the responses so that people were aware of the actions taken following the survey. Spending monies were kept for some people. These were securely stored. Records of monies were maintained. Those checked detailed all spending, were signed and receipts were kept. The amounts kept tallied with the records held. Since the last inspection the manager had organised staff supervision so that these regularly took place. The records of staff supervision checked showed that all staff were provided with supervisions on a monthly basis, so that they were appropriately supported and appraised. A programme of staff training was in place. The training records checked showed that staff were provided with training in health and safety, food hygiene, moving and handling and first aid. The manager had a programme of planned training in place to make sure staff were provided with refresher training at relevant intervals to maintain their skills and knowledge. Systems were checked and serviced to make sure they were safe. Fire extinguishers had been serviced in September 2009 to make sure they were in working order. A gas safety certificate was seen, dated 16/10/2009. A fire book was maintained and staff were provided with fire training to make sure they could respond in an emergency. Whilst fire drills took place, these were infrequent and meant that some staff may not participate in a practice drill for a considerable length of time. The manager stated that further drills had taken place since this inspection visit. Monthly monitoring reports had not been undertaken by the owner, Dr. Khan, to evidence that the home was appropriately monitored. A requirement relating to this issue had been made at the last inspection, which has been carried forward. This was brought to the attention of the owners son, Rashid Khan, during feedback at the end of this inspection visit. The manager informed us that a monthly monitoring visit and report had been undertaken by Rashid Khan since the inspection, a copy of which had been left with her for information. The manager stated that she would forward a copy of the report to us, to show that the home was being monitored. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 31 26 The Provider must send copies of his monthly visit reports to CSCI. To demonstrate that he is monitoring the progress. 01/04/2009 Care Homes for Older People Page 26 of 30 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 All risk assessments must be 26/02/2010 regularly reviewed. This would ensure they contained up to date information to keep people safe. 2 8 12 Peoples personal care needs 26/02/2010 must be met. Staff must observe and monitor peoples personal hygiene and take appropriate action as required. This would ensure that people were well looked after and their health was not put at risk. 3 19 13 The designated smoking area must be provided where it does not cause obstruction. This would ensure that people had a clear access and exit to the home 26/02/2010 Care Homes for Older People Page 27 of 30 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 4 26 16 All parts of the home must be kept clean. The lounge and corridor carpet must be cleaned or replaced to eradicate the odour. This would ensure that people had a pleasant and safe place to live. 26/02/2010 5 31 26 The provider must undertake monthly monitoring visits. A copy of the report must be sent to us. This will show that the progress of the home is being monitored. 26/02/2010 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 1 3 The updated assessment document should be undertaken at each new assessment so that full and accurate information is obtained. Care plans should be better organised so that important information is easier to find. People should be provided with a choice of fresh fruit on a regular basis to improve their diet and health. The written complaints procedure on display in the entrance hall should be updated so that people have access to correct information. Stained bedroom carpets should be cleaned or replaced to improve living space. 2 3 4 7 15 16 5 19 Care Homes for Older People Page 28 of 30 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 6 7 8 9 19 19 19 38 Old and worn towels should be replaced to assist peoples comfort. The ground floor corridor carpet should be replaced to maintain cleanliness. Worn and old towels should be replaced to assist peoples comfort. Practice fire drills should take place more frequently so that all staff can participate in these to maintain their knowledge. Care Homes for Older People Page 29 of 30 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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