Care Home: Oaks Residential Care Home (The)

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well The home was clean and free from offensive odours. The recruitment processes are robust and in accordance with current legislation. Training of care staff is good and 95% of staff have achieved a National Vocational Qualification at level 2 or 3. The staff team work co-operatively with each other and this was observed during the inspection process. Their interaction with service users is good, and they are knowledgeable as to the needs of the individual. Service users told us that the meals are very good and that they are always given a choice. Drinks and snacks are always available throughout the day and night. Complaints are viewed as positive, and are dealt with in accordance with the home`s policy and procedures. Currently there are no safeguarding issues that relate to the home, and staff were very clear around the importance of safeguarding vulnerable adults. The administration of medication is good and the service has audit systems in place to monitor controlled drugs and other medication. What has improved since the last inspection? Care planning documentation is more detailed, and generally the file management and systems at the home have improved. The appointment of a permanent administrator has helped this process. Daily activities have improved and again this has been helped with the appointment of an activity co-ordinator. Services users and staff have been involved in planting runner beans and tomatoes in the garden and have then been able to pick these for use in the home. The extension has now been completed and this has improved the communal facilities for the service users in that another large lounge, with easy access to a paved garden area, is available. What the care home could do better: Daily recordings should be more reflective of the outcomes identified in each person`s care plan and such recordings will aid the review process and the updating of care plans. Also to involve service users in more community activities such as local clubs, pubs and shops. This would also be helped in service users became members of transport services such as dial-a-ride. The registered person must ensure that all parts of the home are maintained in a good decorative condition, and this particularly relates to the original building, and also that there is sufficient and appropriate storage for wheelchairs and zimmer frames. The quality assurance system in the home should be more robust so that it takes into account the views of service users, relatives and staff and that the outcomes are available for stakeholders to see. This will also be important to the process of ensuring that the service is always improving for the benefit of service users. Staff must ensure that PRN protocols are put into place, that 2 signatures are obtained when transposing information by hand from medication packs onto MAR (medicine administration record) sheets, and that the actual number of tablets administered is recorded, for example where a prescription is for 1 or 2 tablets. Also the new controlled drugs cupboard must be securely fixed to an external wall in accordance with new legislation. Key inspection report Care homes for older people Name: Address: Oaks Residential Care Home (The) 28 Hall Lane Upminster Essex RM14 1AF     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: User doesnt belongs to any group     Date: 0 7 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 28 Information about the care home Name of care home: Address: Oaks Residential Care Home (The) 28 Hall Lane Upminster Essex RM14 1AF 01708220761 01708510247 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Oaks Residential Care Home care home 26 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: 26 The registered person may provide the following category of service only: Care Home Only - Code 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 - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The Oaks is registered to care for up to twenty-six people. The home consists of a large three-storey house with a back extension, set in a residential area of Upminster. There are 24 single bedrooms and one shared room. Bedrooms have an ensuite toilet and hand basin, with the exception of one room that only has a hand basin. All bedrooms have a TV point and a call system. There is a passenger lift to all floors. There are two lounges, one at the front of the home, and another at the rear of the home which overlooks the rear garden which has disabled access. The dining room is situated to the side of the home. There are car-parking facilities to the front of the Care Homes for Older People Page 4 of 28 0 0 Over 65 26 20 Brief description of the care home property for staff and visitors. The home is situated close to local facilities in Upminster and is accessible by public transport and by car as is the M25, A127 and the A12. At the time of the inspection the fees ranged from £550 to £600 plus depending on the assessment of need. The service does contract with local authorities at their agreed rates. The statement of purpose, service user guide and last inspection report were available in the home, and a copy of the statement of purpose can be obtained on request from the manager. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was undertaken by the lead inspector for this service, Mrs. Sandra Parnell-Hopkinson. We arrived at the home at 09:00 hours on the 7th September 2009 to undertake an unannounced key inspection. The proprietor/manager and the deputy manager were available throughout the day to aid the inspection process. We were able to talk to service users, some relatives, a visiting health care professional and staff, and also took evidence from care plan documentation, maintenance records, complaints log, recruitment files, training records, a tour of the building and other relevant records. We also looked at the annual quality assurance assessment, which is a document required by the Commission which must be completed and returned as required by Regulations. