Care Home: Orchard Court Nursing Home

What the care home does well Orchard Court provides a purpose built environment for older people who have dementia or other mental health needs. The home ensure that peoples needs are met by a team of staff who have been appropriately trained in caring for people with dementia. Appropriately qualified registered nurses are on duty 24 hours a day. The home ensures that people who are thinking about the service are provided with the information they need to enable them to make an informed decision about moving to the home. People are invited to visit the home and admission is only offered following a satisfactory assessment. This is to ensure that the home can meet the assessed needs of an individual. The home`s care planning procedures ensure that people receive care in line with their assessed needs and preferences. The home has established very good links with a range of health care professionals and it ensures that peoples` health care needs are met. Staffing levels are good and these are based on the dependency levels of people using the service. This ensures that there are sufficient staff on duty to meet peoples` assessed needs and social needs. We noted staff interactions with people to be kind and respectful. A visitor also confirmed this and told us that they were always kept well informed about their relative. The home follows appropriate procedures for the management and administration of peoples` medication. The home ensures that peoples` nutritional needs are met. All meals are freshly cooked at the home by the chef. Specialised diets are catered for. The home have been awarded a `5 star excellent rating` by the Environmental Health Department for their food hygiene standards. Procedures are in place which regularly monitor and audit the quality of the service delivered. The home liaises with the Commission and informs us of all significant events at the home. The home takes appropriate steps to ensure the health and safety of persons at the home. What has improved since the last inspection? Since the last inspection the provision of activities for people at the home have greatly improved. A new activities coordinator was employed by the home in March of this year and he has been very proactive in improving peoples` opportunity for social stimulation. We found detailed records about peoples` life history and past interests and we were able to see that activities were being arranged and offered around peoples` preferences. A varied and interesting programme of activities has been developed which include events outside of the home. Good records are maintained for each persons involvement in an activity and this also includes information about the outcome for each person. This is noted to be a very positive improvement for people at the home. We found the standard of cleanliness to be much improved at this inspection and there was evidence that the home had taken appropriate action to address the requirement raised at the last inspection. At the last inspection concerns were raised regarding moving and handling procedures. Action was taken following that inspection and at this inspection, we observed staff following appropriate moving and handling procedures which were in line with the individuals assessed needs. The home has benefited from a major programme of refurbishment and redecoration. Communal areas and the majorrity of bedrooms have been completed and work is ongoing to refurbish bathrooms, remaining bedrooms and the sensory room. What the care home could do better: The home`s procedures for staff recruitment need further improvements. Risk assessments for staff employed on a POVAFirst, pending a full CRB, had not been completed. We were unable to see evidence of how the staff member would be supervised during this period. Although we were informed that issues had been discussed, there was no documented evidence of this regarding issues raised on an individuals CRB. There was no documented evidence that a gap in employment history on a application for employment form had been discussed/explored. The home must also ensure that staff files contain photographic identification of each employee. Although staff confirmed that they felt very well supported. Records did not demonstrate that staff received formal supervision sessions at least six times a year. Key inspection report Care homes for older people Name: Address: Orchard Court Nursing Home Harp Chase Shoreditch Road Taunton Somerset TA1 3RY     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: kathy McCluskey     Date: 0 9 0 6 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: Orchard Court Nursing Home Harp Chase Shoreditch Road Taunton Somerset TA1 3RY 01823351155 01823352277 orchard.court@fshc.co.uk None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodaed is 44 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) Mental Disorder, excluding learning disability or dementia (Code MD) Date of last inspection 44 44 Over 65 0 0 Care Homes for Older People Page 4 of 29 Brief description of the care home Orchard Court is a purpose built home located in a quiet residential area not far from Taunton town centre. Accommodation is arranged over one floor and all areas, including the garden areas, are accessible to wheelchair users. The home is registered with the Care Quality Commission to provide nursing care for up to 44 people older people who suffer with dementia or other mental health problems. The home is owned by Four Seasons Healthcare Ltd. The responsible individual is Pauline Lawrence. The registered manager is David Barenskie. We were informed that fees are currently between £410 & £689 per week. Where service users are awarded a `free nursing care element (RNCC), this is taken by the home and not refunded to the service user. Additional charges are met by service users for: hairdressing, aromatherapy, chiropody and personal toiletries. 