Care Home: Regency Court Residential Home

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What the care home does well During our visit the atmosphere at the home was warm and welcoming. people living in the home are confident and contented about the service they receive. Staff provide people with a good standard of care understanding their care and support needs. Each person before moving in the home have their care and support needs assessed, this ensures that their needs can be met at the home. There is a forum where people and their relatives can have a say about the running of the home and any issues which affect the people living there. The food is good and people are provided with a choice, and their dietary needs are met. What has improved since the last inspection? There is a designated staff who is in charge of the safe handling of medicine in the home; ordering and storage. Staff who administer medication have had training by the dispensing chemist. The home has a good policy on safe handing of medication which provides staff with clear guidelines. There is also a copy of the Royal Pharmaceutical Society Guidelines for residential homes. This will make sure that people get the medication as prescribed by their doctor. Each person has a care plan which is regularly reviewed with the person and their representative. This makes sure people`s care and support needs do not get missed. All staff have had training on adult protection, which helps to keep people safe from abuse. What the care home could do better: The manager should make sure that people living in the home and their relatives are given the opportunity to comment on the service provided at the home. Although there has been some improvement in activities out of the home more effort is needed to provide people with more regular activities in the home. The stair lift must be good working order at all times. This is to make sure people are safe at all times and have access at all times to their rooms on the first floor. Some consideration should be given to replace the vinyl floor covering in the bedrooms. So that people have floor covering that is warm and safe. Ventilation in the conservatory should be revised to make sure that the area is kept well aired and fresh for people. Action must be taken to revise the cleaning staff arrangement. So that they carry out their cleaning duty in the allocated time, and people live in a home that is clean to a good standard. Key inspection report Care homes for older people Name: Address: Regency Court Residential Home Thwaites House Thwaites Keighley West Yorkshire BD21 4NA     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: Valerie Francis     Date: 3 0 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Regency Court Residential Home Thwaites House Thwaites Keighley West Yorkshire BD21 4NA 01535606630 01535602257 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ADA Care Limited Name of registered manager (if applicable) Mrs Angela Peacock Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20 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 Regency Court is located in a rural setting two miles from the town of Keighley. The village of Thwaites is a short walk from the home and there are local bus routes into Keighley town centre. The home provides residential and personal care to people over the age of 65. Care can be provided to a small number of people with dementia. This Care Homes for Older People Page 4 of 29 Over 65 0 16 4 0 0 4 1 0 2 0 0 8 Brief description of the care home former farmhouse is an adapted property located in its own well maintained grounds. Accommodation is on the ground and first floors and there are some changes of levels on both with short flights of stairs. Therefore people living in the home need to be fairly mobile. There is a stair lift to the first floor. Communal areas comprise of a lounge and a dining room. In addition, there is a conservatory that is the designated smoking area for people who live in the home. To the rear of the building is a pleasant patio for people to sit and enjoy the views when weather permits. Car parking is provided at the front and rear of the building. The main entrance is at the top of a flight of stairs but there is level access at the rear of the building. Information about services provided in the home is included in the Statement of Purpose and Service User Guide. Copies are kept in the home and can be provided on request. 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 was an unannounced visit by one inspector who was at the home from 10:00am until 17:30 on the 30th September 2009. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there, and in accordance with the requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents and complaints. A number of documents were looked at during the visit and all areas of the home. Time was also spent talking to people their visitors and staff. Before the visit the manager was asked to complete an Annual Quality Assurance Assessment (AQAA) to provide additional information. This is a self assessment of the service provided, information from this is included in this report. We sent surveys to the home before the inspection, which provided people , visitors, health and social care Care Homes for Older People Page 6 of 29 professionals and staff to comment on the service if they wish. Six people , three staff and one health care professional returned completed surveys. Comments received have been included in the body of this report. The weekly rates of fees are from 397 pounds and 95 pence to 420 pounds. This does not include hairdressing, social activities out of the home and individual newspaper. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The manager should make sure that people living in the home and their relatives are given the opportunity to comment on the service provided at the home. Although there has been some improvement in activities out of the home more effort is needed to provide people with more regular activities in the home. The stair lift must be good working order at all times. This is to make sure people are safe at all times and have access at all times to their rooms on the first floor. Some consideration should be given to replace the vinyl floor covering in the bedrooms. So that people have floor covering that is warm and safe. Ventilation in the conservatory should be revised to make sure that the area is kept well aired and fresh for people. Action must be taken to revise the cleaning staff arrangement. So that they carry out their cleaning duty in the allocated time, and people live in a home that is clean to a good standard. Care Homes for Older People Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with enough information to enable them to make an informed choice about the home. The admission process is good and includes introductory visits. Evidence: Information is made available to anyone interested in moving into the home. The homes statement of purpose and service user guide, give people and their representative some good information that would help them decide if the home can meet their needs. People told us that they were given information about the home before they moved in. Usually the registered manager will visit people in the community and complete an assessment to make sure the home will be able to provide a service that will meet their needs. As part of this process, they also gather information from any other agencies involved in the persons care. Where possible, the person is encouraged to visit the home for a day or for a trial period of four weeks which could provide them with the opportunity to meet everyone and to get a feel for Care Homes for Older People Page 11 of 29 Evidence: the home. Whilst there the home assess if all their needs can be met by them Staff said that they are given information about any new person that was moving into the home. Visiting relatives and people told us they were able to talk about care and support needs. The manager explained that time and effort is made to make sure admissions to the home are personal and well managed. We were also told that people could have a say in how their room is redecorated before they move in. We looked in detail at the assessment process for one person who had recently moved into the home. We saw good information of every aspect of the persons daily life and their health care needs. For example, some life history and the reason for admission. There was evidence that the home also received information from other health and social care professionals before the person moved into the home. This home does not provide intermediate 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. Every effort is made to make sure peoples health and personal care needs are met. Medication policies and practices are good. People are treated with dignity and respect. Evidence: The case records of three people were looked at in detail. We saw that following admission, the manager has put systems in place to ensure that all people living in the home have a care plan that covers the activities of daily living, identifying some of their likes and dislikes; for example, one persons plan informed staff that pressure relieving mattress and seat pads are to be used at all time to eliminate the risk of pressure sores. There was evidence of the involvement of health care professionals with peoples care; such as, the tissue viability nurse has input into the care of one person despite this good information more effort is needed to ensure that people have a person centered care plan, which should include details of each persons preferences in how their care is given and also highlight what people can do for themselves, which will help maintain peoples independence. The manager told us that she recognises that more work is needed on care plans. We saw that care plans are reviewed monthly Care Homes for Older People Page 13 of 29 Evidence: and staff sign to indicate this. However, any new information resulting from the review should be written into a new care plan. This would ensure that identified needs do not get missed. Evaluation of care plans should be developed to provide meaningful feedback of the effectiveness of the care plan over the previous months. Although there was a clear indication in some peoples care assessment that they had a dementia; and some care plans had some detail about the person and their dementia there was not enough information that would show us how these people would be supported by staff. Peoples relatives told us that they were happy with the care their relatives were getting and they were given the opportunity to be involved in the care planing process of their relative. One person who commented on the new staff at the home said I am not quite sure if the new staff could meet my needs but it was early days and I have no concern During the visit we saw staff approach to people was respectful and their practices demonstrated that they respected peoples dignity. Staff seem to know the people they care for. Health care professionals said as the home is small, the staff quickly build up a good relationship with residents and the new management have improved standards, the environment in which residents live and arrange outings and entertainment. There are a range of risk assessments some of which are completed showing the action to be taken to manage the risk. We saw that the home also seeks the advice of health care professionals whenever necessary. For example, we saw that one person has regular visits from the district nurses. We were told and saw records that all staff have safe handling of medication training. We observed the medication round which was done by the senior carer. Records were found to be completed, which indicate that people get their medication as prescribed. The home also have good procedure for safe handling of medication. However, the information in the homes statement of purpose indicated that peoples medication would be given by the homes staff. This indicated that people are not given the opportunity to self medicate. Some consideration should be given to assessing people who may wish to self medicate. One of the senior care workers has the responsibility for ordering and safe handling of medication. 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 have the opportunity to take part in social recreational activities in and outside of the home, in accordance with their preferences and capabilities. People are provided with a good and varied diet that takes into account individuals choice. Evidence: We saw in the care plans seen that each person had some information about their past life. The manager said she and her staff support people to make choices about their daily lives and to use their time in the way they want. Some people who could walk independently were able to move from communal sitting areas to their bedroom. Other people were seen sitting, sleeping, talking to each other or watching television. One person told us that he regularly went out for a walk to and from Keighley. Relatives are encouraged to be involved with their relative care and to have a say in the running of the home by attending regular residents relatives meetings, where items such as meals and outings are discussed. In the AQAA the home told us: When