Care Home: River Meadows Nursing Home Limited

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What the care home does well All of the people consulted during the inspection were happy with the care they or their relative receive. People told us carers look after them well and relatives we consulted told us they are kept in touch with any changes or other important information. Peoples` health needs are well monitored and we saw evidence of the home engaging the support of health care professionals where necessary. We observed good interaction between staff and the people who live at the home. Staff were seen to respond to requests for assistance in a friendly but respectful manner. River Meadows provides people with a clean and comfortable place to live with the opportunity to personalise their own bedrooms. What has improved since the last inspection? A person living at the service is happy to meet and talk with prospective individuals, their family or friends. This person has also attended a staff meeting to represent the views of other people living in the service. People told us that the management team are accessible and listen and act on issues raised. Training opportunities have been improved, staff told us they thought the training they receive was good. The home continues an ongoing programme on decoration and refurbishment. What the care home could do better: There were no requirements made at this inspection. Although staff feel they are supported to do their job there was a lack of evidence to demonstrate staff receive formal supervision. Staff should receive six formal supervisions in 12 months and these recorded. The provision of activities is somewhat limited at the moment due to the post of activities coordinator being vacant. The manager is currently attempting to recruit into this post. Some areas of the home are in need of redecoration including downstairs corridors, the downstairs bathroom, both stairwells including replacement curtains and the communal dining room/lounge on East wing. Key inspection report Care homes for older people Name: Address: River Meadows Nursing Home Limited Edgebolton Shawbury Shrewsbury Shropshire SY4 4EL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Karen Powell     Date: 1 4 0 7 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: River Meadows Nursing Home Limited Edgebolton Shawbury Shrewsbury Shropshire SY4 4EL 01939250700 01939250118 river.meadows@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Springcare (River Meadows) Ltd Name of registered manager (if applicable) Alison Pattison Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 44 The registered person may provide the following category of service only: Care Home with Nursing (Code N); 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 (OP) 44, Physical disability (PD) 13 Date of last inspection Brief description of the care home River Meadows is a Care Home registered with the Care Quality Commission (CQC) to provide accommodation, nursing and personal care, for a total of up to 44 older people and young adults, of whom one may have learning disability, and ten may have a physical disability. The service is a non smoking home. The home also currently Care Homes for Older People Page 4 of 26 Over 65 44 0 0 13 Brief description of the care home accommodates two pet cats. The home is in the village of Edgebolton, on the outskirts of Shawbury with good road links to the larger towns in North Shropshire. There is a limited bus service which runs near the home from Wellington and Shrewsbury. Set in its own grounds, the home enjoys views of the surrounding countryside from most aspects of the building. It is a prime site for bird watching. The accommodation comprises an original two storey converted country house, and a more recently added purpose built single storey wing. The home is divided into two wings and has a variety of communal areas comprising of three communal lounges, and a conservatory. The majority of bedrooms are for single occupancy, and many benefit from en -suite facilities. All areas are maintained and furnished to a good standard, providing welcoming and comfortable surroundings. The home is set in well-maintained grounds with lawns, flowerbeds, and seating areas, which are accessible to residents of various physical abilities. The home is owned by Springcare Ltd, the Managing Director being Mr Lee Cox. Springcare Ltd makes the services of River Meadows known to prospective residents in their statement of purpose, and its brochure/service user guide. A copy of the most recent CQC report is also freely available at the entrance of the home for people to look at. The current fees charged vary between 435.00 and 750.00 per week depending on the care, support and accommodation provided. Additional charges to people living at the home are for hairdressing, toiletries, and newspapers. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of the service was unannounced and took place on 14th July 2009 by one inspector over a period of approximately seven hours and a half hours. A range of evidence was used to make judgements about this service to include discussions with people using the service, visitors, the registered manager, deputy and staff. We also examined a number of records to include care records of people living at the home, staff training, staff recruitment and health and safety records. Three people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting them, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. An Annual Quality Assurance Assessment (AQAA) document was posted to River Care Homes for Older People Page 6 of 26 Meadows for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. By law they must complete this and return it to us within a given timescale. The registered manager completed this, and some of the information is included in the report. The purpose of the inspection was to assess all 22 Key National Minimum Standards for Care Homes for older people and any further standards necessary. An annual service review was carried out on 8th August 2008. This did not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection. The report is available at the service. Information to produce this report was gathered from the findings on the day and also by review of information received by CQC prior to the inspection date. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent/good/adequate or poor based on findings of the inspection. Fees are published in information given to prospective clients. The weekly fee range is 435.00 to 750.00 per week. Readers wishing to know more about this information should contact the service directly. 