Care Home: Neath House

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What the care home does well The home ensures that people using the service have their needs assessed prior to moving in. This is to ensure that all identified needs will be met. The home ensures that people`s health, personal and social care needs are set out in an individual care plan detailing their wishes and how identified needs will be met. The home ensures that the activity facilities provided in the home match people`s expectation, preferences and satisfies their social, cultural religious and recreational interests. The home has a clear and accessible complaints procedure, which means that people using the service and their relatives can be confident that their complaints will be listened to, taken seriously and acted upon. The home ensures that people live in a safe and comfortable environment, which is able to meet their changing needs along with their cultural needs. People live in a home that is well managed and the health and safety systems in place are regularly reviewed to ensure that people`s safety and welfare are promoted and protected. What has improved since the last inspection? The home has acquired a conservatory which means that people are now able to enjoy a range of activities and be entertained in a comfortable and spacious environment. The home continues to be proactive in meeting the diverse needs of people using the service by providing suitable and up to date training for staff to ensure that the care provision is seamless. What the care home could do better: Staff`s practice in the safe handling, recording and administration of medication must be consistent to ensure that people`s health and welfare are not compromised. The home must review the practice of soaking cleaning cloths overnight to ensure that it is not contravening the Department of Health infection control guidelines for care homes. The home must have a clear system in place to identify when staff are working ahead of the full criminal record bureau (CRB) clearance. This is to ensure that people`s safety is protected. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Neath House Currier Drive Neath Hill Milton Keynes MK14 6NS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joan Browne     Date: 1 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Neath House Neath Hill Currier Drive Milton Keynes MK14 6NS 01908607248 01908231333 paula.bonner@excelcareholdings.com 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) : Neath Hill Care Centre care home 47 Number of places (if applicable): Under 65 Over 65 0 47 dementia old age, not falling within any other category Additional conditions: 47 0 The maximum number of people to be accomodated is 47 The registered person may provide the following categories of service only: Care home with Nursing(N) to service users of the following gender: Either Whose primary needs on admission to the home are within the following categories : Dementia`(DE) Old age not falling within any other category (OP) Date of last inspection Brief description of the care home Neath house is a purpose built home located on the northern side of Milton Keynes on the Neath Hill residential estate. There is a local shopping centre nearby which includes a post office, chemist and newsagents. The local buses give access to many other areas in Milton Keynes with Milton Keynes town centre only a short bus ride away. The home is situated on two floors and is divided into five small living groups. Each group has its own sitting and dining areas with kitchenette facilities. There are forty-seven bedrooms and these are single occupancy with some rooms having en suite facilities. On the day of the visit there were forty-five people living in the home. People have Care Homes for Older People Page 4 of 27 Brief description of the care home access to the local general practitioner (GP) surgery. National Health Service treatment and referrals can be accessed via the GP. 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: 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: This unannounced key inspection was conducted by Joan Browne on the 18 May 2009 and covered all of the key National Minimum Standards for older people. The last key inspection of the service took place on the 7 June 2007. Prior to the inspection a detailed self assessment questionnaire was sent to the manager for completion and surveys were sent to a selection of people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgments about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager, staff, with some people who use the service and one visitor. Examination of some of the homes required records, observation of practice and a tour of the premises. Feedback on the inspection findings and areas needing improvement was given to the Care Homes for Older People Page 6 of 27 manager and regional manager at the end of the inspection. There were three areas in the service delivery that the home needs to improve in. This has been highlighted in the body of the report under standards nine, twenty-six and twenty-nine. We (the Commission) would like to thank all the people who use the service and staff who made the visit so productive and pleasant on the day. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that an assessment of peoples needs is undertaken prior to them moving into the home this means that people will be confident that the home can support them and their diverse needs would be met. Evidence: The home has a statement of purpose and a service users guide so that prospective people to use the service have the information they need to know about the service. The documents contained up to date information and were displayed in the home. The care plan documentation for four people whose care was case tracked was examined and evidence seen demonstrated that the home had undertaken a full needs assessment prior to them being admitted. The four individuals were referred through care management arrangements and a summary of the care management assessment and a copy of the care plan were available for the inspection purpose. The manager explained that pre-admission assessments were carried out either by herself or a Care Homes for Older People Page 10 of 27 Evidence: senior staff member. Prospective people and their relatives were encouraged to look around the home and meet the staff and other people using the service. After completion of the pre-admission assessment and the home is confident that it can meet the individuals needs further information is obtained from the individual or their relative about their life history and background. This information is recorded in a diary called a carers diary to ensure that as much information is obtained to enable the home to meet the persons diverse needs. The annual