Care Home: Meresworth

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What the care home does well "Meresworth has exceeded our expectations" was one of several positive comments received about Meres worth during this inspection process. The standard of care observed to be provided was good and that view is supported by comments made by people living in the home and also by health care professionals consulted during this inspection. The standard of dementia care training for care staff and the consequent understanding of the particular needs of people living with dementia enables the home to achieve good care outcomes for them. The general standard of training, recruitment, medication and care planning records is good and should provide people living in the home with confidence that their health, safety and well-being is being safeguarded. The management and quality assurance systems of the home are good and provide people living in Meresworth with various opportunities to express their views on the care service they receive and should provide them with confidence that they are listened to and action taken to ensure that wherever possible their care is specific to them, their individual needs and preferences. What has improved since the last inspection? Any issues raised following the last inspection in June 2007 appear to have been addressed satisfactorily. In their AQAA the home have indicated that th home have benefited from the appointment of a housekeeper manager to oversee housekeeping and maintenance and this view was supported, with only minor exceptions, during this inspection. The rating of Meresworth as `excellent` in June 2007 came at the beginning of the use of the `star rating` system by the then Commission for Social Care Inspection. After three years not all homes previously rated as excellent have been able to sustain that assessment or rating. It is therefore a credit to Meresworth, its staff and management team to have been able to demonstrate successfully that care outcomes for people living in the home have been maintained at a high standard. What the care home could do better: The CQC have been copied into one complaint about the care experienced by one person which is being dealt with appropriately under the Quantum Care complaints procedure. One issue raised in that complaint related to medication administration and whilst the overall standard found during this inspection was satisfactory and essentially provided a good level of protection and support to people who live in the home, there were some instances where staff had not complied with the home`s own policies and procedures. In a similar way, although the overall standard of cleanliness and repair were found to be good, there were instances where for example light bulbs had not been replaced, which whilst it may seem trivial in the overall scheme of things, does detract from the experience of people living in the home and can be easily remedied if noticed and rectified. Necessary temporary management changes in the home have been supported well by Quantum Care, however it was noticeable that where the management of some units of the home had been subject to periods of absence, the standard for example of some care plans and staff supervision had been affected adversely. The above reservations should not detract from what was overall a very positive inspection which is reflected in the assessment of Meresworth as a home that achieves excellent care outcomes for the people who live there. Key inspection report Care homes for older people Name: Address: Meresworth Dell Wood Field Way Rickmansworth Hertfordshire WD3 7EJ     The quality rating for this care home is:   three star excellent 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: Jeffrey Orange     Date: 0 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Meresworth Dell Wood Field Way Rickmansworth Hertfordshire WD3 7EJ 01923714300 02923714351 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.quantumcare.co.uk Quantum Care Limited Name of registered manager (if applicable) Mrs Teresa Ann Giddings Type of registration: Number of places registered: care home 51 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 Meresworth is a purpose built care home and was registered in 1996 to provide single bedded en-suite accommodation for up to 51 older people, including people with dementia and or physical disability. Located in the suburb of Rickmansworth, it is easily accessed by local buses from Watford and Uxbridge. The home is a short drive from the M25 motorway and is also near to the Metropolitan line station. Parking is available outside the home. The home is divided into four units. Each unit has a lounge and additional seating Care Homes for Older People Page 4 of 27 Over 65 51 51 51 0 0 0 Brief description of the care home areas; a dining room; a fully fitted kitchenette; a medication storage station; an assisted bathroom and an assisted shower room. The home has a hairdressing salon and a large activities room; a fully equipped kitchen for the preparation of all main meals and an on site laundry. A sun lounge leads to a courtyard garden with patio and seating areas. The gardens extend around all sides of the home except for the front of the building and are screened by mature trees. At the date of this inspection, the weekly fees range from £630 to £730 per week and further information about these can be obtained by contacting the home. Services such as hairdressing and chiropody are not included in these fees. The service user guide and a copy of the most recently published inspection report, including contact details for the Care Quality Commission (CQC) can be obtained by contacting the home. Care Homes for Older People Page 5 of 27 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: We last inspected Meresworth on the 29th June 2007. The current inspection was unannounced and was carried out by one regulation inspector, where this report refers to we it recognises that it is written on behalf of the Care Quality Commission (CQC). The inspection started early in the morning, which provided an opportunity to see the routine of the home as people who live in Meresworth were getting up, having their breakfasts and getting ready for the day ahead. During this inspection site visit we were able to speak to people who live in Meresworth, including some who have been there for a number of years as well as those who have only recently moved into the home. This gives us a range of views on the experience of both moving into and then living in Meresworth. We were able to speak to people visiting the home and to visiting health care Care Homes for Older People Page 6 of 27 professionals as well as to people who work in Meresworth. We had discussions with various members