Care Home: Melrose Residential Home

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What the care home does well Melrose Residential Home presents as a warm, caring and friendly care home and residents appeared relaxed and comfortable with the staff. It was evident through interviews, general observations and discussions that staff had a good knowledge of the residents` individual care needs and the level of support required. During our visit staff were observed spending a great deal of time with residents, either on an individual basis or within a group. Care was seen to be given in a discreet, sensitive manner and staff were patient and gentle in their approach. Feedback from residents was very good; comments regarding the service included "nice people", " very caring and always treat me alright", "find time to listen" and "excellent care provided". Prior to admission the manager assesses residents` health and social needs. Information collected is then used to form the basis for the plan of care. Assessment documentation seen had been completed to a very good standard and included key areas regarding the residents` health and general well being. The physical accommodation is of a good standard, with appropriate aids and adaptations available for the residents. There is an experienced and enthusiastic team of staff who work well together and enjoy taking part in training and development sessions. The staff are motivated and keen to ensure that residents receive high standards of care. The manager was experienced and ran the home well. She made sure she checked out staff before they started working at the home and gave them training and support to make sure they did the job to the best of their ability. The manager communicates a clear sense of direction, is able to evidence a sound understanding and application of `good practice`, particularly in relation to continuous improvement, staff training, resident satisfaction and quality assurance. What has improved since the last inspection? The written care plans have been updated when people`s needs have changed, so that staff have accurate written guidance to follow and residents receive the correct care and support. The medication practices have further improved. There are clearer and more detailed information about the administration of "when required" medication particularly when 2 different medicines are prescribed together for the same condition. This helps to ensure that the residents are given the correct medication. The manager ensures that regular checks of all aspects of medication management in the home are undertaken so that mistakes and bad practice will be identified and rectified. The faulty freezer and the oven have been replaced and the outside grounds further improved to make a pleasant area for the residents to enjoy. The manager makes sure sure that the numbers of staff working in the home are based on the dependency and needs of the residents and not just the numbers of the residents living in the home. This is so that residents have the care they need at the right time. The Induction training for new staff that have no relevant qualifications, or worked in care before, are more detailed and cover all the topics recommended by Government guidance. This should help equip staff with the right skills and knowledge to look after people correctly. The manager is registered with the commission. The manager has developed ways of including the views of the residents in any future developments for the home. This ensures that the services and facilities meet the needs of individuals and the resident group as a whole. The formal supervision of staff is better. The manager now supervise staff on a formal one to one basis, so that staff have an opportunity to discuss their work, and therefore develop and improve. What the care home could do better: The staff should ensure that they consult with the residents when reviewing the care plans to ensure that the residents views are taken into account Sufficient stocks of each persons prescribed medication must be maintained to enable safe administration from their own labeled supply and to enable continuity of treatment. A stair lift must be provided from the lower floor area leading to the dining room to assist people with reduced mobility to access these areas. A suitable alternative must be found to undertake hairdressing in the home Key inspection report Care homes for older people Name: Address: Melrose Residential Home 50 Moss Lane Leyland Preston Lancashire PR25 4SH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bernard Tracey     Date: 1 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Melrose Residential Home 50 Moss Lane Leyland Preston Lancashire PR25 4SH 01772434638 F/P01772434638 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Amina Makda,Miss Shazmeen Makda Name of registered manager (if applicable) Miss Julie Anne Saunders Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The home is registered in the category Old Age, not falling into any other category (OP) for 25 persons, and one named person in the category of Physical Disability (PD). The total numbers in the home are not to exceed 26 Date of last inspection Brief description of the care home Melrose is a care home providing personal care and accommodation for up to 26 older people. Nursing care is not provided by the home and the district nursing team undertakes any nursing intervention needed. Melrose is privately owned and is situated close to the town centre of Leyland with all the local amenities. The home provides accommodation on three floors in both shared and single rooms. All the former shared Care Homes for Older People Page 4 of 29 Over 65 25 0 0 1 1 9 1 1 2 0 0 8 Brief description of the care home rooms have a single occupant. Five single rooms have an en-suite facility. The communal areas are situated on the ground floors and the home has a passenger lift and stair lift. There are garden areas at the front and the back of the house grounds and parking facilities at the front. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owner and staff and the services residents can expect if they choose to live at the home. A copy of the Service User Guide is issued to all residents and their relatives/representatives on admission. The fees for the care home are in the range of £360 to £405 Extra charges are made for Hairdressing, Chiropody and newspapers Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We (the Care Quality Commission) undertook a key inspection, which included an unannounced visit to the home. The staff at the home did not know the visit was going to take place. The last key Inspection was undertaken on the 19th November 2008. The manager was asked to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, these comments have been included in the report. We spent Five hours at the home over one day. During this time, we looked at care and medicine records; the medicines were looked at by a Pharmacy Inspector. Examination of these records were to ensure that health and care needs were being met and we also studied how information was given to people before they decided to move into the home. A tour of the building was undertaken and time was spent looking at records regarding Care Homes for Older People Page 6 of 29 safety in the home. We also examined files that contained information about how the staff were recruited for their jobs, as well as records about staff training. We spent time speaking to five residents, as well as speaking to three staff and the Manager. Three residents had returned completed questionnaires, and their comments are also included in the report. However we did not received any completed questionnaires from the staff working in the home. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The written care plans have been updated when peoples needs have changed, so that staff have accurate written guidance to follow and residents receive the correct care and support. The medication practices have further improved. There are clearer and more detailed information about the administration of when required medication particularly when 2 different medicines are prescribed together for the same condition. This helps to ensure that the residents are given the correct medication. The manager ensures that regular checks of all aspects of medication management in the home are undertaken so that mistakes and bad practice will be identified and rectified. The faulty freezer and the oven have been replaced and the outside grounds further improved to make a pleasant area for the residents to enjoy. The manager makes sure sure that the numbers of staff working in the home are Care Homes for Older People Page 8 of 29 based on the dependency and needs of the residents and not just the numbers of the residents living in the home. This is so that residents have the care they need at the right time. The Induction training for new staff that have no relevant qualifications, or worked in care before, are more detailed and cover all the topics recommended by Government guidance. This should help equip staff with the right skills and knowledge to look after people correctly. The manager is registered with the commission. The manager has developed ways of including the views of the residents in any future developments for the home. This ensures that the services and facilities meet the needs of individuals and the resident group as a whole. The formal supervision of staff is better. The manager now supervise staff on a formal one to one basis, so that staff have an opportunity to discuss their work, and therefore develop and improve. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed assessments are undertaken before people come into to the home so they can feel confident that their needs can be met. Evidence: The admission arrangements for new residents were very thorough. This ensured that the home would be a suitable placement for that person and would be able to meet their assessed needs. Initial enquiries were recorded and followed up by a visit to the individual, either in their own home or, more commonly, in hospital, to complete a detailed assessment of their needs. The manager liaises closely with family members and any health care professionals involved with the prospective resident. This helped the manager to build up a full picture of the persons needs. The assessment included personal and health care needs, as well as social care and behavioral needs. The manager generally conducted pre-admission assessments. Care Homes for Older People Page 11 of 29 Evidence: All residents had a contract in their personal file, either signed by the individual or their representative. 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. Care plans and care practices ensure that the residents needs are met in a safe, caring and dignified way. Evidence: Significant progress has been made in relation to the care plan documentation and methods of recording how the needs of the residents will be met. Each resident had a detailed up to date and individual plan of care, covering all aspects of personal, health and social care needs. These are based on the pre admission assessment and other specialist assessments in place including social work assessments. The care files of three residents were looked at. Each of these files contained a detailed and comprehensive care needs assessment that describes the help that the resident needs with everyday living including health, personal and social care needs. All of this documents had been reviewed at monthly intervals using a separate document that described any changes in the way that the resident needed to be looked after. It is