quality assurance assessment (AQAA) reflected that people were issued with a contract detailing the services to be provided and information about fees and extra charges. People who responded to the Commissions survey said that they had received enough information about the home before moving in. The following additional comments were noted:senior staff gave a lot of time to this. Care Homes for Older People Page 11 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. The home has systems in place to ensure that people receive effective personal and health care support in a manner that upholds their privacy and dignity. Further improvement is needed in the safe handling, recording and administration of medication to ensure that the system is robust and complies with best practice. Evidence: The care plan documentation for the four people whose care was case tracked was examined. The information in the plans was informative and detailed what action that staff needed to take to ensure that peoples health, personal and social care needs would be met. Risk assessments seen identified how any potential and actual risks would be managed and the measures in place were based upon individuals diverse needs. There was written evidence to verify that the plans were being reviewed monthly or as and when required. Where ever possible, the plans were signed by people using the service or their relative to confirm their agreement and involvement in the process. All the people living in the home were registered with a local general practitioner (GP) Care Homes for Older People Page 12 of 27 Evidence: who visits the home weekly or as and when needed. A record of visits is maintained. Individuals have access to National Health Service via the GP. Access to specialist health care professionals such as, the optician, dentist, dietitian, chiropodist, tissue viability nurse and the community psychiatric nurse is also available. We saw evidence of peoples weights being monitored monthly. Where any significant weight loss was identified individuals would be referred to the GP and monitored. The GP and the district nurse were spoken to on the day of the site visit. The GP was complimentary on the quality of care the home was providing. He said that the homes staff worked closely with him to ensure that people received the appropriate medical care and attention that they require. In his opinion some individuals had very complex medical needs but the staff were satisfactorily meeting their needs. He confirmed that morale amongst the staff team was high and as a result the standard of the service delivery was good. The district nurse confirmed that staff follow her instructions most of the time. She was confident that peoples privacy and dignity were upheld by the staff team and verified that all treatments were carried out in the privacy of individuals bedrooms. On the day of the site visit there were two people being treated for pressure sores. We saw written evidence of some staff members who had been assessed as competent by the district nurse and the GP to check people suffering from diabetes blood sugar levels. This is deemed as good practice. People who responded to the Commissions survey said that they always or usually receive the medical support they need. The home uses a monitored dose medication system and care staff identified as capable to administer medication were requested to leave a sample of their signature in the medication record folder. The annual quality assurance assessment (AQAA) reflected that all staff who administer medication had completed training in the safe handling and administration of medication and their practice observed by the manager. The home has a system in place to ensure that daily medication auditing of the medication administration record (MAR) sheets by team leaders is carried out. The manager undertakes monthly auditing of the MAR sheets. On the day of the inspection there were no people using the service assessed as capable to self-administer their medication. Recent photographs of individuals were included in the medication folder to reduce the risk of error occurring during medication administration. The medication administration record (MAR) sheets were checked and we found no unexplained gaps. Inconsistency in staffs practice was noted for example, a particular person was prescribed for a course of antibiotic treatment Oxyetetracycline tablets 250mg. When the treatment was completed the staff member recording the last entry did not date and sign the entry. A second person was prescribed for Flucloxacillin 250mg 1 tablet four times daily. The box stated that 28 tablets were dispensed. The tablets remaining in the packet did not correspond with the record. It was evident that a tablet had been signed for but was not administered. Since the inspection the manager has informed the Commission that she carried out an investigation and it was established that the Care Homes for Older People Page 13 of 27 Evidence: individual was not administered the morning medicine on a particular day. The staff member signed for the tablet as given in error and should have used the appropriate code to reflect the medicine was not administered. Staff must ensure that the practice in place for the safe handling, recording and administration of medication is consistent so that peoples health and welfare are not compromised. We observed people being treated in a friendly but respectful manner by care staff. Staff did not wear name badges to enable visitors and people using the service with memory impairment to be sure of whom they are speaking with. This was discussed with the manager who confirmed that staffs badges were on order. Health care professionals spoken to during the inspection verified that staff ensure that peoples privacy and dignity were upheld. Medical examination and treatments were provided in peoples own bedrooms. The home does not have any shared rooms. Peoples attire was clean and tidy with attention to detail. The AQAA reflected that if people coming to the end of their life expressed a wish to remain in the home their wishes were complied with. There is a supportive care register in place which means that people are able to change their minds about any decisions they make about the care they receive. The homes manager reviews the register weekly. The home has adopted the gold standards framework and Liverpool pathways end of life care plan system. 