of the homes management team and also an area manager for Quantum Care who was present for part of this site visit. In March this year the home sent us their annual quality assurance assessment or AQAA. The AQAA is a self-assessment document that sets out how well care outcomes are being achieved for people living in Meresworth, it also includes some useful statistical information, for example about complaints and staff training. We sent surveys to some of the people who live in Meresworth as well as to people who work in the home. Where these have been received back they have been used in drawing up this report, any received after it is completed will be recorded and used to inform the future regulation of the home. We have also made use of any other information that we may have received about Meresworth since June 2007. This could be in the form of notifications sent to us by the home about significant events affecting the home and the people who live there, from relatives or other people associated with the home in any capacity including health and social care professionals. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The CQC have been copied into one complaint about the care experienced by one person which is being dealt with appropriately under the Quantum Care complaints procedure. One issue raised in that complaint related to medication administration and whilst the overall standard found during this inspection was satisfactory and essentially provided a good level of protection and support to people who live in the home, there were some instances where staff had not complied with the homes own policies and procedures. In a similar way, although the overall standard of cleanliness and repair were found to be good, there were instances where for example light bulbs had not been replaced, which whilst it may seem trivial in the overall scheme of things, does detract from the Care Homes for Older People Page 8 of 27 experience of people living in the home and can be easily remedied if noticed and rectified. Necessary temporary management changes in the home have been supported well by Quantum Care, however it was noticeable that where the management of some units of the home had been subject to periods of absence, the standard for example of some care plans and staff supervision had been affected adversely. The above reservations should not detract from what was overall a very positive inspection which is reflected in the assessment of Meresworth as a home that achieves excellent care outcomes for the people who live there. 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 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering Meresworth as their home can be assured that they will be provided with comprehensive information to enable them to make a well-informed decision and that they will be able to visit the home before they move in as part of that process. They can be confident that they will only be admitted to Meresworth once a thorough assessment process has established that their care needs can be fully and appropriately met. Evidence: When we asked people who live in Meresworth if they had enough information about the home for them to be able to decide if it was the right place for them before they moved in, the majority said that they did and that they also had a written contract setting out the terms and conditions of their residence. When we spoke to the relative of one person currently living in the home, they told us that the home had exceeded their expectation. Talking to other relatives during the Care Homes for Older People Page 11 of 27 Evidence: inspection enabled us to confirm that they had been able to visit the home prior to any decision being made in order that they could see for themselves what the environment and atmosphere were like. Two relatives we spoke to told us that the home met their expectations and that they felt that they had been provided with all the relevant information that they needed. When we looked at the information provided for people who may be considering Meresworth as a home for themselves or someone they are responsible for we found that it was clearly presented in appropriate formats and was in total comprehensive enough to provide them with the level of detail they required. We confirmed that the Personal Guide includes a detailed home information sheet, details of the complaints procedure, helpful advice about the Mental capacity Act and its implications, a schedule of fees so that everyone can see clearly what the costs of residence will be, what is included in the standard fee and what will attract additional costs. In addition, in other parts of the documentation provided there is general guidance and information about, for example dementia care. The Personal Guide is available in large print and audio formats and Quantum care also have a web site giving this and other information on line, together with individual web-pages for each of their homes, including detailed contact information. All of this should ensure that anyone considering Meresworth as their home has all the information they need, in a format they can easily access and understand so that they can make a well-informed decision. When we looked at assessments of care needs completed for people who have only recently moved into Meresworth, we found that they were in general very wellcompleted and included the information required to ensure that only those people whose care needs can be appropriately met, in a way that takes account of their individual circumstances, preferences and life history are admitted. In their AQAA the home indicate that they have improved their initial assessment process by asking the relevant questions needed to obtain a fuller background picture of the individual concerned. They also recognise that this process can be still further improved to ensure that they have as much information as is possible, including details of significant events and anniversaries, for example, which have sometimes not been as full as they would like. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Meresworth can be confident that they will receive effective health care and support and that systems in place for the administration of their medication are essentially sound and safe. Evidence: When we asked people who live in Meresworth if they receive the medical care they need, they all said that they always did. When we asked them if they got the care and support they need, 75 of those who responded said that they sometimes do and 25 that they always do. 50 said that care staff are usually there when they need them and 50 that they sometimes are. People who live in Meresworth told us that the care staff usually listen to and act on what they say and throughout this inspection we saw care staff treating people who live in the home with appropriate respect and care for their dignity. Care Homes for Older People Page 13 of 27 Evidence: When we spoke to a community nurse they indicated that they felt that the incidence of both falls and pressure sores had reduced and that in their opinion the standard of care that they observed was positive. When we looked at the care plans of people who live in Meresworth, including some for people who had only recently moved in as well as some for people who had lived in the home for some time, we found that they were generally well completed and set out individual health care needs and how they were to be met in line with the preferences and choices of the people concerned. Those care plans seen usually included evidence of a system of regular review which should enable any changes in a persons needs to be identified and their care plan then to be adjusted to meet them. We did discuss with the manager the variable quality of some care plans from different units within the home, especially with respect to the recording of routine reviews for those people who had been living in the home for a long time without significant changes to their needs arising. In the AQAA the home indicate that staff training has been developed and enhanced to build better understanding and further improve care standards and this is reflected in the improvements already noted in pressure care and falls avoidance, each of which is of significant benefit to people living in the home. When we checked medication records and administration we found that whilst the basic standard is good, there were some areas of concern which were shared with the homes management. One complaint copied to the CQC included elements of medication practice, however the system of staff training, recording, policies and procedures and monitoring seen should ensure that the standard of protection offered to those people in the home who require assistance with some part of their medication administration remains satisfactory. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Meresworth can be confident that they will be encouraged to exercise choice in and over their lives including daily activities and routines. Evidence: When we asked people who live in Meresworth if the home arranged activities for them to take part in if they wanted, 50 said that they always did and 50 that they usually did. We were told that Meresworth benefit from the very active involvement with the activities of the Friends of Meresworth, including the provision of a twice weekly shop trolley. When we spoke to the engage co-coordinator for Meresworth they provided us with details of the current and past programmes, they outlined the way that the involvement of people who live in the home are recorded so that a realistic assessment can be made of how well individual activities are meeting individual needs. In their AQAA and when speaking to the engage organiser a commitment and Care Homes for Older People Page 15 of 27 Evidence: intention to improve the access of people living in the home to outside activities was made. We could enhance the quality of life for our residents by organising more trips out, either for the day or a few hours at a time. We were told that the furniture has been obtained to establish a coffee shop area in the home which will be a focal point for both people living in the home and their visitors. When we asked people living in the home if they enjoyed the meals provided, 50 said they usually did and 50 that they sometimes did. When we observed breakfast and lunch in different parts of the home, we saw and heard people being offered choices and where help was required, this was being given in a thoughtful and respectful way. Care Homes for Older People Page 16 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Meresworth can be confident that they are able to make a complaint if they feel they need to and that they will be listened to and appropriate action taken. They can also be assured that staff have received training and support to ensure that people living in the home are protected from actual or potential abuse. Evidence: When we asked people who live in the home if they knew how to make a formal complaint, 75 said that they did with 25 saying that they did not. Of those who responded, several noted that they had never felt the need to complain formally and in conversations with relatives during this inspection we were told in every case that they felt able to raise any concerns or complaints informally with the management team, although one did feel that sometimes it seems very slow for them to be addressed another said that If there are any problems we can talk about them and they get fixed. In their AQAA the home told us that in the previous twelve months 4 complaints had been received, all of which were resolved within 28 days and 3 of which had been upheld. The CQC were copied into one case which is currently being resolved, we were able to confirm that as far as process is concerned, this was being dealt with satisfactorily. In their AQAA, confirmed by the relatives spoken to and also when speaking to people Care Homes for Older People Page 17 of 27 Evidence: who live in the home, it was established that the manager has an open door approach, and welcomes contact with people living in th home and those responsible for them or associated with them. The system of recording complaints and the way that the complaints policy and procedure is publicised in a variety of ways, including on the INTERNET and in printed documents as well as in meetings such as the home forum should ensure that anyone who has any concern at all should be able to raise it with confidence that it will be taken seriously and dealt with appropriately. When we spoke to care staff and to the manager we found that they had a very good understanding of Safeguarding and what to do if any kind of abuse was seen or suspected. Training records for staff seen included evidence of attendance at appropriate training and the manager confirmed that this training is monitored and updated periodically. This should ensure that all staff, throughout the home are able to identify abuse were it to be seen and would know what action to take to protect the health, safety and well-being of people living within the home. Care plans include assessments where any form of restraint may be used and this is also covered in staff training and the homes policies and procedures, this should ensure that the rights of people living in the home are considered at all times and are safeguarded. We were informed that there is no one currently living in Meresworth who is subject to a deprivation of liberty authorisation under the Mental capacity Act. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living or working in Meresworth can be assured that the environment is safe, comfortable, clean and well-maintained. Evidence: When we asked people who live in Meresworth if it is fresh and clean, 75 responded that it always is and 25 that it usually is. On the day of this inspection site visit we did not experience any problem with unpleasant odours in the home, although there were contrasting views expressed by some relatives, ranging from the cleaning is not all that impressive to It is always spotlessly clean. Throughout the inspection site visit we saw staff cleaning communal and bedroom areas and in their AQAA the home indicate that they have a newly appointed housekeeper in post who oversees the environment of the home. We noted that on several units there were some light bulbs not working in those light fittings with multiple bulbs in particular. This was brought to the attention of the manager who undertook to address this. We also noted and reported that some lounge chairs did not have seat cushions in place, again we were assured that this would be dealt with. The overall standard of decor was good and care and attention has been taken to Care Homes for Older People Page 19 of 27 Evidence: make appropriate areas suitable and supportive for people who live with dementia by sympathetic signage and provision of relevant style furnishings and decoration. In the AQAA we were informed of plans for the introduction of a cafe area on the ground floor for the use of people living in the home and their visitors. Those bedrooms seen, with the permission of the people whose rooms they were, were personalised with furniture, pictures or ornaments and photographs in order to reflect their interests, life histories and personalities. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Meresworth can be confident that they are protected by the recruitment policies and procedures followed by the home and that there are sufficient numbers of care and ancillary staff with the training, support, skills and experience to meet their needs appropriately. Evidence: When we asked people who live in the home if the staff are available when they need them, 50 said they usually were and 50 that they sometimes were. One comment received in a survey was that care would be improved if Have regular carers on each unit so that we can get used to them - not change around too much. Another person noted that They all try and do their best for us. When we spoke to health care professionals they told us that the felt the standard of care they observed from staff in the home was good. All of those staff who responded to surveys told us that there were always enough staff on duty to meet the individual needs of all the people who use the service and that they always have enough support, experience and knowledge to meet the different needs of people who live at the home, taking into account equality and diversity issues such as gender, age, race and ethnicity. Care Homes for Older People Page 21 of 27 Evidence: When we spoke to members of the care staff team they confirmed that they felt very well supported by the training provided and by the supervision support of their line managers. This view was borne out when we looked at supervision and training records. When we looked at the recruitment files for some recently appointed staff we found that the required checks had been done in order to protect the health, safety and wellbeing of the people living in the home for whom they would be providing care. In their AQAA the home confirmed that over 50 of existing care staff hold the NVQ in care or health and social care at level 2 which is a requirement of the current National Minimum Standards and demonstrates a commitment by both Quantum Care and the staff concerned to provide care based on good practice. When we spoke to people who live in the home, when we monitored call bell response times and spent a 45 minute period sitting and observing care in one communal area on one unit, we found that staffing levels appear adequate to provide good care outcomes for the people who live in the home. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Meresworth can be confident that it is well managed and has an effective administrative and management infrastructure in place in order to support and enhance their health, safety and well-being. Evidence: The current temporary registered manager has led Meresworth through a period that has provided some challenge to the home and staff. When we spoke to people who live in the home and to care staff and visitors we were told that the home has been effectively run during this time. The AQAA was submitted on time and was reasonably well completed. It provided a balanced view of what the home does well and where it was possible to make improvements and how this was to be done. When we looked at some key records such as care plans and medication we found that whilst the standard overall was good, there had been instances where, for example Care Homes for Older People Page 23 of 27 Evidence: staff supervision and care plans had suffered in one particular unit which did not have a unit manager for a period. Whilst the medication administration of the home was found to be generally good there had nonetheless been some instances where errors had not been identified as quickly as would have been expected, given what appears to be the robust monitoring process in place. The system of quality assurance in place appears to be comprehensive and includes a managers dashboard tool covering key areas of the homes operation. Quantum Care offer effective support to the local management team through their area and senior management team which helps ensure good management outcomes for the people who either live in the home or who have dealings with the home on behalf of them. As indicated in this report people in general feel able to approach the management team with any concerns they may have and have a reasonable expectation that they will be addressed promptly and effectively. When we looked briefly at the systems in place covering financial dealings on behalf of people living in the home we found that theses were accurate and robust and safeguarded people living in the home and their financial interests. As noted earlier we have been informed that there is currently no one living in the home who is subject to a deprivation of liberty authorisation under the Mental Capacity Act. Care Homes for Older People Page 24 of 27 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 27 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 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) 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. 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