Care Home: Oak House

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well The recruitment of well motivated and caring staff is recognised as key to providing quality care. Management prioritise training in order to improve practise. Residents and their relatives say that staff are `caring`, `helpful` and `approachable`. The home is well designed to meet the needs of older people with disabilities and mental frailty. Communal areas are comfortable and clean and bedrooms are spacious, airy and well lit. The home has the specialist aids and equipment it needs to provide the right care. The management team are working hard with other agencies to improve practise in the home and to provide good standards of care. What has improved since the last inspection? Since the last inspection the quality of care to residents has improved. Care plans are well written and in general reflect the needs of residents. The home has developed both paper records and computer held records and have kept them up to date. This has helped staff to know how to provide the right care. A wider range of risks to residents have been assessed and guidelines are in place to reduce the risk identified. All residents have been reviewed and any specialist equipment they need has been provided. More staff have been recruited and they have been provided with the training they need to provide effective and safe care. All staff have received refresher training in manual handling to protect residents from harm. Staff are more effectively managed and supervised so that they can carry out the tasks of their job more effectively. Communication systems between staff and management have been improved. What the care home could do better: There is a need to ensure that all staff including carers and ancillary workers receive infection control, COSHH and health and safety training to protect residents from harm. Care plans should contain up-to-date information about the nutritional status and needs of residents. The home should continue to recruit suitably competent and qualified senior staff including a clinical lead and unit managers to strengthen the management team and to aid continuity for residents. Key inspection report Care homes for older people Name: Address: Oak House Oak House Wexham Road Slough Berkshire SL2 4HF     The quality rating for this care home is:   one star adequate 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: Julie Willis     Date: 0 2 1 2 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 29 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 29 Information about the care home Name of care home: Address: Oak House Oak House Wexham Road Slough Berkshire SL2 4HF 01753528419 01753572463 manager.oakhouse@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care UK Community Partnerships Ltd Name of registered manager (if applicable) Mrs Amanda Wendy Jane Marsh Type of registration: Number of places registered: care home 120 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: (1) The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary need on admission to the home are within the following categories Old age, not falling within any other category- (OP) Dementia - (DE) (2) The maximum number of service users to be accommodated is 120. Date of last inspection 1 8 0 8 2 0 0 9 120 0 Over 65 0 120 Care Homes for Older People Page 4 of 29 Brief description of the care home Oak House is operated by Care UK. It has 120 beds divided into eight, 15 bedded units. It provides residential, nursing and continuing care to older people, some who may be suffering from dementia. The cost of the service varies between 750 and 900 pounds per week. Care Homes for Older People Page 5 of 29 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: one star adequate 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 inspection of the service was an unannounced Key Inspection which was carried out over the course of twelve hours on 30th November and 1st & 2nd December 2009. It took into account detailed information provided by the services manager, and any information that the Commission has received about the service since the last Key inspection which was undertaken on the 17th & 18th August 2009. Additionally, a random inspection was undertaken on 17th November 2009 to check compliance with requirements from the previous key inspection. Prior to the visit a questionnaire was sent to the Manager along with survey and comment cards for residents and visiting professionals such as doctors and nurses. Any replies were used to help form judgements about the service. Consideration has also been given to other information that has been provided to the Commission since the last inspection including information from inter-agency safeguarding meetings, information about complaints about the service and reviews. The inspector toured the Care Homes for Older People Page 6 of 29 building, examined records and met most of the residents and four relatives that were visiting at the time of the inspection. The inspector also spent time talking to staff and observing how care was being delivered to the residents. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals with various religious, racial or cultural needs. The inspector gave feedback about her findings to the homes Manager and Operations Director at the end of inspection. There were no requirements outstanding from previous inspections. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 29 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 29 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 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with information to enable them to decide if the home is right for them. People are assessed to ensure that the home will be able to meet their needs. Evidence: The home understands the importance of having sufficient information when choosing a care home. It has developed clear information to help prospective residents decide if the home is right for them. The information available in the Statement of Purpose and Service User Guides helps people understand what services the home can offer. The documents are written in plain English and can be made available in other languages and formats if needed. The Statement of Purpose is specific to the home and sets out the aims and objectives of the home and the philosophy of the service. Additionally, the home provides each Care Homes for Older People Page 11 of 29 Evidence: resident with a welcome pack which contains the Service Users Guide and a copy of the contract, which sets out in detail what is included in the fee, the role and responsibility of the Organisation and the rights and obligations of the individual. Although there have been no new admissions it is clear from records and from discussion with management that all new residents are admitted to the home for a trial period which is normally four to six weeks, after which, a review is held when the resident can decide if they wish to remain in the home permanently. There have been no new admissions to the home since August 2009 so it was not possible to fully evaluate this standard. However, from discussions with management and examination of documentation that related to those people who had been readmitted to the home following hospital admission, it was clear that there is a focus on ensuring that peoples needs are fully assessed before they are admitted. Assessments are carried out by management of the home. The assessment focuses on what care needs a person has and whether they can be met effectively by the home. The management are clear about the criteria for admission and the implications for existing residents should someones behaviours challenge. The home understands the need to manage the admission process effectively in a staged way so that the needs of individual residents can be met effectively by suitably trained and competent staff. Care Homes for Older People Page 12 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and risk assessments have generally improved in content but further consideration should be given to nutritional needs to protect residents from harm. Residents are provided with care in a manner which respects their rights to dignity, privacy, choice and independence. Evidence: There have been a number of complaints and safeguarding matters bought to the attention of the Local Authority which have resulted in a complete review of care planning documentation at the home. All residents have been formerly reviewed by their social worker and staff of the home and as a result a number of people have been moved to more appropriate accommodation in other homes or to different units in Oak House. The recent reviews were carried out to ensure that the care plans accurately reflected peoples needs and that staff have the information they need to provide the right care. Since the last key inspection the home has developed both paper records and Care Homes for Older People Page 13 of 29 Evidence: computer held documentation. A paper copy of each persons care plan is kept in the residents bedroom. The computer system has been completely overhauled since the last inspection to reduce the amount of time it is off line and improve its reliability and performance. Staff now say that it is easier to keep the records on Saturn up to date. This has helped to improve the record keeping generally and improve continuity of care to residents. A wider range of risks are being assessed than previously, to include challenges to the service and the risk of absconding. Where risk has been identified effective management guidelines have been put in place to reduce the risk identified. There were however, inconsistencies in the care plans relating to nutrition. In one unit on the second floor, seven residents had daily food and fluid charts in their rooms, but it was not clear why their nutritional status was being so closely monitored by the staff, as their individual care plans did not identify the reason. Their care plans said that their weight should be monitored on a monthly basis. Three residents had been weighed weekly until October and monthly from then onward, but no reason had been given for the change in their care plan. The inspector met with four relatives that were visiting at the time of inspection. One relative said that they had seen an improvement in the quality of care at the home in recent weeks and were satisfied that appropriate levels of care were being provided. Another said that they generally felt confident that their relatives needs were now being met and felt confident that management would act on any complaints about the service. Another complained about the inconsistent level of care at the home and various other shortfalls in the service provided to their mother. These matters were discussed seperately with management who undertook to try to remedy the shortfalls immediately. The Commission received 19 responses to its residents surveys. All confirmed that there had been significant improvement in the quality of care at the home in recent weeks. The following comments were received, The staff are friendly and helpful and the atmosphere homely, The staff pay individual attention to the residents and the atmosphere is relaxed. However, one survey said, Care is generally good but staffing levels are sometimes stretched. The Commission received two responses to its health and social care professionals survey. Comments received were generally mixed however, improvement in services Care Homes