Care Home: Nether Place Nursing Home

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What the care home does well Nether Place provides good written information for people about the services and facilities provided. There is also plenty of other information displayed in the home, including newsletters and inspection reports, so people can find out what life in the home is like. The admission process for new people is thorough and includes a face to face assessment of the person`s needs. People are welcome to visit the home to look around and ask questions. People told us they were well looked after, saying staff were attentive and helpful. We saw that people received attention throughout the day and appeared to have received good personal care. People had clean clothing, that had been nicely laundered and their hair had been attended to. People praised the choice and quality of the meals served saying they enjoyed their food and there was always plenty to choose from. The chef was knowledgeable about peoples` special dietary needs, and preferences, and catered for them accordingly. The new manager had responded well to complaints and concerns about things that had happened prior to her coming into post. She had also made an appropriate safeguarding referral to the local authority, demonstrating she understood her role in this process. The home provides a safe, warm and comfortable environment, with suitable adaptations and equipment to help people with mobility problems. The standard of decor and furnishing is good, and people were able to make their rooms personalised and homely. Regular health and safety checks and servicing of equipment was seen to be taking place. Hygiene and infection control was good. Staffing levels were good and both nurses and care staff had received additional training and support. A good number of care staff had completed a National Vocational Qualification in care. Recruitment procedures were sound to ensure that people who may be unsuitable to work with vulnerable people, were not employed. A new home manager had been appointed and was being supported by the operations manager and the registered provider, to improve the quality of service being delivered. What has improved since the last inspection? We saw that a number of improvements had taken place, which were having a positive impact on the health and welfare of people living in the home. A thorough review of the handling of medication had been undertaken to improve the way that medicines were handled and to reduce the risk of errors that could cause harm. The home had changed their pharmacy supply and staff had received training on the new medicines system. Records were better maintained and there was no longer a problem with medicines running out. A new person centred care planning system had been introduced. People`s health and personal care needs had been re-assessed and their new care plans and risk assessments showed the level of support they needed. There was evidence that some people had been reviewed by their doctor and other health care specialists to ensure they were receiving appropriate care and treatment. Nutritional assessments had been completed, and staff had received training on nutrition and were monitoring peoples` food intake and weight. Meal times had been altered so they were better spaced throughout the day and people were eating better as a result of this. Staffing levels had increased and additional training had been provided. This meant staff had more time to spend with people and were able to deliver better quality care. The kitchen was being staffed for longer during the day, so care staff were no longer taken away from delivering care to prepare the evening meal. The managers hours were now in addition to the number of registered nurses on duty. Some corridors and one bedroom had been decorated, and a new patio are was being created, for people to sit safely outside. A carpet cleaner had been purchased. The new manager, along with the registered provider, was providing stronger leadership and had put new systems in place that were working to improve standards in the home. Quality monitoring was taking place, and the handling of residents money had been re-organised so it was kept individually and not pooled together. What the care home could do better: There were no statutory requirements made as a result of this inspection, but we make some good practice recommendations. These are; The manager should make sure that staff understand the importance of completing medicines administration records at the time that medicines are given to reduce the incidence of gaps in the records that could lead to medication errors. The work undertaken to bring peoples` care plans and risk assessments up to date, should be continued to ensure these improvements are maintained. The plans to improve the provision of activities and occupation for people should be put into practice, and be continued. Key inspection report Care homes for older people Name: Address: Nether Place Nursing Home Chestnut Hill Keswick Cumbria CA12 4LS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jenny Donnelly     Date: 0 8 0 6 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 28 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 28 Information about the care home Name of care home: Address: Nether Place Nursing Home Chestnut Hill Keswick Cumbria CA12 4LS 01768773267 01768773267 Netherplace@hometrustcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hometrust Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home with Nursing - code N, to people 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. The maximum number of people who can be accommodated is: 32 Date of last inspection Brief description of the care home Homecare Trust Ltd purchased Nether Place in July 2007. A new manager, Mrs Beth McGinley, took up post in April 2010. The home is registered to provide nursing care for up to 32 older people, although they currently only accommodate a maximum of 27, as double rooms are being let singly. Nether Place is a traditional stone building which retains many of its period features alongside a a newer extension. It is situated in a residential area on the outskirts of Keswick. Accommodation is over two floors, served by one passenger lift. There are Care Homes for Older People Page 4 of 28 Over 65 32 0 2 9 0 6 2 0 0 9 Brief description of the care home three lounges and a conservatory for shared use as well as a seating areas in the large entrance hall. There is a well-kept garden with spectacular views over the Lakeland fells. Bedrooms vary in size and shape, with the majority having ensuite facilities. There are assisted bathing facilities and an on site laundry and kitchen. There is an informative enquiry pack available from the home for anyone interested. The weekly fees at the time of this visit were £500.00, plus any registered nursing care contribution due from the government. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 was the second key inspection of Nether Place Nursing Home this year. During the last inspection in January 2010 we found serious shortfalls in the management of medicines and care, which left people at risk. We made seven statutory requirements and five good practice recommendations. We also asked the registered provider to send us an improvement plan for the service. The registered provider sent us a detailed improvement plan, and several progress reports. We met with the provider to discuss the improvements they were making in the service, and to hear that a new manager had been appointed. We also maintained telephone contact with the service and spoke with the new manager about the changes. The lead inspector, Jenny Donnelly, and the pharmacist inspector, Angela Branch, made an unannounced visit to the care home on 8th June 2010. During our visit we Care Homes for Older People Page 6 of 28 toured the home, speaking with people who live there, their visitors, the manager and staff. We also spent time looking at files and documents and watching what was happening in the home. The main focus of this inspection was delivery of health and personal care. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? We saw that a number of improvements had taken place, which were having a positive impact on the health and welfare of people living in the home. A thorough review of the handling of medication had been undertaken to improve the way that medicines were handled and to reduce the risk of errors that could cause harm. The home had changed their pharmacy supply and staff had received training on the new medicines system. Records were better maintained and there was no longer a problem with medicines running out. A new person centred care planning system had been introduced. Peoples health and personal care needs had been re-assessed and their new care plans and risk Care Homes for Older People Page 8 of 28 assessments showed the level of support they needed. There was evidence that some people had been reviewed by their doctor and other health care specialists to ensure they were receiving appropriate care and treatment. Nutritional assessments had been completed, and staff had received training on nutrition and were monitoring peoples food intake and weight. Meal times had been altered so they were better spaced throughout the day and people were eating better as a result of this. Staffing levels had increased and additional training had been provided. This meant staff had more time to spend with people and were able to deliver better quality care. The kitchen was being staffed for longer during the day, so care staff were no longer taken away from delivering care to prepare the evening meal. The managers hours were now in addition to the number of registered nurses on duty. Some corridors and one bedroom had been decorated, and a new patio are was being created, for people to sit safely outside. A carpet cleaner had been purchased. The new manager, along with the registered provider, was providing stronger leadership and had put new systems in place that were working to improve standards in the home. Quality monitoring was taking place, and the handling of residents money had been re-organised so it was kept individually and not pooled together. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hometrust Care Limited provided people with good information about the service and facilities offered at Nether Place. The admission assessment was thorough and enabled people to know if the home would be able to meet their needs. Evidence: We saw there was good information for people about Nether Place Nursing Home, describing the facilities and services offered. The information was set out in a Statement of Purpose and Service User Guide, which were frequently updated to reflect any changes. Copies of these documents were given to people on request, as well as being on display in the home. People could also access information about Nether Place from the Hometrust Care Limited web site. We looked at the admission procedure for two fairly new people who had moved into the home, and found this included a detailed assessment of their needs. We saw their assessments had been completed with a good level of detail using a standard format Care Homes for Older People Page 11 of 28 Evidence: to help staff capture all the necessary information. The home also had copies of relevant information from other professionals, including hospital discharge information and assessments by the persons social worker. The assessment helped staff to ensure they had everything in place, including any equipment needed, for new people arriving. These assessments were used to draw up a plan of care for the person, and this is commented on further in the next section of this report. People we spoke with told us that the staff had made them feel welcome when they arrived in the home. People said they, or their families, had been able to come and look around the home, to see the vacant rooms and speak with the manager or staff. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were receiving a good standard of health and personal care delivered in a way that was acceptable to them. Evidence: At the last inspection in January 2010 we found serious shortfalls in the way medicines and care were being managed in the home. Since our last visit, nurses and care staff had received training in medicines, care planning and care delivery. A new care planning system, based on person centred care, had been introduced, and care plans were being checked more thoroughly by the Homecare Trust senior staff. A new medicines system had been introduced and the supplying pharmacist changed. We looked at a large selection of care plans, focusing on those people with more complex health and personal care needs. Plans were well laid out following a simple format that was easy for staff to follow. The plans were very individual and gave a good level of detail about each persons particular needs and wishes. We saw that all Care Homes for Older People Page 13 of 28 Evidence: risk assessments and care plans had been reviewed at least monthly for the last three months, and had been updated to reflect any changes in peoples care needs. There were clear records of input from external professionals such as doctors, specialist skin care nurses and mental health professionals. There was evidence that staff had been pro-active in seeking advice about wound care and pain control. We saw this meant people who previously shouted in a distressed way, were much calmer and were eating better. New nutritional risk assessments had been completed and staff were much more aware of who was eating what, and recording and acting on any dietary concerns. Some care