Care Home: Pennsylvania House

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What the care home does well Pennsylvania House is well managed and provides a safe, comfortable and homely place in which people can live their lives as they choose. There was good interaction observed between people and staff. Those people spoken with and who were able to directly comment said they were happy with the care they receive at the home. The home tries to treat people as individuals with each one receiving the care and support they need and want. There is a good assessment process that assures people thinking of moving into the home that their needs will be met, and there is good care planning that ensures all aspects of care continue to be monitored and needs met. Staffing levels are sufficient and recruitment and training is robust to ensure individuals are protected from harm. All records, including those relating to medication administration, fire precautions, risks and finances were well maintained. There is a clear and simple complaints procedure and any complaints made to the home are investigated. People felt that meals were very good and the home is commended for the level of choice made available to people. There was also a high degree of satisfaction with the level of activities and entertainment available and the home is also commended for its commitment to provide leisure activities to people who are at risk from isolation. What has improved since the last inspection? The care plans have been improved to provide better information about how each person wishes to be supported and the daily care notes are clear about how someone has spent their day. Redecoration and refurbishment of bedrooms and communal areas continues indicating the home owner`s commitment to maintaining a pleasant and safe home for people. What the care home could do better: No requirements were identified at this visit and only three recommendations have been made. These are the development of a training plan and overview to ensure all staff receive the necessary training and no updates are overlooked and that the programmes to cover radiators and to fit thermostatic valves to sinks accessible to people living in the home should continue to reduce the risk of burns and scalds. Key inspection report Care homes for older people Name: Address: Pennsylvania House 7-9 Powderham Crescent Exeter Devon EX4 6DA     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: Jane Gurnell     Date: 2 4 0 8 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 26 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 26 Information about the care home Name of care home: Address: Pennsylvania House 7-9 Powderham Crescent Exeter Devon EX4 6DA 01392256346 01392433224 henry-morgan@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Henry Arnold Morgan care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Pennsylvania House, is a privately owned home, situated in a residential area of Exeter. It is within a short walk of the city centre. It comprises three adjoining terraced houses with accommodation on the ground, first and second floors. There are 21 single bedrooms and 2 shared rooms: the majority of rooms provide en suite facilities. There two lounge rooms and a dining room on the ground floor and a further lounge on the first floor. A passenger lift provides access to the upper floors. To the front is a small garden and there is car parking and a two courtyard areas to the rear. Mr Morgan, the owner, is planning a large extension to the rear of the building, which will incorporate a new laundry, kitchen, dining area and garden. The home provides care Care Homes for Older People Page 4 of 26 Over 65 25 25 25 25 0 0 0 0 Brief description of the care home and accommodation for a maximum of twenty-five older people with dementia, mental health needs and learning disabilities. The reports from CSCI inspections are displayed on notice boards around the home. Fees range from 391 to 475 pounds per week. Fees do not include hairdressing, chiropody or outings. 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 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The previous inspection of Pennsylvania House was undertaken on 18th and 20th July 2007 when the home was judged to provide good outcomes to the people living there. This unannounced inspection was undertaken on 24th August 2009. The homes care manager was available and she and the staff team assisted the inspector. Prior to the inspection, the home owner had completed an Annual Quality Assurance Assessment (AQAA)which is a document provided by the Commission to allow the home to tell us what they do well and what their future development plans are. The information in the AQAA indicated the home has improved the menu planning as well as ensuring meal times are not interrupted; improved the variety and choice of leisure activities and consulted further with health care professionals regarding nutritional care, skin care and end of life care. Future developments include upgrading the facilities and redecoration as well as an extension to the rear of the building which will provide more bedrooms, an improved kitchen, dining room and laundry. Care Homes for Older People Page 6 of 26 As part of the inspection process we ask as many people as possible for their opinion on how the home is run. This included sending out questionnaires out to 10 people living at the home, three health and social care professionals and 10 staff. At the time of writing the report, responses had been received from six people living at the home, three health and social care professionals and 10 staff and the results are included in the main body of the report. During the visit a large number of the people living at the home were spoken with, as well as 2 visitors and the staff on duty. A full tour of the building was made, staff were observed interacting with people and going about their duties and a sample of records was looked at, including medications, care plans, the fire log book and staff files. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 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 26 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 considering moving to Pennsylvania House are encouraged to visit, and an assessment of the support they require ensures that the home can appropriately meet their care needs. The home does not provide intermediate care. Evidence: The care manager confirmed that she or the home owner visits people considering moving to the home to provide them with information about Pennsylvania House and to undertake an assessment of their care needs. The care planning documents for three people were looked at in detail and these contained evidence that these assessments had been undertaken prior to their admission. People are invited to visit the home to meet the other people living in the home and the staff team. One visitor explained that he had visited the home of behalf of his Care Homes for Older People Page 10 of 26 Evidence: relative has she had been too unwell to visit herself. He said his relative had settled well and he was confident with the care and support she received. Care Homes for Older People Page 11 of 26 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. Care plans are well formulated and give clear information to enable staff to meet peoples health and social care needs. People are treated with dignity and respect and their health care needs are well met, with evidence of good multidisciplinary working taking place where necessary. To ensure peoples safety, all medicines are stored securely and administered appropriately. Evidence: many of the people living in the home were spoken with. Those who were able to comment directly about the care and attention they receive said they were very happy living at Pennsylvania House. Those who are not able to comment due to their confusion appeared cheerful and contented. People were seen to move freely about the home using the communal areas and were involved in conversation with staff and other residents. All six surveys returned by people living in the home confirmed they received the care Care Homes for Older People Page 12 of 26 Evidence: and support they need. One person said the home provides, excellent continuity of care and another person said the home looks after me very well. Four care plans were looked at in detail, one for somebody newly admitted to the home, two for people in poor health and who were being nursed in bed, and one for someone who had lived in the home for a long period of time. The care plans were based on the information collected prior to admission and subsequent risk assessments undertaken upon admission. The care plans covered each persons physical abilities and their preferences, as well as nutritional, pressure area and moving and handling assessments. Each plan also contains a life history which is particularly important for staff when supporting people with confusion who are unable to share this information themselves: this also included information on hobbies and anything the person may like to try. Those care plans looked at provided evidence that the person or their relative had been involved in developing the plans and agreeing the content. One visitor confirmed he had been shown his mothers care plan and risk assessments which he found to very informative. Care plans gave detailed instructions to staff on how to meet peoples day-to-day needs and not only included instruction about health care issues such as the management of diabetes, but also peoples preferences, for example one lady liked to wear brightly coloured clothing and make-up. There was evidence that peoples health care needs are well met and those health care professionals who had completed a survey confirmed their confidence in the home to meet peoples needs: this was confirmed by a visiting social worker on the day of the inspection. Comments included they have done everything possible to give my client the best possible quality of life, and they work very well with the Community Nurse and GP. Two people whose health had deteriorated considerably since moving in to the home were being nursed in bed. Staff were receiving additional support and guidance from the District Nursing Service and it was evident from records and discussion that staff were aware of the actions necessary to maintain a good level of nutrition and fluid intake as well as skin care. Staff were observed going in and out of these two bedrooms to talk and offer drinks etc. The home uses a pre-prepared blister pack for its medication administration system which reduces the risk of mistakes occurring. All medicines are stored securely in a locked cupboard and medication is administered and signed for appropriately: the blister pack is taken to each person before the medication is removed and staff sign to say it has been taken. In line with the homes policy and procedure all medicines received into and returned from the home are counted and recorded, and all staff who Care Homes for Older People Page 13 of 26 Evidence: administer medicines have received appropriate training. Additional safe storage was available for controlled drugs and a sampled of these were checked and the balances were found to be correct. Staff were seen to respect peoples privacy, knocking on doors and generally offering personal care in a discreet manner. It was evident staff have a caring and friendly relationship with people in the home and staff were seen in conversation and laughter with people. Care Homes for Older People Page 14 of 26 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. Links with visitors and the community are good, giving opportunities to support and enrich peoples social life. The home offers a suitable range of activities and entertainments to stimulate and occupy people. Meals were seen to be well presented, providing nutritious variety and choice for individuals. Evidence: Those people spoken with and who were able to directly comment about the activities provided at the home said they very much enjoy these, particularly the trips out. The care manager said that during the summer months the home arranges a trip to a local place of interest each week, and over the winter months, every fortnight or three weeks. The home hires a minibus for these trips and people said that they enjoyed the recent trip to Buckfast Abbey: other trips have included a trip on a River Barge, a visit to the Donkey Sanctuary and visits to Torquay, Paington and Exmouth. People had been given photographs of these events as a reminder of their day out. Other activities arranged in the home include massage sessions twice a week, orientation and reminiscent sessions from a retired nurse each week, weekly exercise sessions, quizzes and board games, arts and crafts sessions, karaoke singing, visits from the Care Homes for Older People Page 15 of 26 Evidence: Donkey Sanctuary, film evenings, a visiting shop and church services each Sunday. There is a list of activities for the week displayed on the notice boards in the lounges. People said that they generally spend their time as they please, reading, knitting, going to the private park opposite the home and the local shops or watching TV. They said that they enjoyed the activities, and there was usually something going on every afternoon. From reading the daily care notes it