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Daily recordings should be more reflective of the outcomes identified in each persons care plan and such recordings will aid the review process and the updating of care plans. Also to involve service users in more community activities such as local clubs, pubs and shops. This would also be helped in service users became members of transport services such as dial-a-ride. The registered person must ensure that all parts of the home are maintained in a good decorative condition, and this particularly relates to the original building, and also that there is sufficient and appropriate storage for wheelchairs and zimmer frames. The quality assurance system in the home should be more robust so that it takes into account the views of service users, relatives and staff and that the outcomes are Care Homes for Older People Page 7 of 28 available for stakeholders to see. This will also be important to the process of ensuring that the service is always improving for the benefit of service users. Staff must ensure that PRN protocols are put into place, that 2 signatures are obtained when transposing information by hand from medication packs onto MAR (medicine administration record) sheets, and that the actual number of tablets administered is recorded, for example where a prescription is for 1 or 2 tablets. Also the new controlled drugs cupboard must be securely fixed to an external wall in accordance with new legislation. 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 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who intend to use the service and/or their relatives are given sufficient information to enable them to make an informed decision that this is the right home for them, and that it will meet their needs. Evidence: The service has a comprehensive statement of purpose and service user guide which were reviewed recently due to a change to the registration of the home as a result of an extension and increased bed availability. The guide details what the prospective service users can expect when moving into the home, the quality of the accommodation, qualifications and experience of staff and how to make a complaint. A copy of the most recent inspection report is available in the reception area of the home. Prior to a service user moving in, a full needs assessment is undertaken by qualified staff for those who may be self-funding. For those service users who are being funded Care Homes for Older People Page 10 of 28 Evidence: by a local authority, the service insists on receiving a summary of the assessment and a copy of the proposed care plan. Where possible, prospective service users and/or their relatives can visit the home and spend time talking to service users and staff. We were able to speak to a visiting relative who told us I visited the home for my mother, and as soon as I walked in I liked the friendly atmosphere and manner of the staff and knew that this would be the home for my Mum. All service users are provided with a statement of terms and conditions or a contract, and these set out the fee, the role and responsibility of the provider and the rights and obligations of the individual. Such statement of terms and conditions or contracts are regularly reviewed. Information can be provided in different formats if required by a service user. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs within the principles of respect, dignity and privacy. Evidence: Service users receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness and respect. Care plans were comprehensive and covered personal healthcare needs including any specialist health, and dietary requirements. However, daily recordings should be more reflective of the identified outcomes in the care plans. This will give more detailed information as to areas of improvement, or areas which still require improvement, and will aid the process of reviews and the updating of care plans. We observed staff responding in a positive and responsive way to the varied and individual needs and preferences of the service users. Care is flexible, consistent and person centred. Service users are supported and helped to be as independent as possible, and are encouraged to take responsibility for their personal care needs. Currently no service user has pressure ulcers. Care Homes for Older People Page 12 of 28 Evidence: All service users are registered with a GP, and we were informed that there are several GPs with whom service users are registered. We were also told that some of the GPs are really good and responsive to the needs of the service users, but others were not particularly responsive and pressure had to be applied for a home visit which was undertaken reluctantly. All service users have access to a dentist, chiropodist and optician and other health and social care professionals as necessary. Where necessary risk assessments are in place, and regularly reviewed. All service users have an emergency detail form which gives relevant and appropriate information in the event of them having to be admitted to hospital. Aids and equipment are available where appropriate and necessary, and these are well maintained. However, storage of these items is a problem but the bathrooms and toilets are not appropriate for the storage of these as they can pose a health and safety hazard