Care Home: Oakwell

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What the care home does well People living at Oakwell describe the place as being "very homely". Important information is obtained about people prior to agreeing to their moving to the home. Every person has a care plan that is discussed and agreed, so that everyone knows what is required from the team. The team of staff have good links with professionals, which helps to improve peoples` health and for some helps them on the road to recovery so that they can return home. People who live at the home say that the staff are "very kind and caring" and are well trained. Their relatives are very satisfied with the care and also say that their relations are "very content". People living at the home told us they are treated as individuals and always have something "to look forward to". The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. Families and friends say that they are encouraged to visit whenever they wish to and are kept informed about any changes. The home plays an active part in the local community and regular meetings are held with Age Concern for example. There is a good choice of appetising and well-balanced meals. People tell us that the choice is good and meals are "tasty" and are "always very good". Oakwell is a spacious and comfortable place to live. People who use wheelchairs or walking aids find it easy and safe to get around the home. The garden has plenty of seating and there are raised beds so that people can enjoy the flowers and fresh air. People living there say that it is always clean and well maintained. Staff feel well supported and are encouraged to do a lot of training so that they care for people properly. What has improved since the last inspection? The assessment of people needing admission to Oakwell under the `rapid response` service has been improved and ensures that the team have a full and thorough assessment of a person`s health, social and psychological needs before being admitted to the home. Handwritten records of medication that is prescribed for a person and the recording of when medicines have been taken/given to an individual have generally improved. Quality assurance checks are being done and have reduced the risk of errors being made. What the care home could do better: Oakwell is an exceptionally well run home that has effective quality assurance systems in place. Therefore, we have not needed to make any legal requirements. A clearer system for recording controlled medication should be put in place, so that people are not put at risk of potential errors being made. Key inspection report Care homes for older people Name: Address: Oakwell Lyddicleave Bickington Barnstaple Devon EX31 2JZ     The quality rating for this care home is:   three star excellent 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: Susan Taylor     Date: 1 7 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: Oakwell Lyddicleave Bickington Barnstaple Devon EX31 2JZ 01271327252 01271329332 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: http/www.devon.gov.uk Devon County Council care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The home may admit up to 10 service users on the intermediate care unit over the age of 50 years The maximum number of placements including that of the service users under 65, will remain at 20, of whom 10 may be in the intermediate care unit Date of last inspection Brief description of the care home Oakwell is situated in the quiet village of Bickington on the outskirts of Barnstaple and was originally constructed in 1974 as a home for older people, it is owned by the Local Authority. In 1994, there was a total refurbishment of the premises; it reopened as the North Devon Community Care Support Centre. The centre houses a residential unit providing accommodation and personal care for up to 20 older people with physical and/or mental health needs; of this 20 up to 10 clients aged fifty years and over may be admitted for short term intermediate care, which also includes admission Care Homes for Older People Page 4 of 29 Over 65 10 10 0 0 Brief description of the care home of people under a rapid response service. A respite service and rapid response service is also provided at Oakwell. The centre also houses a home care service and a day centre. Fees are £570.50 per week; additional charges are made for some things such as hairdressing, chiropody, toiletries, magazines and newspapers and transport booked by clients. A copy of previous inspection report is available in the entrance of the home and on notice boards throughout the home. 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: three star excellent 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 quality rating for this service is three stars. This means the people who use this service experience EXCELLENT quality outcomes. This was a key inspection of Oakwell under the Inspecting for better lives arrangements. We were at the home with people for 9 hours. We looked at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We met 10 people that live at Oakwell and observed how staff looked after them. We also met 9 staff. Their comments and our observations are included in the report. Care Homes for Older People Page 6 of 29 In December 2009, the fees were £570.50 week for personal care. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk 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: Oakwell is an exceptionally well run home that has effective quality assurance systems in place. Therefore, we have not needed to make any legal requirements. A clearer system for recording controlled medication should be put in place, so that people are not put at risk of potential errors being made. Care Homes for Older People Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 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 involved in the assessment process and information is gathered from a range of sources to ensure that individuals needs are known. Evidence: People living in the home and relatives verified in a survey that the home provides sufficient information for them to make decisions about whether to live at the home or not. We saw that everyone had a copy of the service users guide in their room. Similarly, everyone that responded in the survey had received a contract. We spoke to a number of people that live at the home who told us that Oakwell meets their needs. Visitors told us that the home is fantastic, we looked at other homes but nothing compares and the reputation is very good locally. The manager told us that people are assessed by herself or deputy managers who go to visit the person in their current setting to make an assessment. Since the last Care Homes for Older People Page 11 of 29 Evidence: inspection, the team have developed a referral form that is used to obtain information about people using the intermediate care service or rapid response service. This ensures that professionals involved in the individuals care provide a full and thorough assessment of the persons health, social and psychological needs before being admitted to the home. And has prevented unwanted outcomes for people using the service. The manager told us that the number of inappropriate referrals had decreased to around 15 percent. We looked at the care files for 3 people that we case tracked, one of which was for a person receiving intermediate care after a hospital stay. A thorough assessment of needs had been completed with people and their relatives when they moved into the home. Assessments completed covered establishing any risks for an individual about their tissue viability, falls, and nutritional status. Additionally, information about the individual had also been obtained from social services where care package had been commissioned by them. Oakwell has an intermediate care service. We case tracked a person that had been in hospital and needed intensive therapy. Important information had been obtained and professional assessments had been completed by the physiotherapist and occupational therapists that work in the home 3 days a week. The individual had clearly written goals, which had been reviewed every week with the individual. These had been set out in easily achievable steps and daily records demonstrated that staff had been following these with the invididual. The stated aim for this person is to be independent and to be able to return home. The person said that Oakwell is a comfortable place to be after having spent time in hospital and felt they were on the road to recovery. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive person centred that is based upon the rights of dignity, equality, fairness, autonomy and respect. Medicines generally handled safely for people living in the home. Evidence: We casetracked 3 people by speaking to them and also observing the care they were given. We read their care plans and concluded that individual personal preferences, routines and social activities were well known by staff and had been documented. This has ensure that all staff have a good understanding of how each person prefers their care and support to be delivered. We looked at 3 care files, which demonstrated that the home has good professional relationships with general practitioners, nurse specialists and the consultant psychiatrist. For example, a person with dementia had been visited at the home by the consultant psychiatrist and their medication had been reviewed and changed. In addition to this there are good links with the mental health and social services teams. Letters seen on files indicate good communication and partnership working that Care Homes for Older People Page 13 of 29 Evidence: ensures that people living in the home receive appropriate care. A person who was receiving intermediate care following a stay in hospital had a clearly laid out care plan, with achievable goals that had been agreed with the individual. The care was managed by the professional team, including the physiotherapist and occupational therapist. Care records demonstrated that the individual was making good progress towards their goal of independence. We spoke to the person and they said that Oakwell is a comfortable place to be after having spent time in hospital and felt they were on the road to recovery. The home had clear policies and procedures about risk assessment and management, which had been robustly implemented. All of the care files had guidance on action to be taken to minimise identified risks with regard to tissue viability, falls, manual handling, and continence. All of the assessments had been regularly reviewed. Where a high risk of development of pressure ulcers had been highlighted, we read similiar entries in the persons care plan and saw that the individual had pressure-relieving equipment on their bed. Staff that we spoke to had a good understanding of preventative care and were seen encouraging the individual to keep mobile. A high standard of information is recorded, demonstrating that care and health needs are constantly assessed and monitored. Verbal information and feedback in respect of individuals personal and health care needs is given to staff at the start of each shift. This process was observed at the beginning of the afternoon shift. This handover also gave staff time to ask questions and give their view about how an individual was doing. One persons care file highlighted that there were risks associated to medicines because the person had poor eyesight and sometimes non compliant with taking their medicines. We observed that when this person was given their medicines staff did this by taking account of the individuals disability