Care Home: Nazareth House

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What the care home does well People that live at Nazareth House have a multi-professional health care team on site including a physiotherapist team and a GP who visits the home twice a week and is also on call 24 hours a day. The medication procedures are being followed by staff correctly on all floors. Residents health records show that the staff are providing a good standard of care with all relevant details recorded. We spent time talking to residents on all 3 floors and were told by numerous residents that they are happy living at Nazareth House. Relatives of residents also told us that they are extremely pleased with the support and care service provided to their relatives living at Nazareth House. The staff working at the home were all seen to be interacting well with residents using their preferred titles and talking to them. Staff were seen to be patient with residents and were not telling them what to do but assisting them. There is a range of activities provided in group sessions and also one-one. The staff at the home is working hard to ensure all residents have some form of activity support. Activity coordinators have completed training for providing activities to people that have dementia. The staffing levels at the home are good and all residents have their care and support provided as written in their care plans. Staff spoken to stated that they have a good team on each floor and were very supportive of each other. The training provided to all staff is of a good standard. Records showed that all staff have continual training. The home has 2 training coordinators that work closely with all staff to ensure they have up to date training. The food provided at the home is of a good standard, fresh produce is purchased daily and all residents dietary requirements are catered for. The menus looked at were varied and nutritious. What has improved since the last inspection? We looked at the assessment records of 6 residents and all records had been signed and dated. All records looked at were legible and up to date. The assessment records are reviewed monthly and the acting manager audits files on a monthly basis. What the care home could do better: The organisation must ensure that all senior nursing staff are competent in the procedure for completing records and informing professional bodies about any incidents that occur at the home. This procedure must be completed in the specific timescale. Key inspection report Care homes for older people Name: Address: Nazareth House Hammersmith Road London W6 8DB     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: Jackie Derbyshire     Date: 0 4 0 3 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Nazareth House Hammersmith Road London W6 8DB 02087483549 02085637421 srcelinemarie@yahoo.co.uk www.sistersofnazareth.com The Congregation of the Sisters of Nazareth care home 95 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 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 Additional conditions: The maximum number of service users who can be accommodated is: 95 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Nazareth House is registered to care for a total of 95 people of either gender. The home is owned and run by The Sisters of Nazareth. There are currently 93 people living in the home, 40 being privately funded. Care is provided by a staff team comprising of nurses, care assistants, domestic, catering, administrative and maintenance staff. The home is situated over three floors and accommodation is provided both in single and double rooms. Nazareth House is over 150 years old and there are restrictions on adapting the premises, as it is a listed building. There is lift access to all floors. The home has a very large garden that residents use on a daily Care Homes for Older People Page 4 of 30 Over 65 0 95 95 0 Brief description of the care home basis. Inside the home there is a small library, chapel, hairdressers and a shop. The home owns a specially adapted vehicle for local trips outside of the home. The home is situated in Hammersmith and is close to public transport links and local amenities. There is currently 64 care staff, 28 nursing staff and 48 domestic kitchen staff employed at Nazareth House. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is 3 star. This means that the people using the service receive an excellent service. Throughout this report the word we will be used as meaning the Care Quality Commission CQC.This unannounced inspection took place on the 2nd march 2009; we spent 12.00 hours visiting the home. We spent time talking with the acting manager, the responsible individual, residents, residents relatives, nurses, care staff, the administration officer and a maintenance officer. We looked at the care records of 6 residents, checked all medication storage and temperatures on all floors. The medication records of 20 residents were looked at and all the controlled drugs were checked. There were 2 requirements set in August 2008 that have all been fully met, we spent time discussing the requirements and looking at relevant records and documentation. There is 1 new requirement set from this inspection. The weekly charge for Nazareth House is from £668.00 to £873.00 this will vary depending on the Care Homes for Older People Page 6 of 30 level of care required. Care Homes for Older People Page 7 of 30 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 on page 4. Care Homes for Older People Page 8 of 30 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment record is always undertaken by a skilled experienced member of staff. The assessment is conducted professionally and sensitively and involves the individual, and their family or representative. Evidence: Comments from residents and relatives. I am very happy living here everyone is so kind. My husbands care is excellent. The staff cater to all of my needs. I live here with my wife and they look after us very well. Care Homes for Older People Page 11 of 30 Evidence: We looked at the homes statement of purpose and service user guide, both of the documents are very informative and have lots of relevant up to date information in place. There are photographs and clear information to inform prospective people what the aims and objectives and philosophy of care is provided at Nazareth House. Both documents can be provided in different formats if requested. We looked at 6 residents files of of which included a contract that was signed and dated and agreed by each of the residents. We discussed contracts for people who have dementia or other forms of cognitive impairment and would not be able to understand what the document was. We were told by the acting manager that family, social services and or advocates would be involved for the resident to make sure they were supported in any decisions made on their behalf. We looked at 6 residents files each one with high dependency needs. All files included full assessments of all of the residents care and support needs including Barthel, Waterlow,Braden and BMI assessments. We were told that there is a designated registered nurse assessor responsible for all initial assessments. We were told that all assessments are reviewed on a monthly basis or sooner if the residents care needs change. We saw reviewed assessments records in all of the 6 files looked at. Nazareth House does not provide an intermediate service at this present time. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are trained and competent in health care matters particularly in the care of individuals who remain immobile for long periods of time. The home arranges training in-house and externally to ensure all health care topics that relate to the health care needs of residents are being met. Evidence: Comments from residents and relatives. The care my husband has received since he was admitted into Nazareth House is excellent, the staff are very caring. I receive top care here, I would not want to live anywhere else. I am very happy living here, I would obviously like to be in my own home but I cannot look after myself anymore and need help. Care Homes for Older People Page 13 of 30 Evidence: We looked at 6 residents files, each had an up to date care plan with all of the individuals health and social care needs recorded. The care plans did work in conjunction with the assessment records. The care plans show day care and night care provided, the care plans are reviewed every month or before if the care of a resident changes. We saw reviewed care plans in each of the six files. The home is also recording the activity programme on the care plans to show how they are working with individuals to provide a stimulating environment. We were told by the acting manager that she audits files on a monthly basis to ensure records are up to date, well recorded and relevant. We looked at the risk assessment records of 6 residents. All of the risk assessment records information corresponded with the initial assessments and care plans and showed identified risk action plans. We spent time looking at health care plans for 6 residents, all of the residents are registered with the local GP. The GP visits the home twice a week and runs surgerys and also closely monitors all of the residents health care requirements. We spent time talking to the GP in her surgery in the home. All medical records are kept in the surgery in lockable cabinets or on the computer system that requires a password for access. We saw copies of residents medical monitoring records including weight charts, blood charts, BMI records, chiropody, optician check ups, hearing check ups and lots of records form other health professionals including psychiatric assessments. On the day of this site visit a speech and language team were visiting assessing the changing needs of a resident. The home has a team of physiotherapists on site where any residents can be treated if required. We spent time with a physiotherapist who had 3 residents having treatment, one resident told us that she found the treatment excellent and it made her more confident when she was walking. We were told by staff that they would liaise with the GP if they had any concerns, the GP will visit the home at any time if there is an emergency. We looked at the medication records of residents on all three floors, all of the MAR sheets records were completed correctly with relevant information in place. The storage of medication was good with the medication rooms temperatures and fridge temperatures recorded daily, all records show that medication is being stored at the correct temperature. We looked at the controlled drugs currently stored in the home. Care Homes for Older People Page 14 of 30 Evidence: There were 6 residents currently prescribed controlled drugs, we checked the amount against each record and the information recorded was correct. Staff were seen to be communicating with residents respectfully and in their preferred form of address. The residence privacy is respected, staff were seen to knock on residents bedroom doors before entering. All personal care is provided in the residents bedroom or in one of the many bathrooms on each floor. In discussion with residents we were told that staff are respectful at all times. We discussed end of life care with the acting manager and also a relative of a resident. We were told that all residents wishes are recorded and followed to ensure dignity and respect is adhered to. A relative told us that the care provided to her relative is done in a dignified way and they always make sure that the individual is kept comfortable. The home has lots of compliment letters form relatives and other people that visit the home. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use this service are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. Evidence: Comments made by the people that use the service and their relatives. I enjoy taking part in the activities, I enjoy the art and crafts the most. I like to read my newspaper and watch the news, staff will ask me and my wife to join in but we prefer to do our own thing. My husband is unable to participate in group activities, however staff spend time oneone talking to him which I find to be a great comfort. We looked at 6 residents files and each contained an assessment of the residents social activity requirements showing what they liked to do, what their hobbies are and their leisure interests. There is a team of 3 activity coordinators working at the home Care Homes for Older People Page 16 of 30 Evidence: who provide a programme of group activities and also one-one activities for all residents. We were given a copy of the activity programme for the next 6 months, there is a lot of different activities provided including art and painting, reminiscence, cooking, reading, watching films, playing games and exercises classes. Nazareth house has a mini bus that is used constantly to take people out into the community. On the day of this site visit 16 residents were in the activity room doing an excercise class in the morning and a quiz in the afternoon. We saw photographs around the home showing different residents participating in activities. We discussed activity programmes for residents that have dementia and were told that all residents are seen by an activity coordinator and will be provided with activities suited to them. There is a chapel in the home that residents go to services on a daily basis, we were told by the acting manager that any residents with different religious beliefs would be supported to continue whilst living at Nazareth House. We were told by the acting manager and staff that visitors are made welcome at Nazareth House, on the day of this site visit residents families and friends were visiting. We