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: 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 unannounced key inspection was conducted over one day (6hrs) by regulation inspectors Kathy McCluskey and Alison Philpott. The registered manager was not available for this inspection though a company regional manager was available throughout the inspection. We were given unrestricted access to all parts of the home and all records requested for this inspection, were made available to us. We were able to meet with the majority of people using the service, staff and a visitor to the home. The home completed its Annual Quality Assurance Assessment (AQAA) and this was received by the Commission with agreed timescales. The AQAA is a self assessment which focuses on how well outcomes are being met for people using the service. It also provides us with some numerical information. Extracts have been included in this report where appropriate. Care Homes for Older People Page 6 of 29 The term we, used throughout this report, refers to we the Commission. We would like to thank all involved for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Since the last inspection the provision of activities for people at the home have greatly improved. A new activities coordinator was employed by the home in March of this year and he has been very proactive in improving peoples opportunity for social stimulation. We found detailed records about peoples life history and past interests and we were able to see that activities were being arranged and offered around peoples preferences. A varied and interesting programme of activities has been developed which include events outside of the home. Good records are maintained for each persons involvement in an activity and this also includes information about the Care Homes for Older People Page 8 of 29 outcome for each person. This is noted to be a very positive improvement for people at the home. We found the standard of cleanliness to be much improved at this inspection and there was evidence that the home had taken appropriate action to address the requirement raised at the last inspection. At the last inspection concerns were raised regarding moving and handling procedures. Action was taken following that inspection and at this inspection, we observed staff following appropriate moving and handling procedures which were in line with the individuals assessed needs. The home has benefited from a major programme of refurbishment and redecoration. Communal areas and the majorrity of bedrooms have been completed and work is ongoing to refurbish bathrooms, remaining bedrooms and the sensory room. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 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 provided with the information needed to enable them to make an informed decision about moving to the home. The home follows appropriate procedures to ensure that an individuals assessed needs can be met by the home before a placement is offered. Evidence: The home has produced a Statement of Purpose and Service User Guide which provides information about the home and services offered. We were informed by the regional manager that there had been no changes to these documents since the last inspection. The homes completed AQAA confirmed that people who are thinking about using the service, and/or their representatives, are given the opportunity to visit the home prior to making a decision about moving there. The AQAA also stated that people can Care Homes for Older People Page 11 of 29 Evidence: stay for the day or for a meal We examined three care plans and were able to see evidence that people are appropriately assessed before a placement is offered. Care plans contained detailed pre-admission assessments which had been completed by the registered manager. The AQAA told us that this process had improved in the last twelve months with the implementation of a more detailed pre-admission assessment tool. Assessments from other health care professionals are also obtained. We spoke with the deputy manager, staff members and a relative during this inspection and no concerns were raised about the homes ability to meet the assessed needs of people living there. It was also confirmed that the home has a good supply of specialised equipment and that they received excellent support from a range of specialised mental health professionals. Training records confirmed that staff had received training in dementia care. 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. The homes care planning procedures ensure that care is delivered in line with peoples assessed needs and preferences. People have access to a range of health care professionals and procedures are in place to ensure that peoples health care needs are met. The home follows safe procedures for the management and administration of peoples medication. People are treated with respect and their right to privacy is upheld. Evidence: During this inspection we were able to observe staff interactions with people using the service. Interactions were noted to be kind and respectful and interventions were unhurried. The atmosphere in the home appeared relaxed and people appeared comfortable in their surroundings. People who were able, were seen to move freely around the home and there was a staff presence in all areas. Care Homes for Older People Page 13 of 29 Evidence: We examined three care plans at this inspection and found these to be well maintained and up to date. Assessments were in place for moving and handling