and also carefully monitored that they had swallowed the tablets. This was challenging because the person did not want to take some of the medicines. We observed the staff dealt with this calmly and respected the individuals wishes. They said I will try XXX again later. I can see by his facial expressions that XXX is in discomfort. We later observed this being done and on the second attempt the person took their medicines. This demonstrates that people receive person centred care that is based around their needs. All medication was kept in a secure place; controlled medicines were stored in accordance with legislation. We case tracked an individual precribed controlled medication. We found the register very difficult to audit, however eventually found the Care Homes for Older People Page 14 of 29 Evidence: right entries demonstrating that stocks tallied with the records kept. The member of staff that showed us this said its very difficult with this register as people are coming and going for respite. Weve asked the company if they do a better register for this. We concluded that the person had received the medicine as prescribed and that steps are being taken to find a better recording system. We looked at medication records for 2 people. Generally these were well kept, however we did see one gap in recording on 6/12/09 at 10pm for an individual we were case tracking. We reported this to the manager, who later investigated this and established through daily records that the medicines had actually been given but staff had been distracted dealing with a violent incident and had omitted to document this on the Marr chart. As a result, staff have been reminded about the importance of keeping accurate records and the manager is doing quality assurance checks to ensure this happens. We observed that staff always knocked on doors before entering peoples rooms. We observed a number of interactions between staff and people living in the home, some of which were quite challenging. Staff responded in a professional and calm manner that immediately put the person at ease and diffused the anxiety and agitation being displayed. We also observed that staff treat people with respect and kindness, and this was further verified by one of the people we met who said they all treat you nicely. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines within the home are suited to individuals needs; they are able to maintain contact with family, friends and the local community and enjoy a nutritious and well balanced diet. Evidence: Information sent to the Commission verify that 100 percent of people living at Oakwell are of christian faith. Staff told us that dependant upon individual wishes, people are taken to church or relatives or congregation members do so. The programme activities had a number of festive events, including carol singing. Throughout the home we saw colourful decorations and Christmas trees, which gave a festive atmosphere. We case tracked 3 people and read the information that had been obtained by the home about each person. Information sent to the Commission tells us that monthly reviews are done with peoples relatives, where the person lacks capacity in which ideas are sought from them about their relations social history including significant relationships, social networks, interests and hobbies. This information was reflected in all three peoples care plans. For example, one person is a fan of Daniel ODonnell and their care plan outlined how this interest could be encouraged. We observed this person watching a DVD of Daniel ODonnell, which they appeared to be enjoying by Care Homes for Older People Page 16 of 29 Evidence: singing along to songs and tapping their feet. We observed 2 people doing a jigsaw with a member of staff, who demonstrated good skills when interacting with the individuals who were engrossed in the activity and who later we discovered had dementia. We spent some time sitting in the lounge and saw that people appeared alert and stimulated. Staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. Information sent to the Commission tells us that a weekly meeting is held, which includes Age Concern who support people receiving intermediate care when they are discharged home. This demonstrates good continuity and partnership working with agencies that provide additional support in the community. Lunch was served during the inspection, which was well balanced and appetising. We saw at least three different choices being served. Plenty of fruit and vegetables were creatively incorporated into all courses and staff sought informal feedback from people throughout the meal. People we spoke to made comments like lunch is lovely and they know what you like . We also observed how staff supported people that needed help with eating their meals. Carers focussed all their attention on the individuals concerned chatting with them, gently explaining what was on the plate and at a pace that suited the person. We saw that equipment such as plate guards were used enabling people to continue feeding themselves without assistance. We looked at 3 care files, which demonstrated that weight is checked on a monthly basis to ensure that people stay within a healthy weight. These records showed that people had either steady gained or decreased weight towards more healthier levels dependent upon their needs. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Oakwells policies ensure that people are protected and able to voice their concerns, safe in the knowledge that these will be acted upon. Evidence: Information sent to us by the manager tells us that since the last inspection they have shared the learning gained as a result of complaints investigated as a management group across the locality and have also shared best practice. We looked at the documentation relating to a recent complaint that the manager had investigated. This demonstrated that concerns had been taken seriously and a thorough investigation had taken place. Careful consideration had been given as to how best to feedback the findings to the individual concerned, which demonstrated a respect for that persons view point. People living in the home that were able to tell us said that they are satisfied that the home listens to them and deals with any concerns in a timely way. The Commission received no complaints before or during the inspection. We saw a copy of the Alerters guide. The home also had a whistle blowing policy, which all of the staff we spoke to understand. Kind and caring interactions were observed throughout the day between staff and people living in the home. Staff engaged positively with people who had dementia and demonstrated genuine warmth when engaging those individuals. A relative told us that the staffs were kind and Care Homes for Older People Page 18 of 29 Evidence: caring. Another visitor commented that their relative was very content. All staff have the required essential employment checks carried out before they are employed. We looked at 2 staff files and saw evidence of this. A member of staff we spoke to said that the recruitment procedures are very thorough. Information sent to the Commission tells us that 80 percent of the staff holds an NVQ in care, part of which is about safeguarding people. Staff told us that policies and procedures are discussed with them. We looked at training records and saw that Safeguarding Adults training had been provided for staff. Information sent to us by the manager verified that no safeguarding or Independent Safeguarding Authority referrals had been made. We observed that people are treated with respect and encouraged to see Oakwell as their home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and well maintained home that meets their needs. Evidence: Oakwell is a purpose built home and provides an environment that is suitable to the specific needs of the people who use the service, for example access to the home is good and a there is a lift to other floors, the doorways and hallways are wide and this helps when equipment or mobility aids are being used. We case tracked 3 people and looked at all of their bedrooms. Their rooms are of a good size with facilities such as en suite toilets. One of the people we case tracked was receiving intermediate care with the goal of working towards independence so that they could return home after a hospital stay. The equipment in the persons room had been assessed by an occupational therapist and specifically related to their needs, for example they had a long handled shoe horn and a grabber. The person said this helped them to be more independent when putting shoes or slippers on. We were shown maintenance certificates, which demonstrate that Oakwell, both the premises and equipment are routinely maintained by qualified contractors and this is organised centrally by Devon County Council. Additionally, risk assessments are in place which are regularly reviewed by a competent assessor. Records confirm that any risks identified to the Registered Manager and management team are acted upon. Care Homes for Older People Page 20 of 29 Evidence: Information sent to the Commission by the manager verified an audit using the department of health guidance had been carried out and there is an action plan in place to prevent and control the spread of infection. 100 percent of staff had received training about the prevention of infection and management of infection control. The manager showed us a training programme run by the local college that covered infection control, which the service has signed up to and will enable all of the staff to update their knowledge and experience in this area. Hand towels and soap dispensers were seen in wcs, bathrooms and bedrooms. Good hand washing practices were observed as staff were delivering care to people. The laundry was clean and well organised. We observed good infection control measures being followed when staff were dealing with soiled linen and staff told us they had access to gloves and aprons. 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. Recruitment practices at Oakwell are robust and ensure that people are protected. The training and development programme ensures that people are cared for by knowledgeable and competent staff that understand their needs. Evidence: We examined duty rosters for four weeks up to the week of the inspection. On the day of the inspection there was 5 carers, a deputy manager, and manager were on duty, with 2 cleaners, a kitchen assistant and cook throughout the day. The intermediate care unit also has qualified therapists working in home: A physiotherapist and ocupational therapist both work 3 days per week and there is a rehabilitation nurse 1 day per week. In addition to this, a GP visits who specialises in rehabilitation and intermediate care. Staff we spoke to told us that they were busier in the mornings but did not feel rushed. Maintenance staff had also been employed. We observed that people were attended to promptly and appeared relaxed. We examined the files of 2 of staff appointed since the last key inspection. Information sent to the Commission tells us that there is a very low turnover in staff, which gives consistency to residents. Two satisfactory written references had been obtained for both of the staff prior to employment. Independent safeguarding authority checks had been undertaken and criminal records bureau certificates had been obtained before employment commenced. The home had a written procedure about recruitment and Care Homes for Older People Page 22 of 29 Evidence: retention of staff and it was clear that practice is robust and protects the people living in the home. Information sent to the