Care Home: Margaret House (Abbots Langley)

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What the care home does well Margaret House has a very welcoming and warm atmosphere which was seen throughout this inspection. The manager and staff work tirelessly to improve and further develop this service. The Inspector had the opportunity to speak to a variety of people throughout the day, including several residents as well as several visitors. There was a range of positive comments made, including "I couldn`t be happier" the staff are all so kind". I have only been here a few weeks but have already settled in well thanks to the staff". The core staff team have been working within the home for several years and therefore provide a stable and consistent team of people that the residents can feel confident in providing their care. The management systems within the home are good with staff training a priority. The environment has been redecorated within the past twelve months and the majority of the areas within the home are bright and pleasant. It is unfortunate that the two requirements made as a result of this inspection have resulted in the service being rated as adequate. However it is recognised that all other aspects of this service have been assessed as good. The manager stated that there are plans are in place to reorganise the communal areas within bungalow 2 and its an issue that the service have been aware of for sometime but have been awaiting approval for the works to take place. What has improved since the last inspection? The manager has worked hard to improve on standards relating to both fire precautions and the choices of meals. These issues were identified in the last inspection reports as requiring attention. The manager stated in the AQQA that improvements have been made within the last twelve months "less use of agency staff, more NVQ assessors within the service, more activities and people appear to more settled within the home". What the care home could do better: There are two requirements made as a result of this inspection which relate to infection control standards and environmental standards. There are also recommendations made in relation to developing a more specialist activities programme for people with dementia. The hours currently available for staff appears inadequate for this service especially with the specialist needs of the people within bungalow 2 and 5. This is not a criticism of the staff providing the current activities as they clearly work tirelessly to provide a meaningful range of activities but are clearly are over stretched and provide a lot of their own time to support this service. This issue is an operational one and should be addressed as part of the annual quality reviewing process, with a focus on outcomes for service users. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Margaret House (Abbots Langley) Parsonage Close Abbots Langley Hertfordshire WD5 0BQ     The quality rating for this care home is:   one star adequate 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: Julia Bradshaw     Date: 2 7 0 2 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 28 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 28 Information about the care home Name of care home: Address: Margaret House (Abbots Langley) Parsonage Close Abbots Langley Hertfordshire WD5 0BQ 01923261190 01923299902 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Quantum Care Limited Name of registered manager (if applicable) Patricia Teakle Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Margaret House is a care home for men and women who are usually over 65 and who may also have a physical disability or dementia. The home comprises six purpose-built, single storey units, or bungalows, two of which are for residents with dementia and are now managed and staffed together. The resulting five units each has its own lounge and dining area and small kitchenette. There is one other bungalow dedicated to dementia care, while two are for those with higher needs, leaving one bungalow for those whose needs are lower. There are two courtyard gardens outside and also a patio area. Car parking is in an adjacent area to the front of the building. The home is situated in a residential area of Abbots Langley and there is a nearby walkway leading to the High Street where there are shops, pubs and restaurants. The Statement of Care Homes for Older People Page 4 of 28 care home 51 Over 65 51 51 51 0 0 0 Brief description of the care home Purpose and Service User Guide are both available within the main reception area of the home and also the latest Inspection report is avalaible upon request. The range of fees are from £437 to £650. 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: 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 focus of the inspections undertaken by the Care Quality Commission is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting two people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. Care Homes for Older People Page 6 of 28 We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors to the service. The visit took place over one day and by one Inspector. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the registered manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 8 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided to help people make decisions about their care and a thorough assessment takes place, which helps to ensure that their needs can be met. Evidence: The service has developed a statement of purpose, which sets out the aims and objectives that the person can expect to receive. This includes a guide which provides basic information about the service and the specialist care that is available. The guide details what the prospective people using the service can expect and gives an account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. People who use the service are given a copy of the guide. When requested the service can provide a copy of the statement of purpose and guide in a format which will meet the capacity of the resident. The homes CQC reports, the Service User Guide Care Homes for Older People Page 11 of 28 Evidence: and Statement of Purpose are made available in reception. One person using the service stated that when I moved here the staff were very kind and caring, they could not do enough for me. All questionnaires sent out to the people who use the service all responses were positive. A further person who uses the service commented that My mother was quite anxious when she first moved in, but the staff were very kind and tried their best reassure her. Admissions are not made to the service until a full needs assessment has been undertaken. A senior person always completes the assessment prior to admission to the service. A number of pre assessments were seen and completed well. The service also completes a secondary assessment on admission to review any changes in need, this information is used to inform the personal plan. The assessment explores areas of diversity, including preferences, religion, gender, age and cultural needs, involvement from family, partners and advocates, race and disability. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. 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. Suitable care planning systems and documentation was in place to ensure that the health, social, medical and physical care needs of the people who use the service were being met. Evidence: A total of four care plans were case tracked fully, it was established that people who use the service receive appropriate personal and health care support drawn up from the initial assessment and the in consultation, where possible with the person using the service. There was evidence seen to confirm that there are individual assessments for the management of falls and manual handling assessments . Through case tracking of the care plans there were some areas that require updating, these included omissions in one weight chart from October 2008 to January 2009 , limited information on the activities record of three care plans and one care plan had not been signed by the person receiving the service or their representative. In the main the care plans that had been reviewed were responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the Care Homes for Older People Page 13 of 28 Evidence: privacy and dignity of all people. Staff were observed chatting to the people who use the service and engaging with them in a dignifying and respectful manner. One person who uses the service commented that I know about my care plan. Whilst a further person stated that My relative is treated with respect kindness and is always kept clean. The service listens and responds to individual choices and decisions about who delivers their personal care. The care plan also details another additional personal preferences, this included food types, night time preferences, activities, religion, personal appearance, personal time and how the person would like to be addressed. People are supported and helped to be independent and can take responsibility for their personal care needs as detailed in their care plan. The health care needs of people are managed by visits from local health care services. Monthly audits ( regulation 26 visits) are conducted by the regional manager assessing many aspects of care to allow continual quality assessment and improvement. The service has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. The general management of medication at the service was good, with no errors on the recording sheets detected. The management of controlled medication is also carried out effectively and efficiently. Fridge and room temperatures were being recorded in all the medication. A total of four peoples medication was case tracked in order to ensure compliance. These records were all reconciled with the recording sheets and found to be accurate. Care Homes for Older People Page 14 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. The service provides sufficient and suitable meals to ensure their dietary needs of people are being met. Although the activity programme provided offers suitable activities to the majority of people. Specialist activities for the people with dementia should be provided to ensure everyone living within this service has the opportunity to take part in meaningful and stimulating acidities. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from one person using the service on the day of the inspection confirmed that relatives and or representatives are always welcome. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. People who use the service have the opportunity to develop and maintain important personal and family relationships. On the day of the inspection a number of people who use the service were waiting for family members and or friends to visit and commented that they are able to have visitors as they wish. One person who uses the service commented that my friends and family come to see me as often as they can. Feedback obtained in a questionnaire from a relative stated that Care Homes for Older People Page 15 of 28 Evidence: provides a caring and homely environment. She always enjoys her meals and the laundry is always done . A number of people who use the service were seen to be very relaxed and calm within their own environment and engaging with staff in an equal manner. The people using the service had a variety of communal and or personal spaces to relax. One person commented that we can do what we like, I like reading books and chatting with staff . Part of the care planning process identifies peoples preferred activities and comments about their life history. The service currently has 30 hours allocated to providing activities to 51 people using this service. However the organisation should review and possibly increase these hours in light of the needs of the specialist activities required for people within the dementia units. There are notice boards advertising forth coming events and important updates for the people who use the service. Staff were directly observed simply sitting with a number of individuals and taking about every day life. There was also a group of people enjoying an afternoons art session run by one of the residents. Regular activities include, hairdressing twice a week, musical afternoons, armchair activities, art afternoons and trips to the theatre, to London and also to the coast during the warmer months are also organised. The people living at Margaret house who have dementia could benefit from receiving more specialised activities being offered in an environment that is quieter and less busy. Also the manager and staff could provide additional visual and sensory support to people with dementia by creating memory boxes or putting photographs of individulals outside their bedroom, in order to assist in identifying where there room is located. The inspector observed several people within the dementia units becoming anxious and confused within their communal