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. The home has an activity programme which means that people are given the opportunity to take part part in cultural and age appropriate activities. Meals provided are healthy, well presented to stimulate appetite and served in pleasing surroundings. Evidence: The home provides a range of activities to meet peoples diverse needs. The activity programme for the week was displayed in the home so that people using the service and their relatives were aware of what was being provided daily. The annual quality assurance assessment (AQAA) indicated that in each persons care plan their hobbies and interests are identified to ensure that the home is able to match their expectations and preferences. In the care plan documentation examined for those people whose care was case tracked we saw evidence of peoples social care needs recorded and how they were being met by the home. We were told that the homes activity programme is planned after discussion with individuals so that their views were sought and taken into consideration. The activity programme seen included outdoor walks, ball games, bingo and board games. There was also an activity called SONA which was popular with individuals. We were told that the name SONA was Gaelic for well-being. The activity was a multi-sensory method activating communication for people with memory Care Homes for Older People Page 15 of 27 Evidence: impairment. A discussion was held with the activity person who seemed very enthusiastic to ensure that the activities provided was meeting peoples diverse needs. She confirmed that one to one activities were provided to individuals who did not wish to participate in a large group. A newsletter is circulated quarterly notifying individuals of forthcoming events In addition outside entertainers are bought in such as, local dance groups and singers. The home currently has two miniature dogs that visit the home, which some people who like pets enjoy having around.The home was able to demonstrate how it was supporting people to promote their spiritual needs. For example, regular visits to the home by ministers from different denominations are made and a lay preacher provides Holy Communion weekly to those who wish to receive it. People who responded to the Commissions survey said that there were always or usually activities arranged by the home. Additional comments noted were:There are arranged activities though sometimes I do not always want to take part in. The home operates an open visiting policy. People are able to receive visitors in private in their own rooms if they wish to or in the communal areas and choose whom they see and do not see. Each unit is equipped with a small kitchenette area where people using the service and their visitors can make tea and snacks The annual quality assurance assessment (AQAA) indicated that where possible people are encouraged to manage their own finances. If they were not able to, the home would suggest that an Age concern advocate assist them with their finances. People are made aware of their entitlement to bring personal possessions with them if they wished to. Some bedrooms seen were personalised with individuals personal belongings. The home ensures that people are provided with three meals daily and hot and cold drinks and snacks are available at all times and offered regularly. The home provides a four week menu which is changed seasonally. We were told that the home had recently adopted protected mealtimes, which means that people are able to enjoy their meals uninterrupted. Information on all meal times was displayed in the reception area. Lunch was observed on Woburn unit and the choices on offer were lamb stew, cauliflower bake, peas, broccoli and trifle for dessert. Drinks such as water and fruit juices were available. The inspector sampled the cauliflower bake and it was tasty. People spoken to said that the meals provided were tasty and the right amount. The food was presented in an attractive manner to stimulate appetite. There were no individuals requiring assistance or prompting with their meals but staff were available if needed. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure in place this means that people using the service and their relatives can be confident that their concerns will be listened to and acted upon. Staff are provided with safeguarding of vulnerable adults training which mean that people are looked after by staff who have been trained to protect them from potential harm or abuse. Evidence: A copy of the homes complaints procedure was displayed in the reception area to enable people and their relatives to have a clear understanding of how to make a complaint and when they will get a final response. There was also a free phone telephone number that the organisation has made available for people and their relatives to contact them directly if they wished to raise a concern or a compliment. The annual quality assurance assessment (AQAA) demonstrated that the home had received two complaints within the last twelve months. One of the complaints was upheld and the nature and outcome of the investigation was clearly recorded in the homes complaints folder. The Commission has not been made aware of any complaints about the service. People who responded to the Commissions survey said that they knew how to make a complaint. Evidence seen on the day of the inspection verified that the home was clear when an incident needed to be referred to Social Services as part of he local safeguarding procedures in place. The manager has been trained and deemed competent to Care Homes for Older People Page 17 of 27 Evidence: investigate some provider led safeguarding matters. The local safeguarding team decides what incidents should be investigated by the provider. There has been one safeguarding incident within the last twelve months which the home referred to the local safeguarding team and a decision was made by the safeguarding team for the investigation to be provider led. The manager carried out the investigation and the outcome of the investigation was made available for the inspection purpose. The homes training matrix demonstrated that staff regularly update their knowledge in the safeguarding of vulnerable adults. Staff who responded to the Commissions survey said that the home provides them with the opportunity to update their training needs which means that people are being looked after by staff who have been trained to promote their safety and well-being. 