Care Home: Oak Tree Lodge

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What the care home does well This home provides people with a safe, clean and homely environment to live in. People have access to a full range of health care support as necessary and receive personal support in the way they prefer and according to their needs. Before anyone can move into this home they undergo an assessment. This helps to prevent someone moving in whose needs cannot be met and helps people to decide whether the home is right for them. Staff are appropriately trained and recruitment procedures offer people living at the home protection. Staff are caring and helpful and friendly. The home is well managed and staff, people living at the home and visitors to the home said that the manager is approachable and always available to discuss any issues that may arise. People`s friends and relatives are made to feel welcome in the home and can visit as often as they please. People are free to make their own decisions and choices and receive a healthy diet. What has improved since the last inspection? All previous requirements have been met. People are now given a contract at the time of moving in detailing their rights`. Changes to the physical environment have been made as previously required and the home has continued to make other changes such as the new conservatory and redecoration of rooms. Everyone now has new bedroom furniture and lockable storage. The replacement of the downstairs carpets have eliminated any odours previously remarked upon. Policies and procedures have been updated on a regular basis and the home continues to make improvements to the care planning process. What the care home could do better: There were no requirements or concerns as a result of this inspection. People`s care plans do need to provide more information regarding how dementia or other mental health related issues affect the individual and how to best support them with these. We have not made a requirement about this as the home has demonstrated that they provide good outcomes for people and the manager agreed to address this issue. Some people have told us that they would like to have the opportunity to go out into the local community or on trips more frequently. Key inspection report Care homes for older people Name: Address: Oak Tree Lodge 114 Lyndhurst Road Ashurst Southampton Hampshire SO40 7AU     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: Chris Johnson     Date: 2 3 0 7 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 32 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 32 Information about the care home Name of care home: Address: Oak Tree Lodge 114 Lyndhurst Road Ashurst Southampton Hampshire SO40 7AU 02380292311 02380292311 pennylargent@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Carewise Homes Limited Name of registered manager (if applicable) Penelope Largent Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 19. 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)(E) Mental Disorder, excluding learning disability of dementia (MD)(E) Date of last inspection 19 19 0 Over 65 0 0 19 Care Homes for Older People Page 4 of 32 Brief description of the care home Oak Tree Lodge is a registered care home providing personal support and accommodation for up to nineteen older people with Dementia and Mental health needs. Carewise Homes Limited owns the home, and Mrs Penelope Largent is the registered manager and she has been in post since October 2006. The home is situated just off the main road that runs through the village of Ashurst, within close proximity to Lyndhurst and other areas of the New Forest. Accommodation is provided in a large detached extended house with four shared and eleven single bedrooms, on both the ground and first floor. Access can be gained to the first floor by a staircase and passenger lift. There is a dining room and large conservatory,a smaller second lounge is situated off the dining room. Care Homes for Older People Page 5 of 32 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: The purpose of this inspection was to assess how well the home is doing in the meeting of all key National Minimum Standards, compliance with regulations, compliance with previous requirements and to assess what the outcomes are for people who live at his home. The findings of this report are based on a number of different sources of evidence. These included: An unannounced visit to the home, which was carried out over one day on 23rd July 2009, whereby we looked at all key standards and followed up on requirements that were outstanding from the previous inspection. Any regulatory activity since the last inspection was reviewed and taken into account including any notifications sent to the Care Quality Commission and the predecessor organisation the Commission for Social Care Inspection. Care Homes for Older People Page 6 of 32 The Commission for Social Care Inspection carried out an Annual Service Review (ASR) of the home on 30th 2008 and this did not change the commissions opinion of the service or raise any issues for concern. The registered manager of the home completed an Annual Quality Assurance Assessment (AQAA) prior to the visit and this forms part of the evidence for this report. During this visit we looked at the physical environment including, peoples bedrooms and all communal areas of the home. We examined records, policies and procedures. We talked to people who live at the home, relatives and visitors who were there on the day and some members of staff. We observed staff during their day-to-day interactions with those living at the home. We also left surveys for staff and people living at the home. At the time of writing this report we had received completed surveys from nine people who live at the home and four members of staff. The manager was present during the visit to answer questions and discuss issues. Verbal feedback was provided at the end of the inspection. Care Homes for Older People Page 7 of 32 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 Care Homes for Older People Page 8 of 