Care Home: Margaret Clitherow House

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What the care home does well Margaret Clitherow House has a sense of formality and respect, which is appreciated by people living at the home. People are encouraged to maintain their independence and to exercise choice and control in their daily lives. Clear information is available for people thinking about moving to the home, which includes a video about life at the home. The home always sends a member of staff, often one of the assistant managers, to medical appointments and hospital admissions to support people. This happens at any time if family are unable to attend. Social activities are provided regularly in the home. Many people spoke of the importance of maintaining their faith and living in a community where this was accessible to them. The home is linked internally to the adjoining Catholic church. This means people can attend religious observance without having to leave the main building. However people do not have to be Catholic to live at Margaret Clitherow House. There are utility rooms on the first and second floor where people can make their own hot drinks and snacks if they wish. The house is converted from a convent, and has a large walled garden, where vegetables, fruit and flowers are grown for cutting as well as areas for sitting near to a summer house. People who live at the home have the opportunity to contribute to the gardens at a regular meeting with the gardener. The house is impressive, full of period features and atmospheric. There are shaft lifts that service rooms above the ground floor and the property is well maintained. Comments people made about the home included: "I much appreciated no pressure being brought upon residents as to their whereabouts within the house, with the understandable exception of mealtimes. Privacy when desired is very welcome." "Every encouragement being given to residents to retain our independence as much as possible" "I`m 85. Now I feel 75. I wish I`d come here a long time ago." "I have settled here very happily and have no wish to leave". "It`s a wonderful place I am a very satisfied customer" What has improved since the last inspection? Since the last inspection the home has: Continued to refurbish the period windows in the property in accordance with its listed building status. Improved areas of the care plans to ensure they reflect people`s personal profiles and the way in which people like their care to be delivered Fully implemented an effective quality monitoring system. This helps to ensure that people have a say in the way the home is run, and that ways in which it can be improved are identified and addressed. A full recruitment procedure is being followed for all staff including the obtaining of references and criminal records bureau checks. This helps to ensure people at the home are being cared for by people who are suitable to be working with vulnerable people. Prescription dressings are not being held in the general first aid kit, to ensure they are not used for people for whom they are not prescribed. Expired dressings are being destroyed. A system of individual supervision has been implemented.. This helps to make sure staff are working consistently and to their full potential. Hot water systems should ensure that water temperatures are regulated to ensure people cannot be accidentally scalded. Some redecoration as identified has been undertaken in one person`s room. Staff have received updated training in Safeguarding and prevention of abuse. A new contract has been undertaken for the cleaning of windows. The manager is carrying out a series of internal audits against the national minimum Standards to ensure the home is working well. Body maps are now being used to help identify any bruising people may sustain and it`s cause. What the care home could do better: Where a prescription dosage is variable the home manager needs to make sure the prescription is clear. This helps to ensure people do not receive too much medication. The home may wish to consider whether people who live at the home can increase their involvement in the committee who make decisions about how the home is run. People who live at the home might be helped by staff wearing name badges. The home manager needs to consider ensuring staff are protected in their working duties from challenging behaviours. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Margaret Clitherow House Priory Road Torquay Devon TQ1 4NY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Finniear     Date: 2 2 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Margaret Clitherow House Priory Road Torquay Devon TQ1 4NY 01803326056 Telephone number: Fax number: Email address: Provider web address: mchaO@tiscali.co.uk Name of registered provider(s): Margaret Clitherow Housing Association care home 41 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Margaret Clitherow House provides residential care for up to 41 older people. There are 38 bedrooms, of which three could be double if required. All but one room has en suite facilities, and that one has an adjacent wc. Most of the Home is accessible via the shaft lifts, with a short flight of steps to some rooms. There is a dining room large enough to seat all the residents while providing quiet corners. There are two shared sitting rooms, a gazebo and a conservatory. There is a kitchenette where residents may make hot drinks or snacks, if assessment shows this to be safe. The Home has extensive gardens, which are accessible to residents. There is suitable garden furniture and shade provided. Vegetables are grown for the kitchen. The Home is adjoining the Catholic Church, and is close to the St. Marychurch precinct with all its Care Homes for Older People Page 4 of 29 Over 65 41 0 0 7 1 0 2 0 0 8 Brief description of the care home amenities and services. Transport is provided for medical appointments and social activities. There is a Residents Social Fund, which pays for entertainments. The Manager will supply a copy of the latest CSCI report on request. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: To complete this inspection the home completed an Annual Quality Assurance Assessment or AQAA, which gave us information about how the home is run; we sent questionnaires to people who live and work at the home; we made a site visit of over eight hours to the home without telling them the day we were coming; we spoke to people living and working at the home about what it was like; we toured the accommodation looking at rooms, cleanliness and how well people were able to personalise their environment; we spoke to the homes management to look at how they ran the home; we looked at the systems in the home, records and documentation; and we looked at what has happened since the last key inspection, including what we found on two smaller random inspections which we carried out since the last key inspection. Care Homes for Older People Page 6 of 29 What the care home does well: What has improved since the last inspection? Since the last inspection the home has: Continued to refurbish the period windows in the property in accordance with its listed building status. Care Homes for Older People Page 7 of 29 Improved areas of the care plans to ensure they reflect peoples personal profiles and the way in which people like their care to be delivered Fully implemented an effective quality monitoring system. This helps to ensure that people have a say in the way the home is run, and that ways in which it can be improved are identified and addressed. A full recruitment procedure is being followed for all staff including the obtaining of references and criminal records bureau checks. This helps to ensure people at the home are being cared for by people who are suitable to be working with vulnerable people. Prescription dressings are not being held in the general first aid kit, to ensure they are not used for people for whom they are not prescribed. Expired dressings are being destroyed. A system of individual supervision has been implemented.. This helps to make sure staff are working consistently and to their full potential. Hot water systems should ensure that water temperatures are regulated to ensure people cannot be accidentally scalded. Some redecoration as identified has been undertaken in one persons room. Staff have received updated training in Safeguarding and prevention of abuse. A new contract has been undertaken for the cleaning of windows. The manager is carrying out a series of internal audits against the national minimum Standards to ensure the home is working well. Body maps are now being used to help identify any bruising people may sustain and its cause. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 29 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. Clear information is available to help people make a decision about whether Margaret Clitherow House is the right place for them. People are fully assessed before a decision is made about whether the home can meet their needs. Evidence: Margaret Clitherow House has a statement of purpose and service user guide available. These contain information about the home such as the services and facilities provided, and are available both to people currently living at the home and also to people considering whether they wish to move in. The service user guide is available in large print and the home also has a video for people so that they can see what the home is like. This information can help people make a decision about whether the home is the right place for them. Most of the people spoken to however had chosen the home because of its connection to the church or through prior knowledge. People living at the home receive a contract, or statement of terms and conditions of Care Homes for Older People Page 11 of 29 Evidence: residency. Copies of completed contracts were not seen on this occasion, but were seen at the last inspection. People who are funded by the local authority also receive a contract from them outlining what they can expect to receive. Information about terms and conditions is also included in the service user guide. This helps to make sure everyone understands their rights and responsibilities while living at the home. People considering moving to Margaret Clitherow House are assessed by the homes manager or senior staff before a decision is made about whether the home can meet their needs. People complete an application form as a part of this process. They are encouraged to visit the home and meet people living there as well as look at the accommodation available. During the inspection site visit time was spent looking at the last two admissions to the home. It was clear that peoples needs had been assessed, and in one case the person had visited the home over a period of three months before making a final decision to move in. Time was also spent talking to people at the home about whether they felt they knew enough about the home before they decided to move in, and whether it had lived up to their expectations. People said they were very happy they had moved in. The home does not cater for intermediate care. This means that they do not provide specialist rehabilitation programs for people with a view to returning them to their own home. 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. Peoples healthcare needs are being met. Evidence: The people who live at the home that we spoke to, and the people who completed questionnaires told us they were happy with the home and that their care needs were met. On the site visit we looked at the care plans for six people who lived at the home and who had a range of needs. We also had some discussions with staff on duty and talked to people about the care they received. The care plans that we saw showed the home completes an assessment of each person and compiles a plan of the support that they require and how they like this to be given. Since the last inspection the home have increased the amount of detail in the plans, however some additional information is still required to detail the individual impact that a disease or impairment may have. As an example the care plan might indicate that a person has some degree of short term memory loss. Additional details might