for Older People Page 14 of 29 Evidence: had been recognised. Comments included, The care especially on the first floor has improved since August, care plans are generally improved and communication is better. There were however, a number of comments on where professionals felt further improvement could be made at the home including, the length of time between when illness is noticed and calling GP could improve, training in sensory needs would be of benefit, Care plans are generally good but I am not convinced all workers have knowledge of them or if they are a paper exercise, more dementia training is needed, staff feel isolated from management and there is a need for suitable assessments to be carried out for equipment and people should be encouraged to remain as independent as possible. The Commission received eight responses to its staff survey. Comments included the home has good open days and garden parties, there are activities for those who wish to participate, the training package for all new starters is excellent and the home has massively improved, all the staff are well guided toward further progress. Residents and relatives confirmed that residents are provided with access to health and social care professionals for advice and support as necessary. They regularly see the GP who visits when needed and are referred to hospital when necessary for further advice, support and treatment. Routine screening and preventative treatments are provided to all residents of the home. Records indicated that there have been medication errors and omissions in past months. As a result management have introduced a new auditing system which has helped to reduce the frequency of errors. Refresher training has also been provided to all staff in the safe handling of medicines to ensure the on-going safety of residents. At the time of inspection, medication was being administered safely, stored securely and disposal systems were safe. The home has purchased a number of medication storage safes for residents rooms. This will enable residents, particularly those on the Intermediate Care Unit to self medicate in future. The home has a policy on self medication and the use of homely remedies to ensure the safety of residents. Observation of practise concluded that care was being provided to residents in a manner which maintained their rights to dignity and privacy. Personal care was provided discreetly and with sensitivity. Care Homes for Older People Page 15 of 29 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. A range of activities is offered that provide opportunity for mental and physical stimulation. Residents are encouraged to maintain contact with their family and friends and are able to have visitors at any time. The home provides a varied and nutritious menu designed to meet the needs of its residents. Evidence: It is clear that the residents capacity to join in with activities varies according to their particular needs and abilities, however support and one-to-one assistance is offered on a routine basis. Efforts are made to engage socially with all of the residents on a daily basis in each part of the home. However, the Activities Organisers say this is difficult given their limited resources. The home employs one full time and one part time activities organiser and there is a full time vacancy which is yet to be filled. On the ground floor the activity organisers are supported by two hostesses who engage socially with residents and generally support them. The hostesses provide additional support to residents at mealtimes and generally provide additional assistance throughout the day. The activities organisers Care Homes for Older People Page 16 of 29 Evidence: and hostesses are very enthusiastic about their roles and are keen to provide a wide range of interesting, varied and age appropriate activities. There are rummage boxes on all floors and at the time of inspection they appeared to be well used by the residents. Crafts, games and puzzles are popular activities and the kitchenette on the top floor is the focus of many of the activities that take place. The Christmas festivities are well underway with Christmas parties, carol concerts, piano recitals and bell ringing already planned. Residents may have visitors at any time and relatives confirm that they are always made welcome and are offered appropriate hospitality during their visits. The routines at the home are as flexible as possible and are designed to offer residents choice and autonomy. Residents can rise and retire at a time of their choosing. They can choose whether to be alone or in company and may wander freely around the home and gardens. Policies, procedures and practise guidance at the home focus on residents being empowered to take control over their own lives within a structured environment. Residents regard the food they are given as one of the most important factors in determining their quality of life. Two residents were critical of the food provided. One resident said, it varies, sometimes its good and sometimes not so good and sometimes the meat is tough however the majority of residents were entirely satisfied with the meals on offer. One resident said, Its all I have to look forward to, it does vary, but mostly its good another said, Ive no complaints really its OK. The home operates a four week revolving menu which is due to be entirely revamped by the newly employed Head Chef. The Chef has recently had meetings with residents to ascertain their preferences and to try to incorporate new food choices into the menu. The chef confirmed that he has a satisfactory budget for meal provision and adequate resources. He said that his team are able to cater for a range of special diets including diabetic diets, vegetarian