32 order line 0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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. This home provides people with sufficient information prior to them moving in and this assists them on deciding whether the home is right for them. The home continues to assess peoples needs before moving in and this lessens the chance of someone moving into the home whose needs cannot be met. Peoples rights are better protected now that they each have written contracts. Evidence: The last time that we visited this home we were concerned as it was found that people living at the home did not have contracts detailing their rights and therefore their rights were not fully protected. The home has since told us that they had issued everyone with a contract detailing their terms and conditions. This was also recorded in the Annual quality Assurance Assessment (AQAA). Everyone who returned a survey to us said that they had been issued with a contract. We were also shown copies of these for each person living at the home during our recent visit. Care Homes for Older People Page 11 of 32 Evidence: Feedback from surveys, discussion with people living at the home and their relatives was that they had all been given sufficient information about the home prior to moving in and that this information had helped them in making the choice to move in. The homes policy is that wherever possible when someone is interested in moving in they are invited to visit the home. In discussion with people during the visit and their relatives they confirmed that either themselves or their representative had the opportunity to visit the home, see the room available, talk to the manager and were given written information about the home. One relative commented that they had been shown copies of previous inspection reports and that they considered that they had been given all relevant information on which to base their choice of home. The last time that we visited this home on 25th July 2007 we found that the home was carrying out a satisfactory assessment of peoples needs before making a decision as to whether they could meet theses needs. The Annual Service Review (ASR) carried out on 30th June 2008 did not suggest that this had changed. The AQAA completed by the manager prior to this most recent visit stated that, A comprehensive needs assessment is carried out before an admission. This is carried out during and after meeting with a prospective resident. As the manager I would visit the person either within their own home or in hospital.This would either be carried out at the clients home or at a hospital. Discussions would take place with all relevant parties eg. care manager, health professionals, any family members, friends and advocates. If the resident was being transferred from another residential home discussions and assessments would be carried out with the staff of that home to ensure that we could meet all the needs of that resident. We looked at the assessment information for a sample of people who had moved into the home since our last visit. Thees provided us with evidence that each person had been assessed appropriately by the manager prior to moving in. The only issue that was discussed with the manager was the lack of written assessment information available from funding authoritys. It was agreed that the manager would insist on this information being available for all future referrals. Care Homes for Older People Page 12 of 32 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 are fully supported with their health care needs and have access to a range of specialist health care support. People receive personal support in the way they prefer and according to their needs. Evidence: The last time that we visited this home we found that there had been improvements regarding the level of information detailed in peoples care plans and to the management of medication. The Annual Service review carried out on 30th June 2008 did not raise any issues for concern. The manager stated in the Annual Quality Assurance Assessment (AQAA), All our residents have a comprehensive care plan which is centred on their choices, preferences and individuality.The care plans are flexible and are changed to meet the changing needs of the resident. They are reviewed monthly, however are reviewed more often if there are major changes with a residents needs. During our visit to the home we looked at the care plans and associated documents Care Homes for Older People Page 13 of 32 Evidence: such as risk assessments and medication records, in respect of three people. Each of the three care plans looked at provided detailed information, with clear and specific guidance as to the level of assistance that people required with their personal care needs. The information recorded in the care plans addressed peoples abilities with regard to personal care and daily living and provided evidence that peoples independence is promoted. Risk assessments had been completed as necessary and risk management plans were in place to address any identified risks. The AQAA stated that improvements made to the care planning process were as follows; We have recently reviewed all the residents care plans and all the information in their personal files and have introduced a number of new recording documentation.We have included personal preference details, life histories, new assessment guidelines. We saw evidence to support this during our visit and some family members spoken with said that they had been asked to contribute to the information. A total of nine service user surveys were returned to us. When asked whether they received the care and support that they needed, six respondents answered, Always and three Usually. in discussion with people living at the home and their relatives the consensus of opinion was that peoples health and personal care needs were being met. All staff contacted as part of this inspection said that they were given up to date information about the needs of people living at the home. Many of the people living at the home have needs associated