recommended that staff should involve residents in the review of their care where possible. Care Homes for Older People Page 13 of 29 Evidence: Any areas of risk for the resident were highlighted along with the planned action to reduce that risk. These included an up to date manual handling assessment and a nutritional assessment tool that is used at the time of the residents admission to the home and then afterwards as required. Nutritional wellbeing is also assessed by direct observation and by regular and up to date weight checks. Skin condition is also checked by direct observation with a pressure area care plan being implemented if required. Care plans demonstrated that residents personal choices and preferences had been taken into account by staff around care delivery, such as who liked a bath and who would prefer a shower. Personal care was provided privately in bedrooms or bathrooms, and door locks or engaged signs were used. One resident told us that the staff were Very good indeed. Always there when needed. All staff very pleasant supportive and helpful Residents wore their own clothes and were dressed appropriately for the weather and their activity. Hair care, nail and teeth care and shaving had been attended to. Healthcare arrangements were also good. Residents had good access to their local doctor and the district nursing service visited the home regularly. Residents spoken with were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity was respected at all times. This was also observed during our visit. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines, for example knocking on bedroom doors before entering. The residents said that the staff had a kind and considerate manner and that the staff spoke to them in a civil and courteous way. The Pharmacist Inspector looked at medicines handling. We found that action had been taken to address weaknesses identified at out previous visit and regular inhouse audits (checks) were carried out to help ensure that, should any shortfalls arise they can be promptly addressed. Staff have completed certificated training in the safe handling of medicines and people wishing to self-administer medication are supported to do so. The home has arrangements in place so that non-prescribed medicines for the treatment of minor ailments can be given (home remedies). This benefits people at the service as they can receive treatment for conditions such as minor pain without delay. We looked at medicines stocks and record keeping. Records for the administration of medicines were up-to-date and clearly showed the treatment people had received. Care Homes for Older People Page 14 of 29 Evidence: But, when medicines were not given the reasons were not always documented. This is important because if medicines are regularly not taken advice may need to be sought from the doctor to ensure people get the best treatment for them. It was of concern that we saw examples where records showed more doses of medication had been given than possible with the quantity supplied for that person. The manager explained that the additional doses had been given from home remedies. But, not all medicines can be purchased and we saw two examples were medicines had not been given because there were none left (run out). Care needs to be taken to ensure new supplies are promptly ordered when it is clear that the quantity left will not last the month, to reduce the risk that doses will be missed because there is none left to give. This will also enable peoples medicines to be safely administered from their own pharmacy-labeled supply. Basic guidance was in place for giving when required medicines but in some cases this could be usefully expanded to include clear information about when they are needed. Similarly, where peoples drinks need thickening the required consistency should be recorded to help make sure it is done correctly. We found that medicines were stored securely and suitable arrangements had been made for the storage and handling of controlled drugs. This helps to ensure that they are not misused or mishandled. 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. The daily routines of the home were flexible and people were encouraged to maintain their leisure interests and activities whilst living there. The management of meals was good and visitors were made welcome to the home. Evidence: The social care needs of people moving in to the home had been assessed by the use of a social history and life preference document which described any significant events in peoples lives and told us about the people important to them. The information gathered also told us about individual leisure interests and hobbies as well as their life history. Collectively this information provided a clear pen picture about peoples lives, interests and preferences. There was evidence available to show that a wide range of activities were available for people wishing to join in. The activities were well organised and planned in advance. We were told about how the home celebrated special events and about the themed activity days during the year. Trips out were arranged at intervals when transport was hired to take people to local places of interest. The activities programme was displayed in the home so that people could decide what events they would like to join in and so that they could plan their days ahead. Those Care Homes for Older People Page 16 of 29 Evidence: living at the home told us that they were able to decide their own daily routines and they were happy with the range of activities provided. Discussions with staff showed that they welcomed the opportunity to be involved in the planning and implementation of social and therapeutic activities. However, one person living at the home said, there is not much to do, but I dont get bored as I spend a lot of time reading my books. The