diets, pureed meals and culturally sensitive meals if required. Care Homes for Older People Page 17 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although staff have been trained in safeguarding matters, occasional deficits in the quality and consistency of care put residents at risk. Evidence: The complaint policy in the home meets the requirement of Standard and Regulation. Residents and relatives are provided with information on how to make a complaint to the home and the formal stages in procedures. Examination of the records indicated that the details of complaints were well documented. The records gave details of what investigation had taken place and the outcome provided to the complainant. From information provided to the Commission and examination of the complaint records and Proprietors Representative Reports (carried out under Regulation 26) it is evident that there have been a large number of complaints made about the quality of care provided by the home and a number of referrals have been made and investigated under joint adult protection protocols since the last key inspection. A relative spoke to the inspector during the inspection, about their concerns about the consistency and quality of care provided by the home. These matters were bought to the attention of management at the time of inspection who undertook to investigate the issues raised and to try to resolve them. As a result of previous requirements some of the staff have received refresher training in safeguarding adults since the last inspection. The training records indicate that 56 Care Homes for Older People Page 18 of 29 Evidence: staff have received formal safeguarding training since 1st January 2009. The home is currently in the process of showing all staff including ancillary staff a video called What do you see which focuses on dignity, privacy and safeguarding matters from a residents perspective. Staff interviewed during inspection confirmed that they thought the training was very powerful and thought provoking. Several staff said they had been very moved by the video and as a result their practise with people, particularly those people with mental frailty had generally improved. Care Homes for Older People Page 19 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standards of decor and furnishings in this home offer residents a comfortable and homely place to live. Standards of hygiene are good throughout. Evidence: The home has been purpose built to meet the needs of older people and people with disabilities. The home is built over three floors, each accessible by lift. Each floor is split into two or three distinct units. However, people can move freely between the units on each floor and were observed to do so during the inspection. There is a large atrium to the front of the building and this is a popular area with residents who can watch the comings and goings of the home. Activities are scheduled to take place in the atrium and there is a piano on the first floor which is particularly popular. From a tour of the building it is clear that the home is well maintained for the benefit of residents. All communal areas were clean, airy and well lit and have been decorated and furnished to a comfortable standard. The home has a maintenance team who are responsible for minor repairs and for carrying out the essential health & safety checks in the building. There is a rolling programme of routine maintenance and a budget is available that reflects this. Care Homes for Older People Page 20 of 29 Evidence: Many of the bedrooms are personalised and were warm spacious and comfortable. The home has a range of aids and equipment available to maintain residents independence and to promote safe care. Profiling beds are available for all residents and specialist mattresses are used routinely to promote tissue viability. There is a choice of bathing and showering facilities both assisted and unassisted and there are sufficient toilets placed strategically around the home to meet the needs of residents. All bathrooms, toilets and sluices have a supply of liquid soap and hand towels to maintain satisfactory infection control standards. The home was clean and hygienic throughout there were no residual odours noted. Residents confirmed that the home is always clean and well maintained and staff work hard to provide a pleasant environment for the residents. Discussion with staff and examination of the staff training matrix evidenced that 32 staff have received training in COSHH (Control of Substances Hazardous to Health)15 staff have received training in infection control and 33 staff have received refresher training in health & safety. There is a need to ensure all staff receive the training to protect the residents from harm. Care Homes for Older People Page 21 of 29 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. There were sufficient numbers of staff on duty at the time of inspection to meet the needs of residents effectively. The skill mix of the staff team was appropriate for the size, layout and purpose of the home. Recruitment policies and procedures at the home are robust and transparent and ensure the safety of residents. Evidence: Examination of six staff records and discussion with staff and management indicated that all necessary checks are undertaken on prospective staff to ensure the safety and protection of residents. Records were well kept and met the required standard. It is clear that the homes policy on recruitment is robust, transparent and meets the requirements of current good practice guidance and legislation. Examination of the staff files and training records evidenced that most of the current staff have either gained or are in the process of attaining NVQ qualifications at levels II & III. The Registered Manager and other senior staff provide the necessary support and guidance to candidates. All staff have been properly inducted and complete a period of shadowing senior staff to ensure that they are confident and competent to carry out the tasks of the job. Staff confirmed that they had undertaken an in-house induction and foundation Care Homes for Older People Page 22 of 29 Evidence: training to Skills for Care specification. There was evidence of many additional training opportunities for staff including Huntingdons Disease training, medication, activity study day, supervision for supervisors, supervision for supervisees, PEG tube feeding, nutrition in the elderly, diabetes, first aid, community care and the law. Mental Capacity Act and Deprivation of Liberty training are scheduled for all staff to attend in the New Year. The staff records were well kept and contained copies of induction training, job descriptions, application forms, two written references, training certificates, supervision and appraisal records. These were examined to evidence compliance with good practice. The home has an up-to-date training matrix, which provides the dates of all training that has been undertaken by staff. The Homes Manager undertakes regular audits of the training records and identifies future training needs and requirements linked to fulfilling the business and financial plan for the home. It is clear that staff are working hard to improve the quality of care provided to residents. All staff spoken with appeared keen, interested and highly motivated. Care Homes for Older People Page 23 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements and systems in the home have been reviewed and strengthened to improve the outcomes for residents. The quality of services are being regularly monitored to ensure residents satisfaction. Evidence: Since the last key inspection there have been a number of changes to the management structure of the home. The Registered Manager - Wendy Marsh has returned to the home after a period of sick leave and is supported in her task by a newly recruited Deputy. To aid continuity and to help improve performance Care UK Senior Management and an experienced support team have been working alongside existing staff. This has helped to improve the quality of care, enhance management auditing methods and generally improve communication in the home. It is recognised that the support Care Homes for Older People Page 24 of 29 Evidence: provided by the Local Authority Social Services team has been a major factor in recent improvements. The posts of Clinical Lead and various Unit Managers remain vacant despite recent advertisements. It is essential to recruit to these positions as soon as possible to maintain the impetus and speed of improvement and to aid management continuity. From examination of records and discussion with staff it is evident that they have the opportunity to express their opinions openly in regular staff meetings, which follow a shared agenda. These meetings, supervision sessions and staff handover times provide plenty of opportunity for the staff to feel included and involved in the way the service is delivered. From discussion with the residents it was evident that they are regularly consulted on issues that affect them and feel that their views are taken into account on a day-today basis. From examination of the minutes of residents and relatives meetings there was evidence that when requests are made or concerns expressed in the meetings the issues raised are followed up promptly by management. The home regularly carries out a range of home audits including medication audits, financial audits and health & safety audits to ensure that the home is operating safely and effectively. The most recent financial audit carried out in September by Care UK found that the financial systems in the home including those specifically designed to manage residents money were generally operating effectively and were safeguarding the interests of the residents. The home has recently carried out a customer satisfaction survey with residents. The results have been collated by Care UK to identify trends and to measure the homes success in meeting its stated aims and objectives. From examination of the surveys and overview it is clear that residents are generally satisfied with the improvement in quality of care provided by the home. This is broadly reflected in the results of surveys carried out by the CQC. Comments in surveys said, They take care of me, staff are kind and considerate, staff are nice, food is good and they keep the home clean. Examination of a number of health & safety records indicated that all necessary checks and servicing of equipment is routinely undertaken to safeguard the health and welfare of people using the service. Unnecessary risks to residents are identified using a comprehensive risk assessment. So far as possible the risks are reduced or Care Homes for Older People Page 25 of 29 Evidence: eliminated by putting in place effective guidelines, policies and procedures. Care Homes for Older People Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Peoples nutritional care plans should be up to date and accurately reflect their needs To protect residents from harm 18/01/2010 2 26 13 Ensure all staff receive training in infection control, COSHH and health & safety To protect residents from risk of infection 18/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 31 There is a need to recruit to the vacant management posts including Clinical Lead and Unit Manager to aid continuity and to strengthen the long term management arrangements. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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