with dementia and care plans addressed memory issues. However there was a lack of information regarding how dementia or other mental health related issues affected the individual and how to best support them with these. This was discussed with the manager during the visit. We have not made a requirement about this as the home has demonstrated that they provide good outcomes for people and the manager agreed to address this issue. From examination of medication records in respect of three people it was evident that staff were following correct administration recording procedures. Medication was stored safely and correctly. The home had a written medication policy and clear procedures. All staff undergo training before being able to administer any medication and regular auditing of the medication stock and records had been completed. People have told us that they receive appropriate medical support. The AQAA stated that, All residents have their own G.Ps, some of whom they have had for many years. If a resident requests to see their GP this is always arranged for them. They have access to all Health Care Services (hospital, clinics etc) and regular appointments are arranged as and when required (along with escorted transport). We saw records to substantiate this during our visit to the home. We saw that people had access to a Care Homes for Older People Page 14 of 32 Evidence: range of services such as GPs, Dentists, Chiropodists and District nurses. This was supported through conversations with people. Health care records were well maintained and demonstrated that the home liaised with health care services and referred people to specialist services as appropriate. Care Homes for Older People Page 15 of 32 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. People living at this home can receive visitors as often as they please and keep in touch with their family and friends. People are free to make their own decisions and choices and receive a healthy diet. Evidence: Following the visit to the home in July 2007, we made two recommendations. These were; That a review of the current activities available to Service users is carried out in Care Homes for Older People Page 16 of 32 Evidence: consultation with them and that changes to the activity programme are made accordingly and that Any review of the current menu be undertaken in consultation with the people living the home. The Annual quality Assurance Assessment (AQAA) highlighted the improvements that the home had made in the last twelve months as follows; Two members of staff have attended a Planned Activities for People with Dementia (PACT) and are very enthusiastic about their new roles. The new activities are all person-centred and reflect the diverse needs of our residents. Residents are always asked what their preferences are and what type of activity they would enjoy. These would then be planned for the week to ensure everyones needs are met. We have purchased new games specifically for those residents who have sight problems or mobility problems. We have installed new pictures within the home to stimulate conversation about days gone by. The new residents information board gives out daily information as to which staff are on duty, the date, whats on today. On the day of our visit the planned activity was Armchair athletics. Several people were observed to join in and others watched. All who took part appeared to enjoy the activity. The staff member facilitating the activity was observed to use a range of inter-personal skills and kept everyone who took part engaged in the activity. In discussion with people living at the home, their relatives and feedback from surveys people were generally happy with the level of activities available. A couple of comments were made regarding the lack of opportunity for people to go out and about in the community or on trips further afield. Currently an outside activities person visits the home three Tuesdays out of four to provide a range of different activities such as, reminiscence, quizzes, and singing. in addition the home provides an activity programme. The following activities were planned for July and August 2009; dominoes, card games, movies, skittles, hairdresser, card making, flower arranging and reminiscence. The manager stated in the AQAA that, We hope to improve stimulation and therefore improve the residents day to day life with the knowledge we have gained from their life History. They have highlighted interesting and surprising facts about the residents and we would like to use these to tailor the activities and services we provide. During the visit we saw a sample of the menus and had a discussion with the cook. We asked peoples opinions about the quality and variety of food on offer. Two of the nine people who returned a survey said that they Always liked the meals, six said usually and one answered Sometimes. In discussion with people living at the home Care Homes for Older People Page 17 of 32 Evidence: most were happy with the food and some relatives commented that they they thought that the variety and choice had improved. However one person did comment, The cooking could be better. The menu for the day of the visit was displayed within the home and this showed that there were two choices of main meal. Records held at the home were well maintained and we could see from these that menu choices are available daily and that people are offered a varied diet. In discussion with the cook we were informed that In the process of re writing menus looking at records to see what is popular. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes policies and procedures serve to protect those who live there. Evidence: The home reported that they had not received any complaints within the last twelve months and this was substantiated through examination of the homes complaints log. People living at the home told us that they knew who they could speak to if they were unhappy and most knew the process for making a complaint. Staff were equally aware Care Homes for Older People Page 19 of 32 Evidence: of the procedure to follow. In discussion with relatives they commented that they had been given information regarding the complaints procedure when their relative first moved in. One person commented, If you have any concerns you can talk to the manager, the deputy manager or staff and they will always sort it out . Another person commented that the manager was always available. The previous inspection did not raise any concerns in this outcome area. The Annual Quality Assurance Assessment (AQAA) stated that, We have written policies and procedures in place for the care and protection of our residents (reviewed regularly) no secrets policy and Whistle Blowing policy. All staff are aware and have knowledge of these policies and procedures.The procedure for reporting incidents of abuse displayed for the staff and also types of abuse are detailed in accessible files within the office. All staff have signed to confirm they are aware and understand the policies. Training is undertaken by staff regarding any changes in policies and legislation. Examination of staff training and recruitment files during our most recent visit provided sufficient evidence to support this. The manager has also demonstrated through recent practice that she is aware of the procedures to follow should there be any issues for concern. People are further protected by the homes recruitment procedures and the home does not look after anyones finances. Care Homes for Older People Page 20 of 32 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. This home provides people with a safe, clean and homely environment. Care Homes for Older People Page 21 of 32 Evidence: When we last visited this home we made three requirements regarding the physical environment. These were that, people must be supplied with secure lockable storage in their rooms, that a programme of repair, redecoration and replacement must be put in place that will provide all bedrooms with suitable furnishings and decor and that the home was to be kept free of offensive odours. During this most recent visit we saw all communal areas and each persons bedroom. On arrival, the home was found to be clean and tidy and smelt pleasant. The Annual Quality Assurance Assessment (AQAA) listed a number of areas of improvement since our last visit and provided the following evidence, We have improved many of the bedrooms by replacing carpets decorating and renewing furniture, curtains and bedding. We have purchased an industrial carpet cleaner and all spillages etc are now cleaned quickly and effectively. We have provided a much improved living area for the residents with the addition of our large conservatory. A new patio has been installed within the last year giving residents safe access to the garden and new garden furniture has been purchased .We continue to upgrade the home as and when required. Several people contacted as part of this inspection commented that they had seen an improvement in the homes physical environment. Everyone spoken with said that the home was kept clean and always smelt pleasant. We saw that people had been able to personalise their bedrooms with pictures and ornaments and bring in their own furniture should they wish to. Each bedroom had been provided with new furniture and every bedroom seen had lockable storage facilities. Our observations were that the bedrooms that had been redecorated were very bright and light. The new conservatory had created extra communal space and was being used by the majority of people during the visit. Other people spent time in the small lounge area watching television. The previous lounge diner has now become a dining room with individual tables each seating up to four people. The manager said that the impact for people living at the home was that they could now choose where and with whom they sit at lunch time. The home employs a housekeeper to oversee that the home is kept clean. We saw that staff are supplied with all necessary protection such as gloves and are given clear guidance and training. Information regarding infection control was displayed in the entrance to the home and all visitors were requested to use hand gel before entering the home. This was instigated by the current risk of Swine Flu. hand gels were positioned throughout the home and each member of staff also carried their own supply. Paper towels and liquid soap were present in all bathrooms and toilets as were Care Homes for Older People Page 22 of 32 Evidence: incontinence units in all toilets. The home has industrial type washing machines with sluicing facilities. These are hired and at the time of this visit they had broken down. As a consequence all laundry was being sent out to commercial laundry to ensure infection control. The home employs a maintenance person and they were on site during the visit. From discussion and examination of the homes maintenance book we saw that maintenance issues are dealt with promptly. Care Homes for Older People Page 23 of 32 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. Staff are caring and helpful. They are well trained and undergo a thorough recruitment process. Staffing levels are maintained. Evidence: We looked at the staff rota for the day of the visit and this proved to be a true reflection of the actual staff on duty. We also saw that the staff rota had been planned for the forthcoming weeks and that arrangements had been made to cover staff leave. The home employs domestic staff as well as care staff and this means that care staff can spend more time attending to peoples needs. Staff were asked whether there Care Homes for Older People Page 24 of 32 Evidence: were enough staff to meet the individual needs of all the people who live at the home. One person responded, Always and the other said that there Usually were. Staff always friendly and chatty When we asked people living at the home and or their relatives whether there were staff available when they needed them, six people said that there Always were, two answered Usually and one Sometimes. One or two people commented on the fact that people do not get to go out and about in the local community