needs, reducing the risk of falls, nutrition and reducing the risk of pressure sores. Care plans had been raised to where concerns had been identified. Care plans contained clear information about how an individuals assessed needs should be met. Care plans also contained information about peoples preferences. Daily records are maintained and regular entries had been made by individuals key workers. Staff spoken with had a good understanding of peoples needs. We observed staff assisting people with their moving and handling needs in an appropriate manner. We were able to meet with a visitor who told us that they were happy with the care their relative received. The visitor also commented on the kindness of staff and stated that they were kept well informed about all aspects of their relatives care. Care plans contained evidence that people had access to a range of health care professionals. We were able to see that specialised mental health care support had been access where required. We were informed that the home has excellent links and support from health care professionals. The home monitors peoples weights at least monthly and we were able to see that care plans had been raised to address any concerns identified. We examined the homes procedures for the management and administration of peoples medication. The home uses the monitored dosage system (MDS) with preprinted medication administration records (MAR). All medicines were found to be securely stored and no excess stocks were apparent. MAR charts had been appropriately completed and contained photographic identification of each individual. Clear instructions were also available of the use of peoples prescribed as required medication. We found that correct procedures were being followed for the management and administration of controlled drugs. Medicines are only administered by the registered nurse on duty. As previously mentioned, throughout the day we noted staff interactions with people to be kind and respectful. We heard staff communicating with people using their preferred form of address and we saw staff knock on peoples doors before entering. People were noted to respond positively to staff. As recommended at the last inspection, to ensure the dignity of people using the service, personal information has been removed from outside of peoples bedroom doors. Care plans contained very good information about peoples life/social history. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from improved activities provision which takes into account their own hobbies and interests. People are supported to maintain contact with their friends and families in line with their wishes. People receive a wholesome and varied diet in line with their assessed needs and preferences. Evidence: The home have employed a new activities coordinator who has been in post since March of this year. Hours provided are 5 hours over 5 days. We were informed that these hours are flexible to meet the needs and preferences of people using the service. We were able to meet with the activities coordinator during this inspection. We also examined related records and were able to observe activities taking place. It was very positive to note the improvements in this area since the last inspection. A wide range of activities are now available to people using the service including trips out. The activities coordinator should be commended for his obvious commitment to improving opportunities for people to benefit from a range of activities. The activities Care Homes for Older People Page 15 of 29 Evidence: coordinator has liaised with the families of each person using the service to ascertain peoples life history and past hobbies and interests. Detailed records were seen to be in place. This enables activities to be tailored to peoples needs and abilities. The activities coordinator has also established links with people in the local community and plans are currently underway for the homes annual summer fete. A regular programme of activities is in place and regular events include music, art classes, outside entertainers, pat dogs, beauty therapy and a cookery club. A photograph album is currently being developed and this contained pictures of recent events which included picnics at Vivary Park, birthday celebrations, easter celebrations and picnics at the home. Plans are underway to introduce flexercise and a gardening club. People have also enjoyed a visit to the home by the womens world cricket team. During the morning of this inspection many people were enjoying listening and singing along to old time music and in the afternoon an outside entertainer provided a sing a long to his keyboard. People were noted to respond positively to both sessions. People appeared to enjoy interacting with the activities coordinator and all staff, and the visitor spoken with were very positive about the improvements and of how people using the service had benefited. Detailed records are maintained as to to outcome of each persons involvement in an activity. People are supported to maintain contact with their friends and families in line with their preferences. We spoke with one visitor who told us that they could visit at any time and were always made to feel welcome. People can choose where to see their visitors and can use the privacy of their bedrooms if they wish. In line with fire regulations, the home ensure that all visitors to the home sign the visitors book when they arrive and leave the home. We were able to meet with the homes chef during this inspection and were invited to join people for lunch. We were informed that recent changes have been introduced around meal times. A lighter meal is now offered at lunch time with the main meal being served at tea time. The