was evident staff accompany people to the shops and park and one person had been taken to the local DIY store to choose paint and wallpaper for their bedroom. The home is commended for its commitment to provide leisure and social activities that mirror ordinary life and provide stimulation and interest for people who are at risk of isolation due to their health or confusion. The two visitors spoken with confirmed they were always made welcome and were kept informed of any changes with their relatives. One visitor said her relative was supported by the staff to ring her sister each week to keep in touch. All the people spoken with and those returning a survey praised the standard and variety of food. Menus are displayed in the entrance hall and showed a range of nutritious food on offer. There was a choice of three meals at lunchtime with two desserts and a choice of two meals at tea time with a dessert. Although people were asked prior to the meal what they would like to eat, the cook confirmed that she always cooks more of each meal so that people can change their minds or choose at the table if they have forgotten what they have ordered: people could also have a second helping of a different meal. Drinks and snacks were offered throughout the day and the care manager confirmed that people were encouraged to have sandwiches for supper to ensure they didnt wake hungry, but that should people wake, staff were able to prepare snacks and hot drinks. The care manager said people are invited to have a sherry prior to Sunday lunch and this proved to be very popular. Special and medical diets can be provided. The home is commended for preparing such a wide variety of food for people. Care Homes for Older People Page 16 of 26 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 living in the home and their relatives can be confident that complaints are dealt with appropriately. People are protected by staff who are able to recognise the signs of abuse and know their duty to report poor practice. Evidence: All those people spoken with and who were able to comment directly said that they had confidence in talking with the staff or the care manager about any concerns that they may have: this was supported by all six surveys returned by people living in the home. Neither the home nor the commission has received any complaints since the previous inspection. The care manager says that she meets with people each day and is able to resolve minor issues immediately. There is a clear and simple complaints procedure displayed in the main hall and the communal lounges. The care manager confirmed that all members of staff had received training in the protection of vulnerable adults, and this was evident in the four staff files examined. Staff spoken with and they were all able to describe differing types of abuse and were clear about the procedures to be followed if they suspected abuse was taking place. This included contacting outside agencies if necessary. Care Homes for Older People Page 17 of 26 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. Pennsylvania house is a comfortable home. It is well maintained and provides sufficient facilities for those people currently living there. Evidence: A full tour of the communal areas of the home was made and several individual bedrooms were looked at: the home was found to be very clean and tidy. The home is comfortable and well maintained, some areas have recently been decorated and new carpets fitted. The care manager confirmed that new carpets were to be fitted in the first floor hallways and one bedroom during the week. People living in the home had been involved in choosing the decor for the communal areas and their own bedrooms and this was evident from talking to people and from the resident meeting notes, where samples of wallpapers and paint colours had been made available. The home employs a member of staff to undertake day-to-day repairs and redecoration. Some radiators are covered to reduce the risk of burns should someone come into contact with them when on. Thermostatic control valves have been fitted to all hot water taps on baths and some sinks to reduce the risk of scalds from very hot water. The care manager confirmed that the home owner was continuing with a programme to fit all radiators with covers and to place control valves on all hot taps accessible to people living in the home. Care Homes for Older People Page 18 of 26 Evidence: There are courtyard areas at the back of houses 7 and 9 as well as a small area at the front of the house which provide seating areas for people in warm weather. There is also a private park opposite the home to which the home has a key, and to which people are regularly taken. The care manager confirmed that the home had obtained planning permission to extend the building and this new development would include a safe and secure garden area. Peoples bedrooms were very different, reflecting the personality of the occupant and they contained many personal items. People said that they were happy with their rooms and had everything they needed in them. There is a range of aids and adaptations around the home, including grab rails, raised toilet seats, bath hoists, and a lifting hoist for the two people who are unable to walk. The home provides pressure relieving cushions and mattresses for those people at risk of developing pressure sores from immobility and frailty, as well as special wedge shaped foam cushions to prevent people falling from bed instead of the traditional use of bedrails which the care manager feels present too high a risk of injury to people who may be confused. Where it is felt necessary, pressure pads are placed next to peoples beds and chairs to alert staff to when someone gets out of bed or their chair and who will need assistance from staff to reduce the risk of falls. Laundry facilities are provided at the rear of the building in a small outhouse. The care manager said that all laundry is done during the day and evening to prevent staff having to leave the building during the night. A new laundry is to be incorporated into the major extension to the home that is planned for the near future. Staff have received training in infection control procedures and disposable gloves and aprons were readily available if needed. Staff wear different coloured tabards when giving personal care or serving food to reduce the risk of cross infection. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and are available throughout the day and night in sufficient numbers to meet the needs of the people currently living in the home. The procedures for the recruitment of staff are robust and ensure as far as possible only suitable staff are employed. Evidence: Those people spoken with and who were able to directly comment about the quality of the care they received said they were supported by kind and caring staff who attended them promptly: this was further supported by all six of the surveys. From discussion with the care manager and examination of the duty rota, it was evident there were usually five care staff on duty during the morning, four during the afternoon and evening and two during the night (one awake and one asleep). In addition there is also a general assistant who assists in the kitchen doing the dishes and preparing teas and coffees, domestic staff, a cook, the care manager and the owner at the home during the day. Staffing levels are suitable to meet the needs of the people currently living at the home. Discussions with staff indicated that they were very aware of the needs of the people living at the home and said they are able to spend some time with those they are keyworker for on a one-to-one basis. Staff spoken with said they were well supported in their role and received training and support from the care manager: this was further Care Homes for Older People Page 20 of 26 Evidence: supported by all 10 of the staff surveys returned to the Commission. People living at the home and the two visitors spoken with were complimentary about the home and the staff, saying its lovely here, the girls are lovely and the staff are very kind and caring. From discussion with staff and examination of the records it was evident staff have received training in subjects relating to the care of older people such as moving and handling and dementia care as well as that in health and safety practices such as fire safety, first aid, infection control, food hygiene, the safe handling of medicines and the protection of vulnerable adults. Staff are also encouraged to take National Vocational Qualifications (NVQ) and the care manager confirmed that all but one member of staff either has achieved the qualification or is in training. Without examining every staff file it was not possible to tell which staff members had received what training and when updates were required. The care manager was advised to develop a staff programme overview which would enable an easy audit of training to ensure individual staff werent overlooked for updates. Four staff files were looked at. All contained all the required pre-employment checks including a Criminal Record Bureau check and 2 references had been obtained ensuring as far as possible on suitable staff were employed. The care manager confirmed that new staff are provided with an induction training programme developed by the home which includes a checklist of tasks as well as working alongside an experienced member of staff. Only once the new member of staff and the care manager feel the staff is confident and competent will he or she be allowed to work unsupervised. The care manger confirmed that all new staff are immediately enrolled in NVQ training once their probationary period is complete. Records indicate staff receive periodic one-to-one supervision as well as annual appraisals from the care manager to monitor their work performance and to identify any training and development needs. Care Homes for Older People Page 21 of 26 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 home is well managed resulting in practices that generally promote and safeguard the health, safety and welfare of the people living there. Evidence: Mr Morgan has owned the home for many years and he is supported by the care manager who holds the Registered Manager Award and a NVQ at level 4 in care; both of these qualifications required the care manager to demonstrate her skills and competence in managing a care home for older people. Staff were very complimentary about the care manager, feeling that she provided good support to them and encouraged them to work as a team. The care manager confirmed that each day during the late morning the staff come together to discuss issues relating to the running of the home or specific to the care of the people living in the home and a note of these meetings was made to ensure all staff were able to refer to this. The home has a variety of quality assurance systems in place including sending questionnaires to people living in the home, their relatives or health care professionals Care Homes for Older People Page 22 of 26 Evidence: who regularly visit the home; occasional residents meetings; staff meetings; care plan reviews and checks on the quality of food provided. The results of the most recent questionnaires from May 2009 were available and indicated a high level of satisfaction. However it was not possible to distinguish which questionnaires were from people living in the home, relatives or health care professionals and the care manager was advised to distinguish between these and to summarise the results, indicating where action had been taken as a result. The home manages monies for several people who are unable to do this for themselves and do not have relatives to assist them. Computer records are maintained and money is kept separately in the homes safe. A sample of these monies was checked and found to be accurate: receipts for all expenditure were obtained. The home submitted an AQAA (Annual Quality Assurance Assessment) prior to the visit that provided evidence that Pennsylvania House complies with health and safety legislation in relation to the maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. The fire logbook, record of fire safety training and accident and incident records were found to be accurate and up to date. All windows above ground floor level are fitted with restrictors, in order to minimise the risk of anyone falling from these windows. Care Homes for Older People Page 23 of 26 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 24 of 26 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 25 The home owner should continue to ensure all radiators in areas accessible to people living in the home are covered or have a guaranteed low temperature surface to prevent the risk of burns. The home owner should continue to ensure all hot water outlets accessible to people living in the home are fitted with temperature control devices to prevent the risk of scalds. A training plan and overview should be developed to ensure all staff have received the necessary statutory training as well as training in subjects relating to older people with dementia or mental health care needs, and that updates are undertaking an a timely manner. 2 25 3 30 Care Homes for Older People Page 25 of 26 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 26 of 26 - 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!