Care Home: Nightingale Lodge

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What the care home does well Prospective service users are given information in the form of two documents to assist them with making the decision to live at Nightingale Lodge. Assessments are always carried out to ensure the service can meet the needs of the service user. Care plans are now in a new format and as these are worked on they will provide a good framework for staff to follow to enable them to give care in the service users preferred way. Access to health care professionals is good and service users are supported to access optician dentists and chiropodists. Service users can be confident that any concerns they have are listened to and acted upon . Increased training in safeguarding adults and deprivation of liberty safeguards (DOLS) provides staff with an increased knowledge of how to uphold service users rights and choices. Staff recruitment is robust and a comprehensive training programme means that service users can be confident that the right people are providing support to them. The environment is having a refurbishment programme carried out which means that service users will have more comfortable surroundings to live in. The manager leads the care team well and service users find the manager responsive to their suggestions. A quality assurance programme is in place and this ensures that service users opinions are centre to how the service operates. What has improved since the last inspection? A review of the medication system has enabled there to be an improvement in the medication system which means that service users can be confident that medication records held in respect of administration are correct and clear. More activities are taking place and those service users who are not always able to decide the activities they participate in are assisted by the use of an activity assessment tool. This means they can engage in appropriate and meaningful activities which give consideration to previous hobbies and choices in their lifestyle. What the care home could do better: There are mixed responses to the catering arrangements at the service. A review of comments and delivery of the catering arrangements may provide clarity regarding some of the comments made regarding the quality of food provided. Key inspection report Care homes for older people Name: Address: Nightingale Lodge Great Well Drive Romsey Hampshire SO51 7QN     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: Kathryn Emmons     Date: 0 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 27 Information about the care home Name of care home: Address: Nightingale Lodge Great Well Drive Romsey Hampshire SO51 7QN 01794512138 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hampshire County Council care home 44 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: 44 The registered person may provide the following category/ies of service only: Care home only - PC 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 - OP Dementia - DE Date of last inspection Brief description of the care home Nightingale Lodge is a large purpose built, two storey building situated in a quiet area of Romsey. There are a small number of local shops within walking distance. The home is registered to provide accommodation for 44 older persons but only accommodates 42 at any one time. Some of the residents have dementia. Nightingale Lodge is divided into 5 living units all with their own kitchen, lounge/diner and bathing/toilet facilities. The home provides 41 single bedrooms and one double bedroom used as a single room. None of the rooms have en-suite facilities but are provided with hand wash basins. The home also offers facilities for service users Care Homes for Older People Page 4 of 27 44 0 Over 65 0 44 Brief description of the care home requiring respite care. Other facilities comprise of a range of offices/staff room, main kitchen, large entrance hall, laundry and separate activity rooms. To the front of the home is a small garden and car parking area and to the rear is a large enclosed designed garden and patio area. . 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: We visited the service on Thursday 3rd September 2009 from 9.30am until 4pm. The AQAA (Annual Quality Assurance Assessment) was received when we requested it and this provided us with a lot of information about the service.We were able to use the information this contained to help us prepare for the inspection visit. We request a completed copy of this document every year. Twelve people using the service were involved in our key inspection and we spoke with four staff and the registered manager and service manager during our visit. Prior to the inspection visit we sent out comment cards to the service for six staff ,and ten service users and three health care professionals . We have used the comments these contained to help us gain information about the service and have reproduced some of these comments in the main part of the report. Care Homes for Older People Page 6 of 27 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. 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 7 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 8 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. Information provided to assist prospective service users is up to date and accurate. Service users are assessed before living at the service which means they can be confident the service can meet their needs if they are offered a place. Contracts give service users confidence in the service they can exact to receive. Evidence: All of the people that live at the service were given a copy of the homes service user guide and statement of purpose to help them decide if they wanted to consider living at Nightingale Lodge. The service user guide contains information about the home, who works there , what services are available and how to raise any concerns or issues. The statement of purpose sets out the services aims and objectives and how these are going to be achieved. Before any one is able to receive a service they will be assessed by either the homes manager or a senior member of staff. This is to ensure all necessary information is Care Homes for Older People Page 9 of 27 Evidence: gained so the service can be confident they can meet a service users needs when they offer them a place at the service. We looked at three files and saw that there were contracts in place which had been signed by the service users and a representative from the service. We spoke to