spoke to relatives and a comment from one relative was that they visit the home at least 3 times a week and are always made welcome by all staff. We looked at 6 residents files that all contained details of family and friends they were in contact with. We spent time looking at the residents financial procedure with the acting manager. We looked at 6 residents financial records that are recorded on the homes computer system. We checked the balance of monies for all 6 residents and each had the correct balance of money in place. The acting manager told us that she will keep money in the safe for residents if they or their family request it, we were told that there are lockable cupboards in some residents rooms and would be provided to a resident if they requested a secure lockable cupboard for their room. We were told by the acting manager that most of the residents like to bring in their own furniture and this is the reason why not all rooms have a lockable cupboard. Meals are prepared in the main kitchen on the ground floor and transported to the floors in trolleys. There is a hot choice provided at all meal times, breakfast, lunch and evening. We spent time on the 3 floors at lunch time talking to residents who were all very positive about the meals provided. We spent time looking at the menus and discussing the provision of specilised diets with the sister in charge and the chef, we were told that all residents have a nutritional assessment that is reviewed monthly, if any residents require a specilaised diet this is always catered for. The menus looked at were varied and nutritiously balanced, the lunch menu was poached fish, chicken, vegetables, salad or a different choice can be requested at all times. The food was Care Homes for Older People Page 17 of 30 Evidence: presented well and staff were seen to be assisting residents with encouragement and patience. We looked at records showing food and fluid intake for all residents, we also looked at the observation record that shows the weight of each resident, this is completed on a monthly basis. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. It is available in a number of formats to help anyone living at, or involved with, the service to complain or make any suggestions for improvement.. Evidence: Comments from the people who use the service and their relatives. I would speak to a member of staff if I was not happy about anything. I know how to make a complaint, but I am quite happy thank you. I would liaise with the manager if I was unhappy about the care given to my husband. We looked at the complaints procedure in the main office however there were copies on notice boards on all floors and all residents have a copy kept in their file in their rooms. The complaint procedure is easy to follow and is also available in different formats. There have been 2 complaints made at the home in the last 12 moths, we spent time looking at the records. Both complaints had been dealt with appropriately with the relevant investigation records in place and the outcome of the complaints. Care Homes for Older People Page 19 of 30 Evidence: We spent time discussing the use of advocates for residents that had no other next of kin. we were told by the acting manager that advocates are used and have been used a lot in the past to support residents in making decisions. There are no residents currently using an advocate service. We looked at the homes safeguarding procedure that shows staff are following the correct procedure in line with the local authority. There has been 1 safeguarding incident at the home in the last 12 months. The safeguarding procedure was followed appropriately with all relevant professionals notified including the CQC. The outcome was that the safeguarding was not upheld and the records were in place that showed the full investigatory procedure. In discussion with one of the head nurses we were told that she checks regulation 37 notifications that are sent to the relevant local authority and CQC. It was stated that at times the notifications would not be sent out until the head nurses or manager was on shift. We discussed with the acting manager that all staff who are in charge of shifts on all floors should be trained in completing the Regulation 37 notification forms. So that the notification of incidents are sent in the relevant timescale to the relevant professional bodies including CQC. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people that live there. The well maintained environment provides specilaised aids and equipment to meet the needs of the people that live there. Evidence: Comments from the people who use the service. I am very comfortable, I have all of my personal possessions around me. I like living here it gives me great comfort. I can appreciate the building is old but they do provide a warm cosy environment, I am very comfortable. We had a full tour of the home and 9 residents bedrooms were looked at. The standard of fixtures and fittings in good. The building is over 150 years old and a listed building so there are shared rooms. We spoke to a married couple that share a room who told us that they are very happy being able to stay together. All of the residents rooms we looked at had their personal items including some furniture, Care Homes for Older People Page 21 of 30 Evidence: pictures, art and ornaments, we were told by another resident that they like to look at their photographs as it makes them smile. The home is bright clean and welcoming. There are communal bathrooms on all floors that have specialist equipment in them if required including different types of hoists and baths. There is works being carried out in bathrooms on all floors, that are being modernised. The completed bathrooms are tastefully done. There are kitchens and dining rooms on all floors where residents will have their meals. There are a lot of small meeting rooms available for visitors and residents to spend time in private, with a room available for the visiting hairdresser and beauty therapist. Nazareth House has a large garden that is accessible for all residents to spend time in, the garden is very well maintained and there are a lot of seating areas around the home. The home has a security system that has cameras outside the building and the main monitor is in the reception area. The home was very clean and tidy on the day of this site visit, we were told by the acting manager that all domestic staff work hard to ensure the home stays clean. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have confidence in the staff that care for them. Rotas show well thought out and creative ways of making sure the home is staffed efficiently, with particular attention given to busy times of the day and the changing needs of people using the service. Evidence: Comments from residents, their relatives and staff. I am happy with the training provided at the home, the manager and head nurse makes sure I am kept up to date. The manager makes sure that we are kept up to date with training and development. I think the staff are very well trained, they look after me extremely well. The staff are very skilled and I am very happy with the care and support given to my husband. We spent time looking at the staffing rotas for all floors that includes nursing staff, care staff and activity coordinators. The staffing levels are good and are meeting the Care Homes for Older People Page 23 of 30 Evidence: care needs of all residents. The acting manager told us that if the care needs of any resident changes she would liaise with the relevant social services or if a private care package the individual and any other significant person, so that the care package increases or changes to meet their needs. We spent time on all floors walking around talking to residents and staff, the staffing levels were good and all residents were being supported with their care need requirements. We looked at the staff files of 6 staff, 3 care staff, 1 activity coordinator and 2 nurses. The recruitment of new staff is coordinated by the acting manager and the administration officer. All relevant checks were seen to be in place that included two validated references, CRB clearance checks, pin numbers with up to date information in place form the NMC. All copies of original documents had a date and signature on them showing who looked at the original and when. A copy of all staff original qualifications is also kept in the staff file. We discussed the registration of new staff with the ISA Independent Safeguarding Authority, we were told by the acting manager and administration officer they would ensure that any new staff would be registered with the ISA. We were sent information from the administration officer showing that 3 staff that have recently been recruited have been registered with the ISA. We looked at the training and development records of all staff working at the home. There is a comprehensive induction programme that covers all mandatory training but also specialised training including Dementia Awareness, Protection of Vulnerable Adults, and a lot more. We were told by nursing staff and care staff that they enjoy the training provided. There are 63 care staff currently working at the home and 55 of them have an NVQ qualification, the acting manager told us that the other 8 staff will be doing the NVQ qualification. The home has two training coordinators working at the home running a training programme ensuring all staff are kept up to date with refresher training and any other specific training required for them to do their job effectively. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The acting manager ,senior team and staff of all levels have a good understanding of risk assessment processes and this is taken into account of all running of the home. Record keeping is constantly of a good standard, records are kept securely and all residents have their care plan records with them in their own rooms. Health and safety systems are regularly reviewed and updated. Evidence: Comments from residents and their relatives and staff. The manager is very approachable and I do like her. The manager is supportive and she is always available to talk if I have a problem. I often liaise with the manager who is very understanding of my concerns relating to Care Homes for Older People Page 25 of 30 Evidence: my husband. The acting manager has worked at Nazareth House for 16 years as a registered nurse and the deputy manager. The acting manager has a lot of qualifications including a Bsc in Health and Social Care for older people, she is currently registered to complete the Leadership and Management qualification. We spent time discussing training and development with the acting manager who told us she keeps up to date with all of her training as she is a registered nurse. We spent time touring the home with the acting manager who was very knowledgeable about all of the residents and spent time talking to them. We were told by the acting manager that she has applied to the CQC to be the registered manager. We were given a copy of the quality assurance summary that was completed in November 2009. The summary shows how the home has liaised with residents, relatives, staff and other relevant stakeholders. The outcome was very positive and any areas that require improvements had action plans in place with timescales to meet them. There are questionnaires in the reception area of Nazareth House and visitors are requested to take a copy and make any suggestions to improve in the service. There are periodic meetings with residents and significant others to chat about the service provision, we were told by the acting manager that the next meeting would take place at Easter. We spent time looking at the residents financial procedure with the acting manager. We looked at 6 residents financial records that are recorded on the homes computer system. We checked the balance of monies for all 6 residents and each had the correct balance of money in place. The acting manager told us that she will keep money in the safe for residents if they or their family request it, we were told that there are lockable cupboards in some residents rooms and would be provided to a resident if they requested a secure lockable cupboard for their room. We were told by the acting manager that most of the residents like to bring in their own furniture and this is the reason why not all rooms have a lockable cupboard. We spent time looking at lots of different records that are either in residents rooms in the office or kept on the computer system that requires a password for access. All records looked were up to date and relevant, we were told by the acting manager that she audits files on a regular basis. All records were legible and had a date and signature showing when and who completed the record. We spent time talking to one of the maintenance officers who told us all health and safety checks are up to date. We were given records of fire alarm tests, water Care Homes for Older People Page 26 of 30 Evidence: temperature checks, gas and electric annual checks and certificates, legionella checks. The maintenance officers work extremely hard ensuring that all areas of the home are safe for the people living there and staff working there. Care Homes for Older People Page 27 of 30 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 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 37 The organisationto ensure that all staff are aware of the procedure to complete when an incident occurs at the home. To make sure that all staff are competent in recording incidents that occur at the home and the relevant professional bodies are informed in the correct timescales. 22/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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