or go on trips. One person said, I would like to go out sometimes for outings for the day. The manager said that on occasions people do gout with staff but on the whole people go out with relatives or friends. It is uncertain how many people would like to get out more frequently if at all. However the home should discuss this with people individually to ascertain peoples wishes. This may mean that the home needs to review staffing levels. We did see however that they had increased the staffing level in the afternoon period with the introduction of an activity person to free up care staff to attend to peoples care needs. This was commented upon by a relative who felt that this was an improvement. Everyone contacted as part of this inspection were complimentary about the staff and felt that they were given sufficient support with their care needs. Several people commented that the atmosphere within the home was Happy. One relative said, Staff are always nice friendly and happy. Another commented, All the staff are very friendly and personable. They spend time with mum and seem to like her as an individual rather than just treating her as a resident. These comments were reiterated by people living at the home. Previous inspections of the home have demonstrated to us that the home carries out a thorough recruitment procedure. The Annual Quality Assurance Assessment (AQAA) provided evidence that this is still the case. During the visit we looked at the recruitment records of two members of staff who had been employed by the home since the last inspection. These demonstrated that the home continues to follow an appropriate procedure. We saw that out all relevant checks had been completed prior to them commencing work at the home. Staff members told us that they considered that they had undergone a thorough recruitment process and that their induction had covered everything that they needed to know to do the job when they started. All staff contacted felt that they received training that was relevant to their role, helped them meet peoples needs and kept them up to date with new ways of working. Staff records showed that staff receive training in core areas such as moving and handling, infection control and medication and that this training is updated regularly. Alongside this staff undertake external training as well as in-house training. At the time of this visit the home employed thirteen carers all part time. The manager reported that four staff had obtained a NVQ level three and five held a NVQ level two. Two further staff Care Homes for Older People Page 25 of 32 Evidence: were due to undertake an NVQ in September 2009. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has an open door policy and is accessible and sensitive to the needs of those living at the home. The home is well managed. The manager and staff team have worked hard to comply with previous requirements. Safety is promoted within the home. Care Homes for Older People Page 27 of 32 Judgement: Evidence: The registered manager has been in post since October 2006. She holds the Registered Managers Award and a NVQ four in Health and Social Care. The manager reported that she received mandatory training when required and that she attended courses to keep updated on current policy and procedures and changes in legislation. The manager reported that she had the autonomy to make decisions and manage the home. The Annual Quality Assurance Assessment (AQAA) completed by the manager prior to the visit to the home proved to portray an accurate reflection of the both the improvements made since the last inspection and reflected the managers ability to identify where further improvement are needed. The manager home has dealt with all previous requirements within agreed timescales. Since our last visit to the home a deputy manager has been appointed to work alongside the manager in delivering training, supervisions and overseeing care plans. The deputy manager also provides cover during the managers absence. Staff, people living at the home and their relatives commented on the fact that the manager had an open door policy and that they could approach her, the deputy manager or any member of staff if ever they wished to discuss anything. One relative commented, Communication is excellent the managers door is always open. Examination of a sample of policies and procedures during the inspection demonstrated that these are kept under regular review. We saw that a representative from the organisation visits the home on a monthly basis to monitor the effectiveness of the service. Records showed that during these visits people living at the home were consulted and spoken to staff were interviewed, the environment and upkeep of the home was monitored and records were examined. In addition to the this a manager from another home within the organisation recently carried out a full audit of the home. The home had recently sent a questionnaire to all of the people living at the Care Homes for Older People Page 28 of 32 Evidence: home and their representatives and at the time of this inspection they were in the process of analysing the results. The manager confirmed to us that the home is not responsible for any persons monies or finances and does not look after money or valuables on anyones behalf. Staff told us that they met with manager regularly for support. Examination of staff files supported this. We saw documented evidence during our visit to the home that maintenance checks, tests and servicing of equipment are carried out regularly. Examination of the fire logbook confirmed that weekly fire alarm checks are undertaken. We saw recorded evidence that regular fire drills take place and the homes fire risk assessment had recently been reviewed. There were not any concerns with regard to safety within the home. Care Homes for Older People Page 29 of 32 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 30 of 32 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 31 of 32 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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