a couple of service users regarding living at the service. One told us they had been able to come for look around before they decided to live at the service. We received comment cards and all of these indicated that service users had been given enough information before they decided to live at Nightingale lodge. The service offers respite care for one to two weeks and also provides a few beds for people to stay in while they consider if they are going to go home or stay in the service. The home does not provide intermediate care. Care Homes for Older People Page 10 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. Care plans generally identify service users needs and preferences and how to deliver care safely. Medication systems keep service users safe. Service users are satisfied with the access they have to health care professionals. Service users dignity and privacy is respected and they are supported in a respectful manner by staff. Evidence: There has recently been a change in the layout and design of the records used to detail the information needed to provide care to the service users. A more streamlined system is in place and all of the key workers for service users have been involved in rewriting care plans and assessments for the new system. We looked at three sets of care notes for current service users. We saw good detail in two of the plans and could see that service users and their supporters had been involved in the care plans. Information included daily needs , likes, dislikes, hobbies and life history. There are additional record sheets for risks such as falls and mobility. We could see that reviews were taking place and any changes to care plans were made as part of reviewing the daily records which are written by care staff. One set of care plans did not contain as much information as the other two and there had been a change in care support needs Care Homes for Older People Page 11 of 27 Evidence: which was known by staff but was not recorded in the care plan. The manager accepted this and said that more training was being provided to those care staff who required more support with ensuring all changes were in the new care plans. Staff we spoke with said they found the new records easy to follow and they provided all the information they needed to provide care safely and to the service users preferences. Two of the service users we spoke with were aware of their care plans. One said I was spoke with and they checked I was happy with the help I was going to get. Medication is managed and administered by the senior member of staff on duty at the time the medication is needed to be administered. We saw picture guidelines for staff and the service user to follow so that the service user could remain independent with taking one of their medications. We saw risk assessments for service users to ensure if they were able to administer their medications .We looked at all of the MAR (Medication administration records) on this visit as last time we visited there had been a few signatures missing. The records we looked at all were written clearly and all medications had been signed for. This means that service users can be confident they will receive their medications safely. The manager said the service has a good rapport with local health care services. All of the service users are registered with the local doctors surgery and the doctor will visit when needed. Service users we spoke with said they received all the health care they needed and saw the doctor when they wanted to. We saw evidence of visits from district nurses, opticians, chiropodists and access to dental practitioners. We received positive feedback from health care professionals who indicated that the service was supporting service users to access the health care services and were helpful when health care professionals visited the service. We spoke with many service users during our visit and spent a lot of time observing how staff maintained service user privacy and their understanding of being respectful towards service users. We saw very good interactions between staff and service users and all of the service users we spoke with made similar comments regarding how staff spoke with them and supported them with their care. These comments included They always knock and wait for an answer, I like them being friendly and they are always nice how they speak to you, We know its important to be kind and respectful to everyone who lives and works here, I always treat the residents how I would want to be treated, I dont know of anyone who isnt very pleasant and kind here. We observed staff knocking on doors before going in even when the person was not able to give permission for the carer to enter their room. We noted that medication was given in a discreet way and any questions about medication were answered in a quiet way. Assistance with using the toilet was offered in a dignified way and out of earshot Care Homes for Older People Page 12 of 27 Evidence: from other residents. Care Homes for Older People Page 13 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. Service users are able to chose how they spend their time. They are involved in an improved activity programme and more purposeful activities are provided. Individual cultural and spiritual needs are known and supported to be met .Service users have mixed views regarding the catering arrangements at the service. Evidence: Part of the assessment process is to identify the service users likes, dislikes and preferences and how they lived their lives before they came and lived at Nightingale Lodge. Activities and hobbies are known and an assessment tool is used to asses the best type of activitys to be provided for service users. Those service users who are able to make choices are asked by the activities coordinator what activities they would like to engage in. For those service users who are not always able to make a choice the assessment tool provides guidance of the type of activity which would be purposeful and meaningful for the service users to be involved in. We saw photographs around the home and the manager told us of recent activities service users had taken part in . These included a trip to local gardens, a garden party at the service,trip to the sea side and the following day after our visit a group of service users were going to another home to participate in a bowling competition using an interactive computer game. Service users we spoke with said they had enough activity Care Homes for Older People Page 14 of 27 Evidence: each day to occupy them. During our visit we saw people engaged in activities such as small group discussion, reading a newspaper, watching television, doing a crossword and one service user told us they were helped to do jigsaw puzzles. A couple of comment cards we received stated that sometimes there were not enough activities taking place. We did not find this to be the case and could see that all of the service users were able to join in activities if this was their choice. We saw an advertisement for a communion service and two service users told us that ministers from two different religions visited the service monthly. We were told by the manager that staff have received training in equality and diversity and believed that this did underpin the daily support service users received. We asked service users about the level of control they had regarding their lifestyle at the service. We were told Its alright to do what you want here, I pretty much do what I like and its alright , they let you do what you want You can join in the activity or you can just watch. We saw visitors attend the service at various time during our visit. The front door is security coded so that service users and staff can be clear who is entering the building to ensure those service users who can not chose who comes into the service are kept safe. Service users told us they were able to receive visitors when they wanted and we could see that there were rooms around the service where service users could meet with their visitors in private. Comment cards contained mixed responses regarding the food provided. A couple of comments about food were Excellent and very good while other comment cards report that fish is hard and burnt, vegetables are rock hard and resident was not able to have a choice as cook had finished working. Since the last inspection we also received information regarding the arrangements in the kitchen. Service users we spoke with on the visit also gave different views on the food provided. Three said the food was very good lunch was very nice, You can always have an omelet or salad and I always like it, very tasty. Three other service users made comments such as The veg is very hard, It depends who is cooking one of them is very good you get a choice to pick from but if you dont like how its cooked there isnt much alternative. We raised all of these comments with the manager. The manager advised that menus had been reviewed, snacks and alternatives were always available and chefs were now working different hours so they can provide alternatives if the food provided at lunch time is not satisfactory. The manager has agreed to review the catering arrangements once again in consultation with service users. We spoke briefly with chef who confirmed that specialised diets were catered for such Care Homes for Older People Page 15 of 27 Evidence: as pureed and sugar free. We saw staff supporting a couple of service users to have their lunch, who needed full support. Staff carried this out in a discreet way and gave service users time to try to help themselves. We observed fresh fruit bowls at various places around the service. Service users told us they could have drinks when they wanted and we saw jugs of squash in all of the sitting dining areas. 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. Service users and their supporters can be confident that any concerns they have will be listened to and responded to. Safeguarding adult systems are in place and protect service users. Staff have received training in the prevention of abuse and are aware how to raise concerns in this area. Evidence: The AQAA informs us that two staff have attended Deprivation of Liberty training so they can cascade this down to other staff. We were also informed that staff are receiving training in respect of the Mental Capacity Act. This means that as part of safeguarding adult systems at Nightingale Lodge, staff are now gaining skills to ensure people who are unable to make decisions for themselves are having their rights upheld and kept safe. We were told by staff and we saw in care staff training records that staff have received training in safeguarding adults procedures. Staff said they had read the services policy and was confident that they would know what to do if they thought a safeguarding adult issue may have arisen. The AQAA informs us that all service users are given a copy of the services complaints procedure when they are admitted to the service. We saw a copy of the complaints procedure on display. The AQAA informs us that no complaints have been received since the last inspection . We discussed with the manger any comments regarding issues in the home such as dissatisfaction with food , should be recorded as part the comments , compliments and concerns . The manager was able to give examples of Care Homes for Older People Page 17 of 27 Evidence: comments that had been made and what action was taken. This indicates that the manager is clear on how to address any comments or concerns and would follow this procedure if a complaint was made. We asked service users what they would do if they had concerns or wanted to make a complaint. We were told I would speak to one of the senior staff or the manager, You can speak to any of them and there is a lady who comes round checking every few weeks.. The manager confirmed to us that once a month the service manager will undertake a Regulation 26 visit and speak with service users to see if they have any comments or concerns to raise. Staff were clear of how they would react if a concern was raised and who they would speak to. 