Care Home: Priory (The)

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What the care home does well The manager and staff team continue to work hard to provide a good service for the residents and to meet each person`s needs. More than half the staff team have got NVQ qualifications and have now had the training needed to help them to provide a good service for the residents. Residents and relatives are given the opportunity to visit the home before making a decision to move in and appropriate preadmission assessments are carried out. The residents spoken to expressed satisfaction with the home. The following comments were received, "the carers are always very kind and helpful to my mother." "During ill health you are well looked after. Catering is always good". What has improved since the last inspection? The requirements made at the previous inspection have been addressed and are now met. Care planning has improved so that people`s individual needs are identified and met by trained and competent staff. Residents healthcare needs are identified and met. Complaints are now well managed and safeguarding procedures are in place which all staff are trained in and fully aware of. Extensive refurbishment and redecoration has taken place improving the ambience in the home. Staff have received all mandatory training and the training program continues, so that they are knowledgeable and able to meet the individual needs of the residents. An acting manager is in place who has provided an action plan outlining further improvements to be made and how these will be achieved. Improvements have been noted at this key inspection. What the care home could do better: Two requirements have been made from this visit regarding the need for staff to complete advanced dementia care training. The acting manager is required to register as a fit person to manage the home with the Care Quality Commission`s registration team. A recommendation has been made that activities that were observed were seen to be enjoyed by the residents but more could be done to improve the overall activities programme especially external activities and outings. Key inspection report Care homes for older people Name: Address: Priory (The) 112 Priory Road Noak Hill Romford Essex RM7 0JU     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: Harina Morzeria     Date: 2 3 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Priory (The) 112 Priory Road Noak Hill Romford Essex RM7 0JU 01708376535 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.priory@aermid.com www.aermid.com Aermid Health Care Properties Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The Priory is registered to care for 30 older people, or for people who have a diagnosis of dementia. However, the home have recently converted all their double bedrooms into single rooms and therefore the accomodation capacity is for twenty five residents. It is situated in a residential part of Hornchurch and is on a bus route to Romford, Care Homes for Older People Page 4 of 28 Over 65 0 30 30 0 Brief description of the care home where there is a railway station. The home is owned by a private company, Aermid Health Care Ltd, who run other similar homes. The house was originally a purpose built childrens home, to which an extension, and loft conversion have been added. There are now 25 single rooms, with the majority having either ensuite toilets, or one toilet shared by two rooms. The rooms are of varying sizes and shapes, but all are big enough for residents to have small personal possessions in place. The bedrooms are on all three floors, which are accessed by a lift and stairs. The dining room, lounge, and conservatory are on the ground floor, and the latter leads onto a patio and well-tended garden. Personal care is provided on a twenty-four hour basis, and health needs are met by visiting professionals. On the day of the inspection the range of fees for the home was between £465 to £550 per week. A Statement of Purpose and Service User guide are available and the latest inspection report is dispalyed in the hallway. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means that people who use the service experience good quality outcomes. This inspection was an unannounced key inspection and took place over approximately 7 hours. The acting manager was present and assisted with the inspection. The inspector looked around the home, spoke to the residents and observed the lunchtime routines at the home. Care staff were observed carrying out their duties. Staff, care and other records were checked. Feedback questionnaires were sent to residents, staff and healthcare professionals and a good response was received. The home is registered to provide care to older people and people with dementia. Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment (AQAA) and the Regulation 37 notifications. The inspector had a discussion with the manager on the broad spectrum of equality and diversity issues and she was able to demonstrate an understanding of the varied Care Homes for Older People Page 6 of 28 needs of the residents around religion, sexuality, culture, disability and gender. Care Homes for Older People Page 7 of 28 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that their needs will be properly identified and met. Information is available in different formats upon request. The home does not provide intermediate care. Evidence: The files of four residents were viewed and all showed evidence of a pre admission assessment. There is a Statement of Purpose and Service Users guide. These have been reviewed and updated and are done so annually. These documents can be made available in different formats and languages upon request. Prospective residents have an individual needs assessment and they are given the opportunity to visit the home prior to making a decision to live there. Referrals are made by Social Services department and they provide initial assessment information. This may be from information that they have gathered or from assessments made by hospital staff. Assessments are then carried out by the manager before an individual moves into the home. At this time the prospective resident and their relatives are provided with Care Homes for Older People Page 10 of 28 Evidence: information about the home and encouraged to visit. The assessments cover all of the required areas and include health, mobility, nutrition, religious, cultural and spiritual needs. Examples of this were seen on residents files. From this assessment information, an initial basic care plan is drawn up to enable staff to provide appropriate care for an individual when they move into the home. Evidence was seen on new residents files that they can visit the home and enter the home for a trial period of stay before deciding to move in permanently. The home does not provide intermediate care. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, personal and social care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents needs. There are medication policies and procedures for staff to follow and medication records are being completed correctly which safeguards the residents with regard to the administration of medication. Residents are treated with respect and the arrangements for their personal care ensures that their right to privacy is upheld. Residents wishes in relation to their funeral arrangements are identified on their care plans but end of life care plans need to be developed for each resident, which will ensure that residents wishes in relation to death and dying are clearly identified. Evidence: Individual care plans were available for each resident. The records of four residents were examined. The acting manager has reviewed and updated all current residents care plans and considerable work has taken place to ensure that care plans truly reflect the residents needs and that these needs are being met. The care plans are Care Homes for Older People Page 12 of 28 Evidence: detailed and comprehensive, identifying the residents personal, social, cultural, religious and health needs and how these should be met. The acting manager informed the inspector that staff are responsible for understanding their role in completing and updating the residents care plans as the need arises. Residents health needs are clearly identified as part of their overall care plan. Records indicate that health professionals including opticions, dentists, chiropodist, GP and district nurse are involved as required. Other written evidence includes residents being weighed monthly. Risk assessments are in place and are reviewed monthly or when a change in risk is identified. The risk assessments are detailed and covered areas such as moving and handling, bathing, breakdown of pressure areas, use of cot sites, continence and falls. Policies and procedures for the administration and recording the medication, guidance on homely remedies and an error and in administration of medication policy are in place. Medication administration records(MAR) were examined and all had been completed appropriately and medication given correlated with the MAR charts. The inspector spoke to a number of residents who said staff were respectful when attending to personal care. Staff were observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as the way in which they addressed residents and when entering bathrooms and bedrooms. On examining residents care plans, a record was seen a persons wish regarding for example, whether they would want to be cremated or buried and who to contact. End of life care plans should be more detailed than this and include the care the resident would like and where they want to be cared for at the end of their life and what they do not want to happen. The manager is aware of this and has arranged for training regarding this to ensure that residents wishes are appropriately recorded. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an activities program that provides variety and interest for people living at home. Visiting times are flexible and visitors are made to feel welcome, this ensures that residents are able to maintain contact with friends and relatives. The residents are assisted to exercise choice and control over their lives. The meals in the home are well presented and nutritionally balanced offering choice and variety to the residents. Evidence: Staff are aware of the need to plan the routines and activities at the home in a way which meets the choice and wishes of the residents. The home tries to be flexible and uses its current resources and staff effectively in order to provide an individual service. At the time of inspection a member of staff was working flexible hours in order to provide an activities program to the residents. The activities coordinator post is currently advertised. Discussions have taken place with the residents about the activities they would like to participate in. As a result of the feedback received some individually tailored activities are taking place for example, three people like to decorate cakes and biscuits, one person likes to play draughts, one resident arranges fresh flowers and helps with the Care Homes for Older People Page 14 of 28 Evidence: gardening. Most of the residents have entered growing sunflowers competition. Discussions are taking place with residents regarding outings. The aromatherapist and a hair dresser visit every fortnight and some residents have manicures regularly. Activities for people with dementia also take place for example, light exercise, reminiscence, looking at photo albums, old-time movies and music. The activities log was checked which listed the activities people have participated in. A musical entertainer also visits the home once a fortnight. However, feedback received from residents and their representatives is thet they would like to see more activities and outings organised in the home, as stated, I would like to go to sea side outing. Although my mother is ---- years old she is quite active and would enjoy things to do. Visiting times within the home are flexible and this was evident during the inspection. Upon examining the visitors book it was evident that there are visitors to the home every day and on the day of the inspection, the inspector spoke to one relative who said the atmosphere in the home is much improved and the staff and residents seem a lot happier. Meals are served in the dining room. On the day of the inspection, the meals were seen to be wholesome and nutritious and were enjoyed by the residents spoken to. Residents said that an alternative is always provided if they dont like the main choice. Special dietary needs are catered for if required. Residents who required assistance with feeding were helped discreetly without being rushed. The cook consults with residents and tries to meet individual preferences and suggested dishes when preparing the menu. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure in place and residents and relatives feel confident that their complaints and concerns are listened to and acted upon. The home has a satisfactory policy and procedures regarding safeguarding adults. The staff have undertaken safeguarding adults training to ensure that there is an appropriate response to any safeguarding allegations. Evidence: The home has a written complaints policy and procedure which meets the National Minimum Standards and Regulations. The complaints procedure is available in the home. Residents and others associated with the provision understand how to make a complaint. The complaint procedure is displayed in the home. There is only one complaint logged in the complaints book and the manager has dealt with this appropriately and to the satisfaction of the complainant. Residents were asked what they would do if they were unhappy about anything in the home. They said they would talk to the manager or staff if they have any concerns and felt confident that they would be listened to. There is a written policy and procedure for dealing with safeguarding issues and whistleblowing. The home also has copies of the Local Authority (Havering) documentation on safeguarding adults. There is an ongoing training program and all staff have now received safeguarding adults training. The manager and staff are aware of the action to be taken if there were any concerns about the safety and welfare of the residents. Care Homes for Older People Page 16 of 28 Evidence: Three safeguarding adults notifications have been investigated by the London Borough of Havering safeguarding team and multiagency case conferences have taken place. Matters raised regarding training, health and safety, risk assessments, care planning, environment and management issues have been investigated. These were specific to the previous manager. A new acting manager is in post. An action plan from the home was received by the Commission outlining the timescales within which the matters raised at the various meetings will be resolved. This key inspection of the service was brought forward by the Care Quality Commission following concerns raised. Improvements have been noted. Inappropriately placed residents have been moved to other more appropriate placements. Staff have received all relevant training and the manager is aware that staff must implement the training received in their work practice. Regular monitoring and supervision of all senior and care staff must take place so that any issues of concern can be resolved before they become problematic. One outstanding matter is being dealt with by the organizations head office and the London Borough of Havering safeguarding adults team. The following comment was received from a relative, the home is back to what it was. Staff are a lot happier, they look after mums needs. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is welcoming and provides the residents with a clean, safe and comfortable environment in which to live. There are sufficient, suitable toilets and bathrooms for the number of residents with appropriate aids and adaptations available to meet residents needs. Residents bedrooms suit their needs. Evidence: A tour of the home was undertaken. The home has an ongoing redecoration and refurbishment program. Since the last inspection the living room and the hallways have been improved. New carpets have been fitted in most of the bedrooms and deep cleaning has taken place to reduce the odour in the home. On the day of inspection, upon touring the building, there was a noticeable improvement in this area. The manager is aware that regular monitoring must take place so that odour control can be maintained. Residents bedrooms visited were appropriately furnished and personalised with photographs, pictures and ornaments from their own homes. They were found to be clean and free from odour. Vacant bedrooms have been redecorated and refurbished. Residents spoken to stated that they were happy with their environment. There is a large garden at the rear of the house which is enjoyed by the residents durng fine weather. Bedrooms have en suite facilities and there are sufficient and suitable toilets and Care Homes for Older People Page 18 of 28 Evidence: bathrooms for the number of residents accommodated. Specialist equipment such as hoists, mattresses and walking aids are available to meet the needs of the residents. Systems are in place to control infection in accordance with relevant Legislation and published professional guidance. Some staff have completed infection control training with seven members of staff yet to do this training. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are on duty who have the skills and training to meet the individual needs of the residents. The home has a clear recruitment policy and procedures and appropriate checks are undertaken, which ensures the protection of the residents. Evidence: The staff rota was examined and it correlated with the number of staff on duty on the day of the inspection. At the present time twelve residents are accommodated in the home. During the daytime there are three carers plus a senior on shift and night time cover includes two waking night staff. In addition, a handyman, cleaners and a cook are employed. Staff have undertaken a wide range of training including safeguarding adults, moving and handling, food hygiene, challenging behaviour, equality and diversity, medication administration and other relevant training. A requirement is made that staff undertake advanced dementia care training as the home is registered to look after people with dementia. The AQAA states that staff will be encouraged to undertake NVQ Level 2 and Level 3 training. Two new staff have been employed are to undertaking induction training. Staff feedback states that, the home provides a good homely atmosphere. The team works well together. And clients are treated with dignity and respect. Feedback from a number of staff states that they would appreciate more support and consultation from people visiting from the head office. This issue has been brought to the attention of the person conducting the Regulation Care Homes for Older People Page 20 of 28 Evidence: 26 monitoring visits who is aware that staff consultation is an inherent part of any monitoring. Staff files checked showed that all relevant recruitment checks had been undertaken. The files checked have two written references, Criminal Records Bureau checks, ID document, and a utility bill. Some files lacked a recent photograph of the staff member, however at the time of writing this report the manager confirmed that these are now in place. The manager also confirmed that two new staff recruited have begun their induction program, which includes the health and safety aspects of the home, policies and procedures. The following comments were received from people who use the service and their relatives, The carers are always very kind and helpful to my mother and very considerate to me, offering tea/coffee when I visit. I am kept informed of any problems about my mothers health. They look after my mother with care and treat her with respect. I could not ask for better carers. During ill health, you are well looked after. Catering is always good. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and provides a safe environment for the residents. The manager and the staff team work well together and receive appropriate support to make sure that residents are safe and secure whilst living at the Priory. The manager sets an example of good practice to her team and is keen to continue to develop the service at the home for the benefit of the people who use the service. Evidence: An acting manager is in post and is required to register with the Care Quality Commission registration team as a fit person to manage the home. She has successfully completed the NVQ level 4 qualification in care. She has a good understanding of the needs of the residents and the areas in which the home needs to improve and further develop. Staff and service users informed the inspector that they found the manager to be approachable and staff were observed to interact with the manager in a relaxed manner. A deputy supports the manager in the running of the home. The manager undertakes regular training and understands and values opportunities for continual professional development. The atmosphere in the home is Care Homes for Older People Page 22 of 28 Evidence: relaxed and friendly and there is a stable staff team. The acting manager communicates a clear sense of the direction, is able to evidence a sound understanding and application of best practice operational systems particularly in relation to continuous improvement, customer satisfaction and quality assurance. Equality and diversity, human rights and person centered thinking are given priority by the manager aiming to continuously improve the service in order to meet the residents individual needs. Residents are asked for their feedback about the service and improvements are made where gaps are identified. Residents personal allowances are handled appropriately and an issue regarding one persons financial arrangements is being addressed by consulting the placing authority. Any other expenses incurred by the residents are invoiced directly to their families or appointees. People are supported to manage their own money where possible. Record keeping is now of a good standard. Records are kept securely and staff are aware of the requirements of the Data Protection Act. Residents know they can access their records at any time. The AQAA contains clear, relevant information that is supported by appropriate evidence. The manager recognizes the areas that they still need to improve and has detailed the ways in which they are planning to do this. The home has a range of policies and procedures to promote and protect the residents and employees health and safety. The manager is proactive with regards to health and safety to ensure that any potential risks are minimized as far as possible. Health and safety awareness issues are cascaded to staff to raise their awareness. Regular health and safety checks are carried out by appropriate professionals. The manager is aware that it is her responsibility to carry out all of the necessary health and safety checks and provide a safe environment for the residents and staff at all times. Staff meetings have been taking place regularly, providing staff with the opportunity to discuss problems and to be involved in the development of the service. Staff meetings have an agenda and are minuted. Staff state that there is good communication and teamwork in the home. Training and development needs are identified as part of supervision. All staff have now undertaken moving and handling and first aid training as well as other relevant training to enable them to competently meet the residents needs. Residents files examined showed that risk assessments are being reviewed on a regular basis or when a change in need is identified. There are clear lines of accountability in the home. Monthly visits are carried out by a responsible individual under the Requirements of Regulation 26 of the Care Homes Regulations and reports of these visits are available at the home. Some staff comments received state that more support needs to be provided by the head office during times of difficulty. The following comment was received, head office could be more involved with the home and provide the staff and management support. They should speak to staff when on the small occasions they visit. This has been brought to Care Homes for Older People Page 23 of 28 Evidence: the responsible individuals attention and the person is aware that these comments need to be listened to. Appropriate insurance cover is in place and the registration certificate is prominently displayed in the home. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 18 All staff must receive training in advanced dementia care. So that all staff are trained and can competently care for people with dementia. 30/09/2009 2 31 9 The manager is required to 30/09/2009 register with the Care Quality Commissions registration team as a fit person to manage the home. So that the home is managed and run by a person who is skilled and competent to operate it in the residents best interests. 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 12 The responsible person to provide a range of individualised activities and outings for the residents to provide variety Care Homes for Older People Page 26 of 28 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 and interest for people living at the home. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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