for people using these facilities. We did discuss this during the inspection and the proprietor has assured us that she will look for alternative storage areas for wheelchairs and zimmer frames. Obviously hoists need to be readily available in the bathrooms/toilets but these should be stored safely so that they do not pose a hazard to the service users. Staff have access to training health care matters and are encouraged and given time to attend seminars on specialist areas of work. During the inspection and having had discussions with the district nurse, she has offered to undertake some training with the staff around health care areas such as catheter care. This offer was readily accepted by the manager and her deputy. Staff were very aware of the importance of equality and diversity issues, but currently all of the service users are white British, although staff are from various ethnic minorities. We looked at the medication administration and generally the home was compliant with the receipt, administration and recording of medication. All staff involved in the administration of medication have undertaken the relevant training. Controlled drugs are currently stored in a wall mounted cupboard, but this does need to be changed in accordance with the new legislation around the storage of controlled drugs. The home has purchased the necessary cabinet and this will now need to be fitted to an external wall. Controlled drugs were accounted for and there is a good system to ensure that this medication is audited daily. We are making a requirement around the procedure for handwritten entries requiring two signatures, the need for PRN (as required) medication to have written protocols and the need to indicate whether 1 or 2 tablets were given where there is choice as prescribed. This was discussed during the Care Homes for Older People Page 13 of 28 Evidence: inspection process with the manager, deputy manager and a senior care worker. The home is currently working on preparing documentation on the preferred place of care and end of life wishes. However, it was evident during the inspection that staff and management work to high consistent standards to ensure that service users who may have a degenerative or terminal condition receive the care they need. The family of a recently deceased service user wrote I would like to express my gratitude to you all for your kind and unwavering support of Mum over the last year and half of her life. I know she wasnt always the easiest person to deal with, but you were all constant in your help and care. You were with her in her last moments, supporting her and saved her from her fear of dying alone. I thank you all from the heart for all you did for her, and your support for me after her death. I would recommend your home highly to anyone considering moving there. Staff understand and are sensitive to the particular religious or cultural needs of the individual and their family. Where necessary the home seeks guidance and support of care for service users who are dying. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use these services are able to make choices about their life style, and are supported to maintain or develop their life skills. However, the service could do more to support people in undertaking more community activities. Evidence: The service has a strong commitment to enabling service users to develop or maintain their skills. Care plans showed that individuals are supported to identify their goals and are supported by staff to achieve them. It was evident from talking to service users, relatives and staff that service users are encouraged to develop and maintain important personal and family relationships. One person told us that she had celebrated her birthday the day previously, and that the home had a party for her. Other service users had been encouraged and supported to make birthday cards for her and these were on show during the inspection. A relative told us whenever I visit we are always made welcome, the staff are wonderful and always offer a cup of tea. I have no concerns with the care of my mum, and am really happy that I chose this home for her. As soon as I walked in there was a really lovely, friendly feeling. Staff practices are such that the human rights of people are respected with fairness, equality, dignity and respect which underpin the care and support being given. Where Care Homes for Older People Page 15 of 28 Evidence: some service users have difficulty in communication, staff understand this and support people to fully participate in daily living activities. The service has purchased a book on visual communication aids, and this has helped several of the service users indicate their wishes. The home now employs an activities co-ordinator who is at the home on three days each week. This has helped to improve the daily activities of the service users, and staff also now become involved in activities. The service is now looking at involving more community activity and are pursuing service users becoming members of Dial-aRide so that they can visit community clubs, shops and other facilities. Currently some member of staff do take service users out in a wheelchair to local shops. The service is committed to promoting and fostering good relationships with neighbours and other members of the community. Currently Community Support Officers with the local police force visit the home on a regular basis to talk to service users. The home does hold meetings with service users so that they become more involved in the running of the home. A member of staff has 2 pet dogs and she brings these into the home when she is off duty, much to the pleasure and enjoyment of many of the service users. The