plans contained a mix of old and new records and this was repetitive and confusing. The manager stated she would be weeding out old information during her next review, once she was satisfied all relevant information had been fully transfered to the new records. We saw and spoke with people in the lounges and bedrooms, and they told us they were happy with the care they received. One visitor told us her relative was always clean and comfortable, and ate well. We saw that people had been helped to wash and dress, with their hair tidy and the gentlemen had been helped to shave. The pharmacist inspector looked at the handling of medicines by checking relevant documents, storage and meeting with the manager and other staff. Overall, we found that the handling of medicines had improved significantly since the last visit. We looked at records for receipt, administration and disposal of medication and these were much more accurate. Staff more clearly recorded the reasons for giving when required medicines to justify their use. The medicines administration records were mostly well signed when medicines were given but there were still a few gaps. The manager should make sure that staff understand the importance of signing these records at the same time that medicines are given to reduce the number of gaps and the risk of errors that could cause harm. We counted a sample of medicines to check that they tally with records. With the exception of one sample they all added up so that they could be accounted for, and to show that they were administered in the correct dose. We looked at a sample of care plans for management of health care and medication. These had improved and some contained good information. However, there was still work to be done to make sure all care plans are up-to-date. We understood that these were in the process of being reviewed. We checked medicines liable to misuse, called controlled drugs and a stock check was Care Homes for Older People Page 14 of 28 Evidence: in order. We also checked storage of other medication. We were concerned that one of the medicines trolleys could not be locked and this could pose a risk if staff were distracted or called away to an emergency during the medicines round, as the medicines could not be secured. The manager had organised a replacement trolley before the end of the inspection. We also saw some medication that was inappropriately stored in the fridge. Staff promptly dealt with this during the inspection, assessing the storage requirements of medicines. The manager was doing regular checks, or audits, of medication so that concerns could be identified and managed quickly. The supplying pharmacist had also visited recently and provided advice and training to improve the management of medication. The manager should ensure that the improvements seen at this visit are sustained in the long run. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager was working to improve the provision of activities and occupation for people to engage with. People enjoyed the meals, and there was good monitoring of peoples weight and nutritional intake. Evidence: People were happy with the meals provided when we last inspected in January 2010, but we were concerned that nutritional assessments were not in place, peoples weight was not being monitored and staff did not pay enough attention to whether people were eating. Since then staff had received training on nutrition, and the new care plan had a section for recording daily food intake and weight. We were pleased to see that some people were eating better and no longer needed nutritional supplements. This was because their general pain control had improved, and because staff were paying more attention to helping people to eat. Meal times had been changed, so that they were better spaced throughout the day. The manager said this had been running for the last month and she found people were now hungry at mealtimes and looking forward to their food. We saw lunch being served and noted that most people ate very well and enjoyed their food. Staff were supporting those who needed help and people were Care Homes for Older People Page 16 of 28 Evidence: given plenty of drinks throughout the day. Menus were being slowly revised, and the manager had sought advice from a dietitian to ensure menus were nutritionally balanced. The manager had plans to improve activities in the home and was in the process of appointing a new activities organiser to work 30 hours a week. The manager also told us she was looking into local mini bus transport, working on an activities programme and planning a summer fete for the local community. We saw she had purchased some reminiscence materials, including quizzes and old newspaper stories to use for discussion groups. We look forward to seeing these plans come to fruition. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns and complaints were listened to and acted on in a timely manner and any necessary changes were made to put things right for people. Evidence: There was a copy of the complaints procedure on display in the home as well as within the Statement of Purpose and service users Guide. We also saw there were reminders about how to raise concerns and complaints in the homes newsletters, and this had been raised at relatives meetings. Relatives had told the manager they were not happy to leave notes in a general communication book about any concerns they had, so a more private record has been created where relatives can leave a note for the manager or ask her to contact them. The manager told us about two families who had complained to social services about things that happened in the home since our last inspection, and prior to her coming into post. We were already aware that social services were investigating these cases. The manager had set up a new complaint log and we saw entries for three concerns, which had been dealt with promptly and professionally. The had been no new complaints or concerns raised in the last six weeks, which we hoped was an indication that the improvements in the provision of care were having a positive effect on peoples experience. Care Homes for Older People Page 18 of 28 Evidence: There were safeguarding procedures in place to guide staff in how to recognise and report any concerns or allegations of abuse. Staff had received training in this last year, and we saw that new staff had received this training recently. The manager had a good understanding of the safeguarding process. She had rightly made two referrals to the safeguarding team, one where staff had been worried about an incident they witnessed between a resident and a visitor, and another involving two residents. The safeguarding team had been able to help the manager ensure these people were getting the help and support they needed. We did not see or hear anything of concern during our inspection. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, comfortable, well maintained home that meets their physical needs. Evidence: The home was well maintained, warm, clean and comfortable throughout. There was a main lounge, two smaller sitting rooms and a large conservatory for people to use. The lounges were pleasantly decorated and comfortable. There were plans to extend the conservatory. There was a small seating area in the entrance hall where some people liked to sit and watch. The home has a large garden, there were plans to improve access to this, and a new patio area was being built at the time of our visit. The manager told us she planned to purchase some air conditioning units to keep the home at a comfortable temperature in warmer weather. There were adaptations to help people with mobility problems, including grab rails, a passenger lift, hoists, bath seats and other equipment such as nursing beds and pressure reducing mattresses. There were two assisted baths, two showers and plenty of spacious toilets. Work was being done to improve signposting around the home to help people find their way. Toilet doors had been re-painted using a dark colour that stood out against the Care Homes for Older People Page 20 of 28 Evidence: corridor walls, and picture signs were being put on the doors. Twenty three of the twenty seven bedrooms had an en suite toilet. Bedrooms varied in size and shape, were nicely presented and had been personalised and made homely with photographs and other personal possessions. Some of the corridors and one bedroom had been decorated since our last visit. The laundry worked efficiently and we saw there were good infection control procedures in place, with hand washing facilities easily accessible to staff and visitors. Peoples clothing and bedding appeared nicely laundered. A new carpet cleaning machine had been purchased. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were cared for a by a competent and caring staff team, who received the training they needed to help them do their jobs well. Evidence: Staffing levels had increased since our last inspection, with 2 nurses and 4 care staff on duty. In addition were the manager, 2 domestics, 2 kitchen staff, and an administrator. Kitchen staff hours had been extended so care staff no longer had to prepare the evening meal. The additional staffing had enabled staff to improve the quality of care and record keeping. There was a pleasant, calm and friendly atmosphere in the home. The two nurses running the shift acted in a professional manner and demonstrated good leadership and organisational skills. We saw they dealt with all issues that arose during our visit calmly and efficiently. Care staff were well organised and able to spend quality time with people. Further staff training had taken place since the last inspection, and the manager was also holding daily half hour staff meetings / training sessions on the new care planning system. A session was held on the day of our inspection to talk about the management of prescribed creams and lotions. These sessions helped all staff to keep up to date with the changes and to re-iterate the standards of care the manager Care Homes for Older People Page 22 of 28 Evidence: expected. Eight of the twelve care staff had completed a National Vocational Qualification in care at level 2 or above which is good. Two new staff had been appointed since our last inspection and a review of these staff files, showed that all necessary pre-employment checks had been carried out, and a three day induction training completed with an external training provider. There were vacancies for nurses and care staff, which had been advertised. In the meantime, some part time staff were working additional hours and one agency nurse was being used on a regular basis, so they were familiar with peoples needs. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements were more robust with a strong focus on monitoring the quality of service delivered to people living in the home. Evidence: Since the last inspection in January 2010 the manager had left, and a new manager, Mrs Beth McGinley had been appointed. She is a registered nurse who has worked as a care home manager before, and she has completed the Registered Managers Award. She had started to apply for registration with the Care Quality Commission in respect of managing this service. The manager is supported by an operations manager, and the registered provider, who visit the home regularly. Homecare Trust Limited had systems in place to monitor the quality of service provided at Nether Place. They had sent out their own quality assurance questionnaires to people last December. The new manager had held two meetings for relatives, one of which had a guest speaker, and had been well attended. There were new checks, or audits, on medicines, care planning and nutrition, to monitor that Care Homes for Older People Page 24 of 28 Evidence: these things were being managed properly and kept up to date. There were also daily staff meetings / training sessions to make sure staff were up to date with new ways of working. There was a system of staff supervision in place. We saw records that showed all staff had received formal supervision sessions with the operations manager within the last six weeks. The home manager told us she would be following up some of the issues raised, and would be completing staff supervisions herself in the future. The manager holds spending money on behalf of some people for safe keeping. Further to our last inspection the arrangements for this had been changed so that each persons money is now held separately for ease of auditing, rather than being pooled together. We looked at the general health and safety arrangements in the home in January and had no concerns. Service records for facilities and equipment had been up to date. The majority of staff had received health and safety training including fire safety, and moving and handling training last year. We saw some staff had received updates since our last visit. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 We recommend that the work undertaken to bring peoples care plans and risk assessments up to date, be continued to ensure the improvements are maintained. We highly recommended that the manager ensure that staff understand the importance of completing medicines administration records at the time that medicines are given to reduce gaps in records and the risk of medication errors. It is recommended that the plans to improve the provision of activities and occupation for people be put into practice, and be continued. 2 9 3 12 Care Homes for Older People Page 27 of 28 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. © 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. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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