information pack provided to people contained details about visiting arrangements, showing that relatives and friends were able to visit at any time and that contact with the local community was regularly encouraged, such as visits from religious ministers and local school children. Information about local advocacy services was accessible within the home, so that people were aware of how to access someone to act on their behalf, should they wish to do so. One visitor spoken to said that he was always made to feel welcome by staff. The food provided at the home was appetising and nutritious and there was plenty of choice. The dining room was light and nicely furnished, with pleasant table settings. Those we talked to told us that the food was good and that they were happy with the choices that were on offer. Lunchtime was a very relaxed, enjoyable experience for those living at the home and people were offered the daily choice of food. Staff were very aware of the likes and dislikes of those who were unable to make their own choices. The management of meals was good. One person living at the home said, the meals are very good and I always enjoy them. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were managed well and people living at the home were adequately safeguarded by the robust policies and procedures adopted by the home. Evidence: There was a clearly displayed and easily accessible written complaints procedure for the people living at the home and their relatives and this was included in the homes information pack. All six people who we spoke to told us that, in general, the staff listened to them and acted up on what they said. All six said that they would know who to speak to if they were unhappy and they would know how to make a complaint if they needed to do so. People who we spoke to said that they had no complaints at all about the service provided and that they were quite happy with the care and support received. However, they said that they would know what they needed to do should they wish to make a complaint. There was information readily available about the use of advocacy services and where people could get advice if they needed it. The advocacy service is used for anyone who would like an independent person to act on their behalf so that they are given the same opportunities as others and so that their affairs are protected. The home had started working towards implementing strategies around the Mental Capacity Act so Care Homes for Older People Page 18 of 29 Evidence: that everyone living at the home were given the same opportunities. When we visited we were informed that no person lacked capacity to consent to the arrangements made for their care or treatment and is being deprived of their liberty without the authorisation of the appropriate supervisory body. There were policies and procedures in place for the Protection Of Vulnerable Adults and the training matrix showed that most of the people working at the home had been given training on abuse awareness. All staff members who we spoke to on the day of our visit told us that they would know what to do should a person living at the home their relative, advocate or friend be concerned about the welfare of someone living at the home. Evidence was available to show that where complaints or safeguarding adult issues had been raised, the manager at the home dealt with them in accordance with agreed polices and procedures and in an effective and efficient manner. Systems for recording any such issues were satisfactory. 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 is clean, safe and well maintained, and provides a comfortable living environment for the residents. Evidence: A tour of the home was undertaken confirming that further improvements to the premises had been undertaken since the previous inspection. These included decorating, repairs to appliances, and some new beds and carpets. The building work in one half of the house to create another dining room and 3 en suite bedrooms was now complete. We found evidence that the visiting hairdresser was using a residents bedroom to undertake her duty. We made the manager aware that this was unacceptable and that alternative arrangements must be made. Following a tour of the home we identified that the bathroom on the first floor could adequately provide for the hairdressing function if a new sink was provided in this room. The manager undertook to ensure that the necessary work was completed and that the use of resident accommodation would cease. The home is in two parts separated on the ground floor by 5 stairs. The main communal space, comprising of a two - part lounge and a through dining room is in one part and some some bedrooms, including the new ones, and the kitchen are in the other part. Staff have to carry food up and down the connecting 5 stairs to and from the kitchen, and residents have to negotiate these stairs to get to the dining room. Care Homes for Older People Page 20 of 29 Evidence: Although not being used at the time of our visit due to reduced occupancy this presents a potential hazard to staff, and difficulties for some residents who may have reduced mobility. A stair lift is required to negotiate this area safely. The home is well maintained, decorated to a high standard and was clean and tidy during the site visit. A partial tour of the building was undertaken, one bathroom, a shower room and six bedrooms were viewed. The bathroom and shower room were clean and tidy and hot water temperatures are recorded each month to ensure the hot water is delivered to a safe temperature. Bedrooms viewed had individual items and were homely. A resident said, I have everything I need, including some of my own furniture.. The home has a well equipped laundry and there was evidence of gloves and aprons for staff use. Infection control training is given to staff and infection control policies are available. Residents commented on the good laundry service they experienced saying that care was taken with their clothes and they were returned to their room in good time. Residents say that there is always plenty of hot water and the temperature in the home can be changed to meet their personal choice, especially in their own rooms. The home is always very well lit, clean and tidy and smells fresh. The resident survey questionnaires said that the home was always clean and fresh. 