areas and unable to locate their bedrooms. The menus were seen as part of this inspection process and they provided a balanced diet and a variety of choices. The food provided appeared appetising and well presented. Comments received included, The food is usually good and if I dont like whats on the menu they will make me something else.. The Inspector had the opportunity to observe the teatime meal being served which appeared both nicely presented and plentiful. Several people spoken to after their meal on the day, stated that they found it to be very flavorsome. Although four of the service user questionnaires returned to the Commission stated that the meals could sometimes benefit from more variety and one another stated that they only sometimes liked the meals provided. The general consensus regarding the standard of meals was positive. Meals and snacks are provided at a time and place to suit them. The care staff are sensitive to the needs of those people who find it difficult to eat and staff were observed assisting people in a respectful and unhurried way. Care Homes for Older People Page 16 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. The service has a robust complaints procedure in place, good staff awareness and attitude to wards safeguarding issues so people who use the service are safe and protected. Evidence: The service has an open culture that allows people who use the service to express their views and concerns in a safe and supportive environment. People who use the service have commented that they are happy with the service provided, feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. One person using the service commented The staff always listen to us. A further person commented that I would always talk to a senior member of staff if Ihad problem. It was evident that complaints are also well managed, resolved quickly in the best interest of the person using the service. The service has a complaints procedure that is clearly written and easy to understand. It is displayed both within the main lobby of the home and throughout the general areas of the home. The complaints procedure is supplied to everyone living within the service a detailed record of all complaints and compliments made and received. Policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in Care Homes for Older People Page 17 of 28 Evidence: safeguarding and felt confident in reporting any issues as they occurred. Staff had a clear understanding of the Whistle blowing policy and when the use of this may be put into practice. The service understands the procedures for safeguarding adults and attends meetings or provides information to external agencies when requested. Quantum Care Homes have robust policies and procedure in place for reporting allegation of abuse and neglect, allowing staff to raise concern within the home or to senior staff outside the home. The PoVA procedures are well documented should the need arise. The AQAA also tells us that the service have received 3 complaints within the past twelve months, 2 were dealt within the 28 day timescale and all 3 complaints were managed effectively and resolved to a satisfactory conclusion for all parities involved. There was 1 safeguarding referral and 1 safeguarding investigation carried out, this has also now been resolved. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally the physical design and layout of the service enables the people who use the service to live in a safe and comfortable environment. However the standards within bungalow two are inadequate and do not meet the needs of people with dementia. Evidence: The people who use the service are encouraged to personalise their bedrooms. All the homes fixtures and fittings meet the needs of individuals and can be adapted if their needs change. Generally the building design supports the needs of people using the service. However one of the dementia units (bungalow two) has a total of 13 people living within it. There is inadequate communal space for people to feel relaxed and comfortable. There were a variety of small hospital style bed tables scattered around the lounge area that could present as a trip hazard and generally the whole area was too cluttered. Also some of the soft furnishings( easy chairs) within this unit are inappropriate, too low and prevent people from getting in and out of them easily. These factors contributed to an atmosphere that was disorganised and not conducive for people with dementia who require a structured, calm and organised environment in which they can feel safe. However the manager is fully aware of the shortcomings within this unit and informed the inspector that there are plans to re-develop this unit before the end of this year. Care Homes for Older People Page 19 of 28 Evidence: The AQAA tells us that a number of improvements have occurred at the service including bungalow one being redecorated and four lounges have had new furniture and carpets fitted. The AQQA also identifies the areas of development within the next twelve months which include, setting up the Ovaltine corner within the social area, refurbish the lounge in bungalow three, new curtains for some of the bedrooms and provide a plasma screen televisions in all four remaining bungalows. The AQQA also identifies the need to improve the current environmental standards for the people living in bungalow Two. The home has an infection control policy. The service is clean, well lit and it smells fresh. However the manager must ensure that there are adequate hand washing facilities provided throughout the home . The hand washing facilities in bungalow 5 were inadequate as in one toilet there was only one hand towel provided which presents as an infection control risk.The reason given for this was that one resident disposes of all the paper hand towels down the toilet. A more effective system for washing and drying hands must be provided. A number of people using the service commented that they liked living at the service. One person using the service commented that my bedroom is lovely, I have been able to bring all my special things in from home and also some people have computers in their rooms, which is lovely for them. All the health and safety audits were up to date and included the most recent fire check being carried out on the 25/02/09, the fire risk assessment was completed on the 13/02/09, emergency equipment was last checked on the 10/02/09. The manager must ensure that the fire manual is updated, at least annually to reflect statutory changes in fire safety. Care Homes for Older People Page 20 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 use the service are cared for by a conscientious, adequately trained work force ensuing that they are supported and protected from harm. Rigorous recruitment procedures are in place that ensures people are protected. Evidence: There are enough qualified, competent and experienced staff to meet the health and welfare of people using the service. Staffing rotas take into account the needs and routines of the people using the service. However there were several comments received back from the service user questionnaires that stated that, on occasions, there appears to be inadequate staffing within the two dementia units. The manager must ensure that adequate staffing is provided throughout the service, even during break times. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards (NMS). The AQAA states The retention of staff has improved as we offer excellent training opportunities and career development. Staff spoken to during this inspection appeared to have a clear understanding of their role and what is expected of them. One person using the service commented that the staff are always are very kind to me. One relative commented that There is always a warm welcome when I come and visit my mother. Care Homes for Older People Page 21 of 28 Evidence: Staff were indirectly observed supporting people appropriately and it was pleasing to observe people engaging positively with people though out the day. Recent training has included, deprivation of liberty, emergency first aid, falls prevention, fire safety, food hygiene, health and safety, management and leadership, manual handling, medication and mental capacity act. All the staff team complete the induction training on dementia and several staff have obtained or are working towards their one year dementia training course. Staff confirmed that they receive regular supervision from a senior or care manager. Staff appraisals are also carried out. A variety of meetings are held , including senior meetings, night care meetings and care staff meetings. The most recent minutes seen were for the 3/01/09. Three staff files were inspected and all records were found to up to date with all the necessary references and CRBs having been obtained prior to the person commencing their post. All staff have a copy of their contract and terms and conditions of employment. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems are in place to ensure the well being of the people who use the service and people are protected. However infection control measures relating to handwashing facilities and environmental standards within bungalow 2 must be improved to ensure peoples health and welfare is maintained. Evidence: The Manager has the required qualifications and experience and is competent to run the home. The Manager and the staff team have a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve the service. Feedback received on the day of the inspection from staff and the people who use the service determines that the management are effective and approachable. The Manager leads and support a stable staff team who have been trained to satisfactory levels. The AQAA determines that there is a clear commitment to all staff obtaining NVQ level 2 . The training opportunities are diverse and offer all staff the opportunity to further their skills and Care Homes for Older People Page 23 of 28 Evidence: personal development in the field of dementia care. The staff have a clear commitment and understand the importance of person centered care and effective outcomes for people who use the service. It was noted by the inspector that several staff come into the home on their days offer to provide extra support for trips and outings that ensures as many people as possible have the opportunity to enjoy social trips outside of the home. This is commendable and people who live at Margaret clearly appreciate and benefit from this commitment. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures that staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. There was evidence on staff records that staff have supervision and staff report that this is always carried out on a one to one basis where staff have the opportunity to discuss their personal development and work related issues. The manager confirmed that continued development and progress is being made with training and supervision. Staff commented that they received supervision. Staff meetings take place regularly and minutes of the meetings are available. The home works to a clear health and safety policy. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. The service provides in house training regarding safeguarding and staff showed a sound working knowledge of action to take in such an event. A training matrix has been developed. It was confirmed that manual handling, fire awareness, risk assessment, fire assessment, medication, safeguarding, food hygiene, and emergency first aid. All health and safety checks observed were up to date and organised. As part of the inspection process, we reviewed a random selection of staff files. Four staff files were audited to ensure suitable checks had been conducted. All records were found to be up to date and accurate. Areas that require action as part of this inspection are the inadequate living and communal space currently provided for the people in bungalow 2 and the inadequate washing facilities within bungalow 5. There is also a recommendation made in relation to the hours currently allocated for activities. Care Homes for Older People Page 24 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 25 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 19 23 The living area within 28/08/2009 bungalow 2 should be redeveloped and improved to ensure the health and welfare of service users are protected at all times. To ensure people are kept safe and have an environment that supports their holistic needs. 2 26 16 The manager must ensure 05/06/2009 that there adequate hand washing facilities throughout the home. To maintain infection control standards in order to protect the people living within the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 28 1 12 The service should review the current activities provided to the people with dementia with a focus for providing specialist activities to meet their individual needs. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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