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. The home is safe, clean, pleasant and well maintained, which means that it is fully able to meet and promote peoples diverse needs. Evidence: The home is situated on two floors and is divided into five units with each unit having its own sitting and dining areas and kitchenettes. There were three patio areas which could easily be accessed from the lounges. Within the last twelve months the home had acquired a conservatory which is used for activities, entertainment and parties. The communal areas of the home were found to be satisfactorily furnished. The management and staff encourage people to see the home as their own home. All bedrooms were single occupancy and some had en suite facilities. Some bedrooms viewed were personalised with family pictures and mementos reflecting the characters of individuals. Corridors were wide enough to accommodate wheelchairs and had been fitted with grab rails to promote peoples mobility and independence. Bathrooms and toilets were fitted with the appropriate aids and adaptation to meet individuals needs and to promote independence. We noted that the work surfaces in the kitchenette areas were chipped and needed attention. The manager confirmed that a routine of planned maintenance work was in place and should commence in this years maintenance programme. The home has a system in place to ensure that equipment used in the home was checked monthly and Care Homes for Older People Page 19 of 27 Evidence: replaced as required. Staff who responded to the Commissions survey said that the home could improve further by providing a landscape garden for people living in the home to enjoy weather permitting. The manager confirmed that permission has been granted for the home to acquire some additional land and it is hoped the home would be able to provide a landscape garden. Overall the home was presented as clean, safe, pleasant hygienic, tidy and free from offensive odours. We observed that J-cloths used for cleaning were left soaking in one of the sluice areas. The manager is advised to review this practice to ensure that it is not contravening the department of health infection control guidelines for care homes. The training matrix indicated that staff training on infection control was up to date and ongoing. People who responded to the Commissions survey said that the home was always or usually fresh and clean. Hand gels were placed discretely in areas of the home to control and reduce the spread of infection. 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. The home ensures that all staff receive relevant and up to date training which means that people are looked after by staff who are appropriately trained and the training provided is focused on delivering improved outcomes to meet their diverse needs. Evidence: The staff rota demonstrated the number and grade of staff on duty to provide care and attention to people using the service for any twenty-four hour period was suitable to meet their assessed and diverse care needs. The manager confirmed that if people request to have personal care provided by staff of the same gender the home would comply with their request The home employs 35 care staff and 18 staff members had achieved the national vocational qualification (NVQ) level 2 or 3 in direct care. All newly appointed staff undertake the skills for care common induction training. The home ensures that staff undertake mandatory training with yearly updates as necessary to maintain their competency to fulfill their duties. The home has introduced electronic (E) learning which all staff have access to. Those who were not computer literate were being supported by the manager or team leaders. Staff who responded to the Commissions survey confirmed that they were provided with updated mandatory training and there was good team work. The three staffs files examined contained all the information required under the care homes regulations 2001 Schedule 2. We noted that one staff member had commenced employment with a PoVA first check. The Care Homes for Older People Page 21 of 27 Evidence: manager said that the individual had worked under the supervision of an experienced member of staff. However, there was no written evidence seen to support this statement. To comply with best practice guidelines when staff are appointed ahead of the full CRB disclosure a named person appropriately qualified and experienced should be appointed to supervise the individual until the full CRB is obtained. There may be more than one named person but this would need to be clearly identified on the staff rota. 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. The manager has the experience to run the home which means that the home is well managed and there are systems in place to continuously improve the service delivery and provide an increased quality of life for the people using the service and to promote their safety. Evidence: The home is managed by a competent and experienced manager. She has twelve years experience of working in the care sector and eight of these years have been in a supervisory and managerial position. She has been managing the home for four years and holds the national vocational qualification (NVQ) in level 2, 3 and 4 as well as the registered managers awards qualification. The manager also holds the A1 assessor award qualification and is a moving and handling assessor. Staff confirmed that the manager operates an open door policy. The manager was able to demonstrate how she continuously works to improve the service and provide an increased quality of life for people using the service with a strong emphasis on meeting individuals diverse Care Homes for Older People Page 23 of 27 Evidence: needs and promoting their privacy and dignity. Experienced care and support workers support the manager in the day to day running of the home. There were clear lines of accountability in the home. We saw evidence of regular staff and residents meetings being held. The manager holds monthly surgeries enabling relatives to meet with her on a one to one to discuss any issues they wish to raise. The home has a business and annual development plan which is based on planning and reviewing the aims and outcomes for people using the service. Quality assurance questionnaires are sent out to people using the service and their relatives at least three times a year. The results are anaylsed and the home develops an action plan where necessary. We saw evidence of day and night audits of the care provision carried out by the homes manager. Copies of regulation 26 monitoring reports were made available for the inspection purpose. The annual quality assurance assessment (AQAA) contained clear and relevant information supported by a wide range of evidence that clearly supports the claims made. The homes manager is not an appointee for peoples pension. The home operates an invoice system for incidentals such as, chiropody treatment, hairdressing and news papers. The health and safety records relating to the fire panel, emergency lighting and water temperatures were examined and verified as being appropriately maintained. A record is maintained of all accidents sustained by individuals. Information in the annual quality assurance assessment (AQAA) reflected that the servicing of the hoists, lifts, portable electrical equipment, heating and gas appliance was up to date. 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 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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