completion of the extension has now meant that the communal facilities have improved with the addition of another lounge/diner. This has meant that both lounges now offer more space to the service users. We were able to observe mealtimes and were pleased to see staff giving assistance to those service users who required this, and this was being done in a sensitive and unhurried manner at a pace dictated by the service user. The menu is varied with a number of choices available, and service users told us the food is really nice, we really enjoy it. There is always plenty and always a choice. We saw that fresh fruit and vegetable are always available. Some of the fresh vegetable are being grown in the homes garden area, and some service users are enjoying picking the runner beans and tomatoes which they had been involved in planting earlier in the year. Where necessary, service users are enabled to make choices around meals with the use of pictorial menus. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Service users are protected from abuse. Evidence: We spoke to service users and relatives and were told that they knew how to complain, and that the manager and her deputy always dealt with complaints in a positive and open manner. Service users also told us that they were very happy with the service provided by the home, and 1 person told us I think my money is very well spent, the home could not be better. People told us that they felt safe and well cared for by staff who are kind and caring. The complaints procedure is supplied to everyone living at the home and is available to people at various locations in the home. The home maintains a record of complaints and of any actions undertaken. We are satisfied that the service views complaints in a very positive manner, and the outcomes are used to improve services to people living at the home. All staff understand what restraint is and the alternatives to its use are always looked for. Equipment that may be used to restrain individuals such as bed rails, key pads, recliner chairs and wheelchair belts are only used when necessary and within a risk assessment process which involves the individual, their families and professionals such as the social worker or the GP. The policies and procedures for safeguarding adults are available and give clear Care Homes for Older People Page 17 of 28 Evidence: guidance to those using them. Staff are clear what constitutes abuse and of the action they would take if they saw, or suspected any abuse of vulnerable people. There is a clear system for staff to report concerns about colleagues and managers, and staff who blow the whistle on bad practice are supported by the service. Two safeguarding referrals have been made by the home about the condition of people who had recently been discharged from the local hospital. These matters are being investigated by the local safeguarding officers of the London Borough of Havering. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables service users to live in a safe, generally well maintained and comfortable environment which aids independence. Evidence: The home was clean and free from offencive odours. With the addition of the new extension the facilities have improved for people living at the home. Both lounges are now more extensively used and this has created more space for service users. Furniture is of a good standard, but some areas of the original building require redecoration, and some carpets either need deep cleaning or replacing. This was discussed with the manager during the inspection, and she has told us that this work will be undertaken as soon as possible. We would also recommend that the manager or the deputy manager undertakes a walk around of the whole home on a weekly basis and this will help to identify quickly those areas which require attention. Bedrooms have been personalised by the occupant, and bedrooms are only shared in limited situations and only by agreement with the people concerned. All of the new bedrooms have an en suite facility. There are sufficient bathrooms or shower rooms to meet the needs of the service users, and these are fitted with appropriate aids and adaptations to meet the needs of the people using the service. However, the home is reminded that wheelchairs and Care Homes for Older People Page 19 of 28 Evidence: zimmer frames should not be stored in the bathrooms as these could pose a hazard to service users. This was discussed during the inspection and the manager is looking at other areas for the storage of these items. The new extension has included a new office, staff room and laundry room in a new building at the rear of the home. Also the kitchen cupboards and equipment have been renewed with some additional alterations to the kitchen area. The garden area has been laid with raised flower beds, and there is a ramp for easy access by service users. Garden tables and seating is available and service users are encouraged to use these when the weather is fine. The front area of the home has been cleared of the large trees and this has opened up the aspect from the reception area of the home which also provides some seating for those people who like to sit and watch the world go by. Car parking areas are available at the front of the home. The home is a non-smoking establishment. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, and to support the smooth running of the service. Evidence: On the day of the inspection there were sufficient staff on duty to meet the needs of the service users. The management is aware of the need to ensure that at times staffing levels need to be flexible so that the changing needs of people continue to be met. Staffing rotas show that some staff work long days but this is in accordance with their choice, and also the needs of the service, but the service ensures that it is compliant with the requirements of the Working Time Directive and other health and safety legislation. There is little staff turnover, and this has meant a more consistent service for people living at the home, and also no current use of agency staff. Training is given a high priority in this service and staff can undertake external qualifications. For example 98 of staff have achieved NVQ level 2, some to NVQ level 3 and the manager, deputy manager and a senior care worker have achieved the Registered Managers Award. Training has included first aid so that there is always a trained first aider on duty at the home, dementia awareness, Mental Capacity Act and Deprivation of Liberty Safeguards, safeguarding vulnerable adults, moving and handling, medication administration, food hygiene and infection control. Staff spoken to had a good understanding of safeguarding issues and also of issues around equality Care Homes for Older People Page 21 of 28 Evidence: and diversity. Staff told us that they worked as a team for the benefit of the service users, and this was observed during the inspection process. Team working involves staff from the management, care, housekeeping, cooking and administration areas of the service. Staff were observed to be interacting well with service users. Recruitment processes and procedures are robust and all staff receive supervision which includes 1:1 sessions, staff meetings and direct observation of care practices. Recently the service has appointed an administrator and this person has made a tremendous improvement to the file management and other systems within the home. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect but the quality assurance systems could be further developed to make them more robust as to ensuring outcomes for service users. Evidence: The manager, who is also the proprietor, has the required qualifications and experience and is competent to run the home. The manager has a clear understanding of the key principles and focus of the service and is working continuously to improve the service. A deputy manager and an administrator have been recruited since the last key inspection, and it is clear that these additions have improved the service provision, especially in the area of file management and systems. We looked at maintenance files and there were up to date certificates around gas, electric, fire risk assessment, lift maintenance, equipment maintenance, legionella testing, health and safety compliance following a visit from the local environmental health officer. The necessary insurance cover is also in place to enable the service to fulfil any loss or legal liabilities. Care Homes for Older People Page 23 of 28 Evidence: There is a focus on person centred thinking and a strong ethos of being open and transparent in all areas of running of the home. The service promotes equal opportunities, and ensures that equality and diversity issues are always positively addressed and promoted. Policies and procedures are in place and these are reviewed and updated in line with changing practices and legislation. Through staff supervision and ongoing monitoring the service ensures that staff are aware of the policies and procedures including health and safety issues, and that theory is put into practice. The service does not hold monies for service users, but will expend money on their behalf and then invoice either the individual or his/her family for reimbursement. Where possible people are supported to manage their own money. Quality assurance procedures could be strengthened to include feedback from health and social care professionals. The AQAA, annual quality assurance assessment, which is required to be completed and returned to the Commission contained relevant information but this could be more comprehensive and this was discussed during the inspection process. When necessary the home sends notifications as required under Regulation 37 of the Care Homes Regulations 2001. However, because the proprietor is also the manager visits and reports are not required under Regulation 26 of the Care Homes Regulations 2001. Currently there have not been any referrals under the Deprivation of Liberty Safeguards. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. To ensure accurate recording two signatures are required when transposing medication instructions from a packed onto a MAR sheet. Also to ensure service user safety the home must develop protocols around the individual PRN medications, and to also record whether 1 or 2 tablets were administered. Also the controlled cabinet must be secured to an external wall in accordance with legislation. 11/09/2009 Care Homes for Older People Page 26 of 28 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 2 19 23 The registered person must ensure that equipment not in use is safely and appropriately stored. This is to ensure the safety of service users when using the bathrooms. 25/09/2009 3 33 24 The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. A more formal quality assurance system which involves feedback from service users, relatives and health/social care professionals would help to identify areas of service which could be improved to the benefit of the people living at the home. 30/10/2009 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 19 The registered person is recommended to undertake a regular walk around of the whole building to ensure that any areas which require attention are identified quickly. This will help to ensure that the home is always maintained to a good standard. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!