for example show how the short-term memory loss affects that individual in their day-to-day life. People spoken to said that they had Care Homes for Older People Page 13 of 29 Evidence: been involved in drawing up of their care plans. Some information has also been provided on peoples social and personal history which helps to put their life and care requirements into context. The home has equipment and systems available to support peoples health care needs. The home has obtained a number of hospital beds for people which make it easier for them to be cared for in comfort. Appropriate mattresses for pressure relief have been provided along with specialist cushions, hoists and mobile hoists. Other aids and adaptations to support to peoples independence such as raised toilet seats and grab rails have been provided. People living at the home who require nursing support received this from the district nursing service. Other medical and paramedical support services are available and accessed as needed. People living at the home said they were supported and enabled to attend hospital appointments and that the staff looked after them well. One person said that they were always accompanied to their dentist or hospital appointments and prescriptions they required for self-medication were delivered to the home for them. The homes medication management systems were seen on the site visit. The home uses a monitored dosage system which means that medication is supplied to the home in a series of blister packs. All medication received into the home is recorded and staff sign an individual record when they give medication to someone. This should allow for a full audit trail, and the records seen were completed appropriately. Medication is only given out by senior staff who have received training in the administration and system in use. Some people living at the home are able to manage some aspects of their own medication. This helps people feel secure that they medication is at hand and ensures it is available to them in an emergency as well as maintaining their independence for as long as possible. The home handles some controlled medication which is subject to special security arrangements due to its strengths and effects. Controlled medication records are completed by two members of staff and reflect the balance held. The home has a homely remedies list approved by the supplying pharmacist which identifies medication that can be bought over the counter that the home may keep as a stock and give to people without prescription. This might for example be a simple linctus or an antacid. Some prescriptions which give a variable dosage might need clarification as some were not clear. Care Homes for Older People Page 14 of 29 Evidence: Discussion was held with the manager concerning the care needs of one person and the challenges this was presenting for staff. The home may wish to seek further advice on the management of this issue. Care Homes for Older People Page 15 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. People have opportunities to follow their chosen lifestyles and have these valued. People may wish to have a greater involvement in the running of the home. Evidence: Margaret Clitherow House offers a home for people whose needs vary considerably from some who are mostly self caring to others who have much higher needs for care. Some people choose to spend much of their time in their rooms, whilst other people mostly only returned to their rooms to sleep. There are a variety of communal areas available at the home where people can spend time, and there are very attractive grounds with gardens, a walled vegetable garden and a summer house. The home is also physically linked to the local Catholic Church, so people can access the church without having to go outside. Many people spoken to cited this as the reason for moving to Margaret Clitherow House. The home is a converted convent, and has religious items, pictures and photographs throughout the building. However the manager is clear that the home is open to people of all faiths or none. During this site visit time was spent talking to people who live at the home about their experience and how they spend their time. The home provides some organised group activities which range from poetry and short story readings, exercises, music and Care Homes for Older People Page 16 of 29 Evidence: bingo. The home has recently instituted a garden group, which meets regularly to receive updates from the Gardner on what he is planning for the garden in the coming months and gives people the opportunity to contribute their experience and interest to this process. People have in the past also had opportunities to have an area of the garden to themselves to cultivate if they wish. People spoken to said they really enjoyed this meeting. Discussion was held on other opportunities for people to participate in the life and running of the home. One person who completed a questionnaire indicated that the home might benefit from a residents representative being on the management committee of the home. The home is administered by the Plymouth Diocesan Catholic womens league. They also felt it would be a good thing if the annual general meeting was open to people living at the home as currently only Catholic womens league members are permitted to attend. People spoken to said they enjoyed the flexibility of the home and felt both they and their wish for privacy were respected. One person who completed a questionnaire wrote I much appreciate no pressure being brought on residents as to our whereabouts within the house, with the understandable exception of mealtimes. Privacy is very welcome. The home has a menu plan which shows a good variety and choice of meals served. There is a daily vegetarian option, and staff are always try to cater for individual choices needs and wishes. On each floor there is a small kitchenette with refrigerator, kettle etc where people can keep food items or prepare drinks if they wish. People spoken to and who completed questionnaires indicated that the food was very good, however the homes own quality assurance survey identified some people who were unhappy with the meal provision. The manager is holding a meeting with people living at home to identify where the problems lie and how they can be put right. The meal being served on the day of inspection was excellent. 