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. Service users live in a clean and comfortable environment. The environment is safe for service users and staff and ongoing review of risk assessments ensure the service maintains a high level of safety. Infection control systems minimise the risk of cross infection. Evidence: The service is divided into five self contained areas which have bedrooms, a large sitting room, kitchenette and dining room and bathrooms. Service users said they liked the environment they lived in and had said they had been able to chose the decor of their rooms and had been consulted regarding ongoing refurbishment of the service. The manager advised us that ongoing work was taking place including fitting new fire safety equipment and the purchasing of new furniture for some of the lounges and sitting rooms. The service has parking towards the front and a large landscaped garden to the rear of the building. There is patio furniture so service users can sit and relax in the garden in warmer weather. There are opportunities for service users to participate in the planting of flower beds and hanging baskets. As we walked around the building ,speaking with staff and service users we saw that the home was clean and tidy and all of the furniture was in a good state of repair. We saw staff using equipment such as hoists and records tell us these had recently been serviced. We saw meals being sent to the separate kitchen areas in hot trolleys which staff have been shown how to move safely.We saw from reading the AQAA that Care Homes for Older People Page 19 of 27 Evidence: servicing of equipment is carried out routinely and staff are aware of how to report faulty equipment for repair. We saw from looking at staffing records that staff had been trained in infection control and during our visit we saw staff wearing aprons and putting on gloves when carrying out personal care. There were hand sanitiser sprays available and staff carried alcohol hand wash gel with them while working. We did not see any obvious hazards during our visit and the manager advised us that an environmental risk assessments in carried out by the health and safety team and this is reviewed regularly. 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. Robust recruitment practises ensure that the right people are employed to support service users. Service users are satisfied with the service they receive. Ongoing training enables the care team to embed current care practises in the support they provide. Evidence: Comment cards we received indicated that service users thought staff were either always available to help or usually available to help. When we spoke with service users all of them told us they had the help and support they needed. Only one service user made any comments regarding the time it takes for staff to respond and then said in the morning when its very busy you sometimes have to wait a while but its not very long. During our visit a couple of times call bells were rung and staff responded to these promptly. Staff we spoke with said that generally they felt there were enough staff on duty and that if there was a shortage the senior staff would always assist with personal care. The manager confirmed there had been no reduction in the staff level however senior staff had more paperwork such as care plans to complete so this may give the impression to some staff that there were less people working out in the service. During our visit we saw that staff had a very good rapport with service users and Care Homes for Older People Page 21 of 27 Evidence: other people that visited the service. Staff said they had a good rapport with each other and the low staff turnover demonstrated that staff enjoyed working at the service. Comments from service users included they are just wonderful really good and so kind to us, i find them just wonderful so nice to you, i wouldnt want to live anywhere else We looked at the recruitment records for three staff . Two of these were new staff and one set of records were for a member of staff who had worked at the service for some time.We could see that staff had been recruited correctly and all necessary paperwork was in place including a criminal records bureau check, two written references and a completed application form which included a full work history.We saw that records of the interview were maintained. Staff told us that they received a full induction when they started working at the service and that they were able to work with support until they felt confident to work independently.Staff told us that they received a lot of training and we evidenced this through looking at the services training matrix and the training files of some of the staff. By providing a high level of training this means that the care team have skills and knowledge which are embedded in their practise and may provide an increased quality of care to service users. 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 service is well managed and service users and staff have confidence in the manager. Quality assurance systems enable the service to continue to evolve and improve the outcome for the service users. The financial arrangements safeguard service users monies and valuables and health and safety arrangements keep staff and other people at the service safe. Evidence: The registered manager for the service is Maxine Dyer. Staff said they found the manager to be approachable and supportive and led the service well. Service users said they saw the manager often and that they found her to be helpful and kind and looks after us well and sees its alright. The manager received supervision monthly from the service manager and also has peer support from other registered managers from other services within the organisation.The manager is also supported by a team of deputy managers who will manage the home in her absence. Service users we spoke with said they were very satisfied with how the service Care Homes for Older People Page 23 of 27 Evidence: operates. They told us that they believed their opinions were listened to and that suggestions were taken seriously. We saw that residents meetings take place and then actions are taken where possible. Staff told us they have staff meetings and are able to raise suggestions with the manager. There is a quality assurance system in place and surveys are sent out to service users, their relatives and various other people who have an involvement with the service such as local care managers and doctors. Findings are reported upon and then put into the services action plan. The service manager who is also based at the service carries out monthly unannounced visits and produces a report on the conduct of the service, these are also part of the services quality assurance plan. We could see that staff receive regular supervisions and appraisals. This provides a formal opportunity for staffs training and development needs to be identified and any issues they want to raise can be addressed. Service users look after their own finances where possible and there are clear audit trails in place for any monies looked after by the service. A clear system is in place for maintaining the health and safety arrangements for the service and a sample of these are reviewed on each monthly audit and review undertaken by the service manger and the registered manager. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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