regional manager and deputy manager informed us that this had resulted in improvements for people using the service. It was stated that people are actually eating more and are experiencing more restful nights. We were also told that the incidents of falls has reduced and that people are more settled during the evening. We were able to sit with people in the dining room during lunch. Two sittings are offered as this enables staff to spend more time with those people who require assistance or a closer level of supervision. People appeared relaxed and staff were Care Homes for Older People Page 16 of 29 Evidence: seen to assist people in an unhurried manner. Lunch consisted of homemade soup, a selection of sandwiches, salads, eggs, vol-a-vents and chips. The chef is made aware of peoples preferences and of any special diets. As previously mentioned, the main meal is now offered at teatime. Breakfast is varied and includes a cooked breakfast. We were informed that snacks are available throughout the day. We have recommended that the home display the daily menu, in a format appropriate to people using the service, as this was not observed during the day of the inspection. The home have achieved a 5 star excellent rating by the Environmental Health department for their food hygiene standards. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has satisfactory systems in place to enable people to raise concerns. Appropriate procedures are in place to reduce the risk of harm or abuse to people using the service. Evidence: The home displays and appropriate complaints procedure. We were informed that the home have not received any complaints in the last twelve months. This was also confirmed in the homes completed AQAA. No concerns have been raised directly with the Commission. During this inspection we spoke with a visitor who confirmed that they would feel very confident in raising concerns if they had any. This was also confirmed by people using the service who were able to express a view. The home has a range of policies and procedures in place to reduce the risk of harm or abuse to the people living there. Training records confirmed that staff had received training in the protection of vulnerable adults. Care Homes for Older People Page 18 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. The home has benefited from a programme of major redecoration and refurbishment and further improvements are planned. The standard of cleanliness at the home has improved and the home follows appropriate procedures to reduce the risk of the spread of infection. Evidence: Since the last inspection the home has benefited from a major programme of redecoration and refurbishment. Work in communal areas and the majority of bedrooms is complete and a further programme is in place to complete bedrooms, bathrooms and the sensory room. A re-opening ceremony was recently attended by the local mayor. Improvements were also noted at this inspection in standards of cleanliness at the home. Standards of cleanliness were noted to be good and apart from a couple of bedrooms, of which action was already being taken to address, no malodours were apparent. We were informed by staff that there were now sufficient domestic staff on duty to ensure that acceptable standards are maintained. We were able to see that appropriate staff hand washing facilities were sited throughout the home and that staff had access to a good supply of protective Care Homes for Older People Page 19 of 29 Evidence: equipment. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that staffing levels are appropriate to the needs of people currently using the service. The homes procedures for staff recruitment require some improvements to ensure people are not placed at risk of harm or abuse. Staff receive the training they need though NVQ training needs to be further promoted. Evidence: We were informed that 34 people were currently residing at the home and that staffing levels were determined on peoples assessed needs. We were informed that current staffing levels were as follows; During the day - 2 registered nurses and 8 care staff. During the evening; 2 registered nurses and 5 care staff. During the night; 1 registered nurse and 4 care staff. We were able to speak to registered nurses and care staff and no concerns were raised about staffing levels or of their ability to meet the needs of people currently at the home. During this inspection, we observed a staff presence in all areas of the home throughout the day. The registered manager works in addition to the care hours. Care Homes for Older People Page 21 of 29 Evidence: In addition to the nursing and care staff, the home employs domestic, kitchen, laundry and maintenance staff. An administrator and activities coordinator are also employed. We examined the homes procedures for staff recruitment. Four staff recruitment files were examined. Photographic identification was not available in all files examined. There was a gap in employment for one staff member and there was no evidence that the reason for this had been explored. References and enhanced criminal record checks were in place but, as raised at the last inspection, there was no documented risk assessment available for staff who had commenced employment on a POVAFirst, pending a full CRB. We also found no documented evidence an issue raised on a CRB had been fully explored or documented. We were informed that seven care staff were due to commence NVQ training in July. The homes completed AQAA did not identify how many of the permanent care staff currently employed had achieved a minimum of an NVQ level 2 in care. We were informed by the regional manager that NVQ training was an area where improvements are planned. We were informed that staff follow an induction programme which links with the Skills for Care common induction standards. Staff spoken with indicated that they had received a satisfactory induction programme along with all mandatory training. All staff have an individual training programme and we were provided with a staff training matrix which indicated that staff had received up to date mandatory training. It also confirmed training in dementia care and training in the protection of vulnerable adults. Staff spoken with confirmed that they had received the training needed to care for people currently at the home. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a registered manager who promotes an open and inclusive style of management. Systems are in place to monitor and improve the quality of the service provided. Appropriate procedures are followed for the management of peoples finances. Staff are appropriately supported though appropriate records need to be maintained. Procedures are in place to ensure the health and safety of persons at the home. Evidence: The registered manager is David Barenskie. Mr Barenskie was not available for this inspection though staff and a visitor spoken with were very positive about his open and inclusive style of management. All spoken with stated that he was very much a hands on manager and that he was very approachable. Care Homes for Older People Page 23 of 29 Evidence: The home has systems in place to seek peoples views on the quality of the service delivered. Annual questionnaires are sent to relatives by the registered provider and we were able to see the results of the most recent survey where results were positive. Regular meetings are held for staff with minutes maintained. We were informed that formal meetings for people using the service were not appropriate and that their views were encouraged and responded to on a daily basis. In line with the Care Homes Regulations, a company representative conducts monthly visits to the home to monitor the quality of the service provided. Detailed reports are maintained at the home. We examined the homes procedures for the management of peoples finances. The home supports people to manage small amounts of money as required or requested. Records of all transactions are detailed on a computerised programme which is managed by the homes administrator. Monies are held in a pooled account and individual statements for each individual are maintained. Statements identify items or services purchased by, or on behalf of individuals. Receipts are obtained and statements are sent to peoples relatives/representatives on a monthly basis. The homes procedures are also regularly monitored and audited by a company representative. As previously mentioned, staff were very positive about the support they received from the registered manager. They also told us that they were encouraged to discuss any issues with him. The registered manager needs to ensure that appropriate records are maintained for all staff supervisions as these were not available at the time of this inspection. We examined the homes procedures relating to health and safety. We toured the premises and examined a selection of records. FIRE SAFETY - up to date records were in place for the testing and maintenance of fire detection and fire fighting equipment. Staff training records indicated that fire safety training was up to date. ELECTRICAL SAFETY - Up to date certificates were in place for the testing of portable electrical equipment and hardwiring. GAS SAFETY - An up to date Landlords Gas Safety Certificate was available. HOT WATER OUTLETS - To reduce the risk of injury, hot water outlets have been fitted with thermostatic controls. Records demonstrated that the home conducts weekly checks on hot water outlets to ensure that temperatures remain within safe upper limits. Appropriate procedures are followed to reduce the risk of legionella. EQUIPMENT SERVICING - Up to date services records were in place for mobile hoists and bath hoists. Care Homes for Older People Page 24 of 29 Evidence: We examined accident records and found these to be unremarkable. As required under the Care Homes Regulations, the home informs the Commission of all significant events at the home. Care Homes for Older People Page 25 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 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 (1) The registered person 19/06/2009 must ensure that robust procedures are followed for the recruitment of staff. This relates to documenting risk assessments for staff working on a POVAFirst, pending a full CRB and for staff where issues are identified on their CRBs. This is to ensure that staff receive appropriate levels of supervision and that the risk of harm or abuse to people using the service is reduced. 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 15 The home should ensure that a daily menu is clearly displayed. This should be in a format appropriate to the people using the service. The home should further promote NVQ training for staff so 2 28 Care Homes for Older People Page 27 of 29 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 that a minimum of 50 of the permanent care staff achieve a minimum of an NVQ level 2 in care. This was also recommended at the last inspection. 3 29 The home should ensure that any gaps in employment history on a staff application form are fully explored and reasons documented. The registered manager should ensure that appropriate records are maintained which confirm that staff receive formal supervision at least six times a year. 4 36 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). 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. 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