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. Margaret Clitherow house has systems in place to manage complaints and protect people from abuse. Evidence: Since the last Key inspection there have been two random Inspection visits to the home to follow up on issues of concern raised anonymously. One set of concerns related to staff who have now left the home and the way in which the manager was addressing concerns about them, the other around general care of people, cleanliness and responsiveness of staff to call bells. In both cases the investigation of the concerns was completed and some areas of development were identified. Other areas were not substantiated. Detail on these concerns and their investigation can be seen in the previous random Inspection reports. However in each instance the home acted in an appropriate fashion to investigate and take action to safeguard people, improve their comfort and work with the staff identified to try to improve their working practice. Since the last visit in October 2008 there have been no further complaints received. There is a complaints procedure displayed on the notice board in the dining room and this is also given to people moving in. People spoken to and who completed questionnaires indicated they were clear about who they would raise a complaint with. Care Homes for Older People Page 18 of 29 Evidence: Systems and policies are in place to protect people living at the home from abuse and abusive practices. People are now being assessed for capacity under the Mental Capacity Act where needed and the senior staff have an awareness of the deprivation of liberty safeguards which have recently been implemented. This will be cascaded to all staff. One staff member spoken to had requested additional training in caring for people with memory loss to enhance their job role which is to be provided. Staff receive training in Adult protection. 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. The home offers individual and attractive accommodation in a historic building close to facilities and services. Evidence: On the site visit we looked round the home, looking at the areas people live in, as well as the service areas such as the kitchen and laundry. We spoke to people about their rooms and how they used the building. Margaret Clitherow House is a beautiful historic and atmospheric building, converted from its original use as a convent. The building is listed and has an extensive walled garden. The home is close to the facilities of St Mary Church precinct, and is physically linked to the Catholic church. The home has 38 bedrooms, three of which are large enough to be used for shared occupation if needed. All of the rooms except for one have ensuite facilities, which range from a full bath and toilet to just a toilet and wash hand basin. There are two shaft lifts to enable level access to most of the home, however some rooms still need to be accessed by a small flight of steps. All rooms seen on this visit were clean, warm and comfortable. People have furnished their rooms with their own belongings which has given each room an individual feel. The home offers a number of communal areas where people may spend time, and corridors are wide enough to allow easy movement with wheelchairs or walking aids. Care Homes for Older People Page 20 of 29 Evidence: People living at their home have their own room keys. Some people chose to lock their rooms when they were not in them. One person commented that some carers despite being reminded periodically by their seniors, still persist in not waiting for a come in when visiting residents rooms, i.e. they knock and walk-in simultaneously. Peoples rooms vary considerably with some having a high ceilings and sea or garden views. The home has had considerable problems installing new windows and although the programme is nearly completed there have still been problems making some draft proof. This is due in part to the requirements of the listing and variations in the stone mullions. The home has large service areas and storage faciltiies. Some refitting is still required to the kitchen areas, but the home have installed a full cleaning and chemical system since the last inspection which has been a good improvement. Additional cleaning for example window cleaning has been provided which has now improved the cleanliness of high windows. The laundry has a disinfecting system installed and there was good practice in Infection control in the areas we saw. People spoken to said the laundry systems worked well. One person wrote personal laundry is done regularly and well; table linen is excellent and clean and bed/bath linen is regularly changed and cleaned. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing arrangements met peoples needs. Evidence: On this site visit to the home we looked out the ways in which the home recruits new staff including viewing their records; we spoke to some of the staff on duty about their role; we watched staff handing over information from one shift to another; we looked at the training records for people working at the home and we spoke to people who live at the home to ask them if they felt staff had the skills and time needed to meet their care needs. Margaret Clitherow House follows a full recruitment process for people appointed to work at the home which includes obtaining references and a criminal records bureau check. People complete application forms and are interviewed. They then have a probationary period before their appointment has finally confirmed. This process helps to ensure that people employed are suitable to be working with people who may be vulnerable. We looked at two files for staff recently employed and found the homes systems had been followed and appropriate checks had been taken up for their appointment. However one file did not contain information about the induction programme to be followed