someone moves in we give them an activities questionnaire to complete. We also discuss with them their interests and families Care Homes for Older People Page 15 of 29 Evidence: and friends who they have regular contact with.We have a volunteer who comes in twice a week, one session is focused on activities with the residents, this is flexible, in that it can either be a one to one or a group sessions. During our discussions with people and their visitors they all felt that activities should be held regularly. On the afternoon of our visit the staff engaged people in ball games exercise and two of the ladies and a man had their hair done by the visiting hairdresser. In the surveys people told us what the home does well is everything; trips out and good TV. We were told what the home could do better is more staff, residents interaction as residents really enjoy it when entertainment is provided; more should be arranged. At meal times we saw that tables were set with tea, sugar and milk,to which people independently help themselves and other people sitting on their table. We observed lunch and tea time meals, and saw that people were assisted discreetly staff sensitively encouraging people to eat their meal, we saw that people have opportunity to have more food if they wanted. We were told by health care professionals, dietary intake of residents have vastly improved due to the employment of a good cook. Flexible meal times, cooked breakfast, snacks are available and regular weight checks carried out. We were told that menus are discussed with people during their meetings or on a one to one basis. We spoke to the cook who said she talks to people individually about their likes and dislikes. During our discussion with the cook it appeared she knew peoples dietary and nutritional needs. We saw that peoples nutritional needs had been assessed, to ensure that people are not at risk of malnutrition. We also saw records in the care files that people have their weight checked monthly. In the AQAA we were told all residents have a choice of menu for their meals. Meal times are paced at the residents pace not the staffs pace; giving people space and time to eat; offering assistance to residents in a way that does not draw attention to them. We saw that the home have a three week rolling menu which offers a wide variety of food. Care Homes for Older People Page 16 of 29 Evidence: People told us the food is good; what they do well is the food; the meals are very good. 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. There are clear complaints procedures available to people at the home and to their visitors. The homes procedures protect people and they can be assured they can feel safe at the home. Evidence: The home has put in place a robust adult protection procedure which will make sure people are kept safe from abuse. All but one staff have had training on adult protection. Since the last the homes registration in April 2008 three complaints has been made and two safeguarding referrals to the safeguarding unit to investigate. From discussion with the manager it was apparent that lessons had been learned she has put system in place to ensure that people get the care and support they need. It was clear that staff knew what to do if they or any person had a complaint or any issue of abuse that was brought to their attention. People and their visitors told us they knew how to make a complaint and felt that the manager would take their concern or complaint seriously. Care Homes for Older People Page 18 of 29 Evidence: Staff told us that they have had some training on the mental capacity act deprivation of liberty, thus enforcing peoples right and choice. We also told that if there was a situation of capacity all steps would be taken and all appropriate agencies would be involved to make sure peoples rights and choice do not get overlook. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is continually being refurbished to meet their needs. Evidence: Since the last key inspection there has been some redecoration of the communal sitting areas one bedroom and the hallways. Carpets to communal areas have also been changed. During our inspection of the premises we saw that most of areas of the home needed thorough cleaning. Bedrooms seen in the late afternoon of the inspection still had food debris on the floor and fitments needed dusting. Some bedrooms had vinyl floor covering which we felt gave the environment a cold feel. There was an odour of stale urine in some bedrooms. We were told by visitors to the home There is a strong perfumed odour present which we feel is trying to mask the smell of stale urine, which we find quite unpleasant, although we are aware they are trying to make the environment pleasant. We were told that staff had received infection control training, we saw no concern during our visit of staff practices of infection control. It was evident that some people had taken the opportunity to personalised their rooms. The manager said the home carries out health and safety and risk assessments for the building, which would assess any potential risk to people, staff and visitors. Care Homes for Older People Page 20 of 29 Evidence: During our tour of the premises we found that the landing of the main stair case was a potential health and safety hazard, this was brought to the attention of the manager, who alerted the owner, who visited and agreed for the work to be started to eliminate the hazard. Since the inspection our visit the manager has informed us that work had been carried out to extend the hight of the banister and this has been completed. Although the stair lift for people to gain access to their rooms on the first floor has been serviced; we were told that it does not always work as it should; and still needed attention. This was brought to the attention of the owner at the last key inspection. The laundry room has become a storage room for unwanted equipment and needs clearing and cleaning. The conservatory is the designated smoking area for people who live there; there was no alternative ventilation in this room; on the day of the visit the weather was warm and the door to conservatory was opened. Some people who live in the home have dementia. We saw that on every toilet and bathroom had signs of both pictures and words on these areas. which help people with their orientation. However, although peoples names were on their bedroom doors, some consideration should be given to have further signage which would help peoples orientation to recognise their room, if they were able. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures protect people living in the home. People are looked after by trained and competent staff. Evidence: During the visit some of the time was spent in the communal area speaking to people who live in the home, staff, visitors, and observing staff interacting with people. There were enough staff to make sure that people were looked after. Since the new registration many of the staff have left and been replaced with new ones. One person commented on the new staff getting use to the way how they like to be cared for. The rota showed the managers availability to people and staff. This is good practice. We were told that the cleaning was carried out by two staff, both have dual roles in the home; care and maintenance. It would appear that some of their cleaning hours were spent working in their other roles. For example, on the day of our visit, the handyman should have been carrying out cleaning duties. However, he was seen painting and moving furniture and equipments for the duration of his shift. If people are to be provided with a home that is clean, the staffing arrangement must be address. Staff spoken to individually and some returned surveys said they felt there were enough of them to provide care for the present group and number of people living in Care Homes for Older People Page 22 of 29 Evidence: the home, they felt that they were given enough information and training in their induction and there was on going training. One staff who had just been registered to commence National Vocational Qualification (NVQ) Level 2 had a visit from the external NVQ assessor. The home has nine staff who have a NVQ Qualification level 2 and above. We were told that the manager supports staff to have training. In the AQAA it was stated that residents needs are suitably met with trained and experienced staff; there is a three week rolling rota covering the needs of the residents. We were also told that they ensure staff employed start their NVQ Qualification training if they do not already have one and make sure staff go through the common standard training. The manager said all new staff are recruited using the homes robust recruitment and selection process. We looked at three staff files and saw that all had enhanced Criminal Record Bureau and POVA first check; two references taken up one from the previous employer. It was also evident that gaps in employment are explored at the interview. There were a training matrix covering all the training staff had received and planned training, the manager said she was continually looking at training for the staff team covering the care need for such as dementia care for the people who live in the home. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience 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 in the best interest of the people living there. Evidence: The manager is registered with us, she holds all the required management qualifications, many years of experience of working with older people and management of a care home. She also hold NVQ level 5 and has in been post for almost a year, during this time she has made many changes that would provide people with a good standard of care and support and staff management. The manager is supported by two senior carers who have NVQ level 4. People and their relatives spoke highly of the homes management, and were confident that all care and support needs would be met and the manager was approachable and available. Staff told us that they were happy with the management and had supervision with the manager giving them the opportunity to discuss any issues they may have and their Care Homes for Older People Page 24 of 29 Evidence: personal development. Visitors told us that there has been some good changes in the home since the new manager came. We were told by health care professional, We feel that there has been a great improvement in the care the residents receive in all areas since the new manager appointment. The home holds residents relatives meetings, where people are able to discuss issues which affect the group of people living in the home. However, there is not a system in place for a quality audit of the service they provide, which would give people, their relatives, staff and other involved in the home to have their say about the service. In the AQAA the home said that they plan to improve by sending out formal quality assurance questionnaires. The manager said the outcome of the audit would be put into the homes news letter which is circulated to people and their relatives. We looked at records and checked money for two people whose finances are looked after by the home; we found that there was a good audit trail of all transaction. In the AQAA the home, said they plan in the next twelve months to encourage people where possible to look after their own finances. We saw records made of accidents occurring to people who live at the home, records were detailed and all reported through to us as required. During our walk around the premises we saw that there were several areas of health and safety all of which were relayed back to the manager.(These are found in the environment outcome area. ) All the required checks; such as the annual gas and equipment checks are carried out in the given timescale with a record kept, the home also carries out risk assessments for all potential risks around the building. This ensures that there were action plans in place to show how the identified risk would be managed and minimised. At the time of our visit we did not see the certificate for the last electrical check carried out for the building, the manager said this was with the owner and she would forward this to us after the visit. 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 19 23 The stair lift must be good working order at all times. This is to make sure people are safe at all times and have access at all times to their rooms on the first floor. 03/12/2009 2 27 23 Action must be taken to revise the cleaning staff arrangement. So that they carry out their cleaning duty in the allocated time, and people live in a home that is clean to a good standard. 27/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 Appropriate signage should be provided in the home to help people with dementia find their way independently to bedrooms, bathrooms and toilets. 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 2 3 19 24 Ventilation in the conservatory should be revised to make sure that the area is kept well aired and fresh for people. Some consideration should be given to replace the vinyl floor covering in the bedrooms. So that people have floor covering that is warm and safe. 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. 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