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 staff team have the collective skills training and expertise to undertake their roles effectively and good recruitment and selection procedures were in place to ensure that the residents were protected. Evidence: Staffing levels within the home were seen to meet the needs of residents. Care staff undertook their duties in a friendly and caring manner, promptly supporting residents when needed. Residents confirmed that staff were always respectful and met their needs competently. In the main, residents were satisfied with the support they were given and described staff as nice people, very caring and always treat me alright, find time to listen and excellent care provided. Three staff files were viewed with regard to recruitment practices and these contained all of the necessary checks to protect the residents. Staff had completed a job application form and two references had been obtained. Staff files contained a Protection of Vulnerable Adult (Pova) check and Criminal Record Bureau disclosure at enhanced level. The necessary checks are in place prior to staff commencing work and the interviewer completes an interview checklist. Individual staff training records provided a clear summary of both induction and ongoing training. This was extensive and wide ranging, with mandatory courses, i.e., Care Homes for Older People Page 22 of 29 Evidence: moving and handling, medication, fire safety, and first aid. Specialist training included care planning, risk assessment, mental health, and Dementia. This training package was confirmed by the manager and was identified in the written AQAA she had provided us with. Similarly, staff who were interviewed confirmed that training was available, that they were encouraged to attend and that it gave them appropriate competencies to meet the needs of the residents. A staff member commented,the training is excellent here. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and practices within the home ensure the safety and wellbeing of the residents and staff. Evidence: The manager has the required qualifications and experience, and is competent to run the home and has recently registered with the Commission. There is a strong emphasis of being open and transparent in all areas of running of the home. The manager and staff work hard to make sure that everyone feels they are included in decision - making and feel valued as an individual. There is a good system in place to gather staff, residents and relatives views through regular meetings and satisfaction questionnaires as part of the monitoring of quality. The manager achieves this by sending out surveys to residents and relatives asking for their views on the friendliness of the staff, the care provided, the laundry service the meals provided, social activities and the cleanliness of the home. Care Homes for Older People Page 24 of 29 Evidence: Staff spoken to had a clear understanding of their role and what was expected of them. Documentation was examined that confirmed that staff received regular supervision and annual appraisal. Residents spoke well of the management team and the care and support that they give. During our visit we were able to witness their approach to the residents and staff and confirm the comments made. Comments made included: Excellent management. Open door policy. All of the staff have a good team spirit. Relevant training sessions. Good induction and support for newcomers. Information provided by the manager in the AQAA and examination of the records, confirmed that all safety equipment is regularly serviced. We confirmed this through examining a random sample. The policies and procedures in the home ensure that the health, safety and welfare of the residents and staff are promoted and protected. The system for the safekeeping of residents finances was good. Individual records are made of all transactions and balances. Receipts are held for any purchases made and receipts are given to relatives when they deposit any personal money for their relative. The Annual Quality Assurance Assessment (AQAA) requested by the Commission was returned in time and was completed with a high degree of detail. Within this document the owner and manager had made us aware of how the were operating the home and also identified how they felt they could improve. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Sufficient stocks of each persons prescribed medication must be maintained to enable safe administration from their own labelled supply And to enable continuity of treatment. 21/12/2009 2 19 13 Suitable arrangements must be made to accommodate the visiting hairdresser. Enable the hairdresser to carry out her function and ensure that the residents personal accommodation is not utilised to carry out the function 29/01/2010 Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The staff should ensure that they consult with the residents when reviewing the care plans to ensure that the residents views are taken into account Where prescribed thickeners are used the required consistency should be recorded within peoples care plans. The stairs between the two parts of the home should be made accessible for residents and staff. 2 3 9 19 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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