when the person started working at the home. The manager confirmed the program had however been followed. Care Homes for Older People Page 22 of 29 Evidence: Staff working at the home receive training to help them do the job. Staff members who completed questionnaires felt they received training that was relevant to the role, helped them understood and meet the individual needs of people and kept them up to date with new ways of working. The home has a program of training both individually for people and also as a group. As an example by the end of the month staff will all have received updates in first aid, moving and handling and fire prevention. On the day of the visit there appeared to be sufficient staff on duty to meet the needs of the people accommodated. The home employees care staff, a manager and assistant managers, domestics, waitresses, gardeners, admin staff, a handyman, laundry person and Chefs. Each person has a clear role, but people spoken to and who completed questionnaires indicated that all of the staff worked well as a team. One person wrote every person will lend a hand when shortstaffed or in an emergency. We dont have a great staff turnover so clients know and trust everyone. The people who lived at the home were complimentary about the staff. People felt staff encouraged them to maintain their independence for as long as possible and several people spoken to has said the staff felt like their own family. One person felt the night staff sometimes were rather noisy, which kept them awake. Another suggested that some people living at home would find identity broaches helpful in identifying and remembering staff names. Some people felt there were not always enough staff on duty. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well managed. Evidence: On the site visit to the home we looked at and held discussions with senior staff about the management systems at the home; we looked at records for the supervision of staff; we looked at financial records kept by the home for money held for safekeeping; we looked at some documents and records in relation to servicing of equipment; we also talked about how the home ensures they provide a quality service. The manager of the home is well-qualified and experienced. She is supported in her role by a team of four assistant managers who have individual areas of specialisation, for example one person has now taken charge of ensuring care plans are up-to-date. The manager has completed her National vocational qualification at level IV, and the registered managers award, which is a qualification specifically for managing a care home. Another assistant manager has completed her National vocational qualification at level V. The manager is also supported by the homes management committee Care Homes for Older People Page 24 of 29 Evidence: which is drawn from ladies of the Catholic womens league throughout the West Country. People spoken to expressed trust in the manager and said they would feel happy to go to her with any concerns and be confident she would listen to them and address them as necessary. We looked at the systems for staff supervision at the home. Supervision is a system combining performance management and personal development and aims to ensure that people are working to their full capacity and consistently to support people living at the home. The supervision systems in place are comprehensive and give staff the opportunity to raise issues or ideas of their own in 1:1 sessions with management, allow for observations of practice and well as ensure they have the skills necessary to care for people at the home. The home has been re-accredited as an Investors in people establishment. The home has now fully implemented a quality audit system. This includes questionnaires for people living at the home, their relatives and other stakeholders such as staff. Information has been gathered through a variety of means, including both internal and external audits which address areas raised in the national minimum standards and are carried out every month. Any areas where it is felt development work could occur are addressed through action plans. The home also has a month by month target and an annual development plan as a result of this system. Quality audit and management systems help to ensure that people living at home have a say in the way the home is run. On the site visit we also looked at health and safety issues in the home. The home has a series of risk assessments available for each department of the home for example kitchen, garden, laundry to address the risks in these areas. There are also general risk assessments for the premises and appropriate surfacing in place for electrical equipment and systems, boilers etc. The home has a contract for the disposal of clinical waste, and a health and safety policy. During the site visit workmen were installing an additional seven valves to wash hand basins identified as needing replacement water temperature control systems. These should now be fitted to all outlets and help to ensure that people living at the home cannot be accidentally scalded by coming into contact with hot water. The home has a financial administrator who deals with any money held by the home for safekeeping belonging to people who live there. The balance for three individuals Care Homes for Older People Page 25 of 29 Evidence: was checked and found to match the identified amount the home was holding. Receipts are obtained for any purchases made on peoples behalf. Care Homes for Older People Page 26 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 27 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 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 9 Unclear variable dosage prescriptions should be clarified with the prescribing doctor to make sure people receive the dosage intended. The home may wish to consider whether people who live at the home can have a more formal say in its management if they wish. The home may wish to consider staff wearing name badges. 2 12 3 27 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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