Commission verified that a wide range of training had been provided over the last 12 months. Records demonstrated that 80 percent of the care staff had achieved the NVQ level 2 award in care or above. We saw individual training files, which contained further evidence of specialist training having been provided or planned for staff, for example dementia awareness courses. Induction records seen demonstrated that training meets the appropriate standards set out by the Skills for Care. Domestic staff verified that they had completed health and safety training, which had provided them with a good understanding about using chemicals safely and fire procedures. We spoke to staff about their experience and training opportunities in the home and people verified that this was regularly offered to them. The training and development plan for the home contained information for the period 2009-10 and reflected the needs of people currently living in the home so would ensure that staff have the knowledge and understanding to meet these needs. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an exceptionally well run home, where their views count and improvements are made. Health and safety is promoted and ensures that people living and working in the home are protected. Evidence: The Registered Manager has several years experience in running the home and has appropriate management qualifications that ensure she has the underpinning knowledge to do this effectively. She told us that she uses the internet extensively, in particular the Commissions professional website, to keep up to date thus ensuring that the care delivered is best practice. Similarly, we saw evidence of best practice being disseminated across the organisation and best practice shared at all levels in minutes of staff meetings. Throughout the inspection we found that the manager had a clear understanding of her role in meeting the stated aims and objectives of the home. Similarly, she provided the Commission with a lot of information in a document entitled AQAA Care Homes for Older People Page 24 of 29 Evidence: (Annual Quality Assurance Assessment). In it she outlined what the home could do better to improve the quality of life of people living there and how it would be done, in addition to explaining what had been improved. The quality assurance and communication systems have ensured that issues are quickly identified and adressed where needed. For example, the assessment process had improved for people needing intermediate and short stay care with greater information being obtained from healthcare professionals in the community involved in the individuals care. We observed that there are clear lines of accountability within the home. People told us that the manager is also very much hands. We observed people being asked for feedback about lunch, their care and activities during the inspection. There is an open door policy that also allows people living there, visitors and staff to speak with the Registered Manager whenever they wish to do so. A monthly newsletter is published and there is a carers forum that takes place every 8 weeks. Information sent to the Commission tells us that records of personal allowances are kept and people receive their full personal allowance to spend as they wish. Savings are invested for people that do not handle their own affairs and these are kept in a separate account. The senior staff at the home were able to demonstrate strict adherance to policies and procedures, which are auditted internally by the finance department of social services. Appraisal records were seen in the staff files we looked at. Staff told us that the manager is always approachable. We looked at 2 records and both staff had had several 1:1 with their line manager. Staff told us that they found this very supportive. This was a particularly difficult day for some staff, who had been notified that they were at risk of redundancy as a result of restructuring care services within the organisation. We observed that this was done sensitively and that staff felt well supported by the manager. This has ensured that staff consistently follow best practice when caring for people and also have the opportunity to seek support and reflect and identify any gaps in their knowledge and experience. Comprehensive Health and Safety policies and procedures were seen, including a poster stating who was responsible for implementing and reviewing these. In information sent to the Commission, the manager verified that risk assessments are carried out. We saw various examples of this with regard to audits done, which included medicines, fire safety and first aid equipment. As we toured the building we observed cleaning materials were stored securely and used with by staff wearing gloves. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for Care Homes for Older People Page 25 of 29 Evidence: cleaning and infection control purposes. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, and staff told us that the alarm was regularly. A certificate verified that an engineer had checked the fire equipment. First aid equipment was clearly labelled. Nearly all of the staff on duty held a current first aid qualification. Risk assessments were in place. Therefore, we concluded that the health and safety of people living, working and visiting the home is maintained. 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 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 9 People living in the home need to be confident that staff responsible for giving out medicines always follow safe procedures, including accurate documentation, so that they receive the right medication at the right time. 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. 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). 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