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 excellent 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 information and encouraged to make informed decisions about the home before moving in. Pre placement assessments ensure that individual needs are met. Evidence: The home has clear information in the service user guide and statement of purpose to help people understand what services the home can provide, this includes the fees charged. The information also explains the assessment procedure prior to someone being admitted into the home. As the completed AQAA and information provided to people enquiring about a place at River Meadows states people are only admitted to the home following an assessment of their needs carried out by the registered manager or a suitably qualified health care professional. We looked in detail at the support for one individual who was recently Care Homes for Older People Page 10 of 26 Evidence: admitted to the home. We talked to them about their experience of the admission, they told us that their next of kin had assisted them with finding a place at River Meadows, following a transfer from another care home. The person told us that they were visited at their previous address by the registered manager where she talked to them before she agreed that River Meadows could meet their needs. We looked at the records for this person and found a pre admission assessment completed by the registered manager. On the day of the inspection we observed a new admission arriving at River Meadows the manager and staff were seen to be welcoming and reassuring to this individual. It stated on the completed AQAA that a posy of flowers is in place in the persons bedroom to welcome them, the administrator confirmed that these had been ordered and were in the room waiting for this individual. The home does not provide intermediate care. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the information they need and have a clear understanding of how to offer care to each person, which ensures peoples health and personal care needs are met in a way that they prefer. Evidence: It was stated in the completed AQAA Person centred care plans are formulated for each individual service user from all of the information gathered in the pre-admission assessment, healthcare professionals and the service users themselves and or their families. Where possible the service user is encouraged to assist in the formulation of their care plan and there after its monthly review or if needed sooner when there is any change in their condition. We saw evidence of this within all three care plans we examined. Care plans we looked at for three people were detailed and explained to staff how people preferred their care to be given. We saw safe systems of working documented that protect people living at the home and staff who care and support them. Care Homes for Older People Page 12 of 26 Evidence: We saw specialist pieces of equipment had been provided when identified as needed within the care plans. All people spoken to told us they were very happy with the care and support given to them and that all of the staff were kind and caring. We observed good interaction between staff and the people who live at the home. Staff were seen to respond to requests for assistance in a friendly but respectful manner. Individuals preferred social activities were documented and when we spoke to people they were able to confirm they were able to carry out the choices they had made. One person told us they like to knit. Another person told us they enjoyed reading the daily paper, which is delivered to them everyday. Care plans contained a record of input from other health care professionals involved in individuals care. For example the visiting doctor and a physiotherapist. We saw evidence of a referral to the tissue viability nurse regarding the management of someone and their pressure area care. This area of the persons care was well documented with regard to the treatment and procedure to be followed. It was stated on the completed AQAA that the home has policies and procedures in place for the safe handling of medication. We looked at a sample of medication administration records and how the medication was stored. At the front of each persons medication administration record (MAR) there is a photo of the person so that new staff would know who to give medication to. MARs had been signed when medication had been given indicating that medication had been given as prescribed. Only trained nurses administer medication at the home. It was stated by the deputy that the home works closely with the doctor to reduce medication wherever possible. We observed the lunch time medication round which was carried out in line with good practice. We heard the nurse explain to the person which medication they were administering. We also saw the nurse spend sometime with this person offering assistance as they were unwell at the time of the medication round. We observed people to be treated with respect during the visit with their dignity and privacy being maintained. Personal care was given in bathrooms, do not enter signs were in use on doors indicating privacy requested during personal care giving. The staff group were patient, kind and caring throughout the day. People we confirmed this is the case at all times. One relative we spoke to told us that staff were always kind and caring whenever they visited their relative. There were many thank you cards from people who expressed their thanks in relation to the care their loved ones had received. Comments included thank you for the loving care you gave to X, after his long illness it was so pleasing and a comfort to Care Homes for Older People Page 13 of 26 Evidence: us to see X settle in such pleasant surroundings with excellent care and attention you gave to him, X was so happy in his last few days of his life. I can never thank you enough, you and your staff have been so kind, caring and compassionate to both X, myself and family and friends who visited X during their brief stay. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at River Meadows are provided with opportunities to experience a meaningful lifestyle that ensures self esteem and well being. People are provided with healthy, well presented meals according to their dietary requirements and choice. Evidence: It was stated on the completed AQQA that on admission, service users are asked about their lifestyle and their preferences in how they like to spend their day, their preferred rising and retiring times along with their food preferences. This information is recorded into their care plan to ensure that all care staff are aware of and can respect their choices and wishes. All three care plans we looked at identified peoples likes and dislikes and preferred routines. We saw completed questionnaires to establish peoples likes and dislikes upon admission. People told us that their daily routines are flexible and they are able to choose how they wish to spend their day. One person told us that although their bedroom is on the East wing of the home they choose to spend the majority of their day with a friend on the West Wing. This includes eating their lunch with them. It was stated on the completed AQAA we are recruiting for a new activities coordinator after the recent resignation of our existing one. We discussed this with Care Homes for Older People Page 15 of 26 Evidence: the manager who confirmed that interviews are in place to hopefully recruit to this post. It was evident through discussion with people that the loss of the activity coordinator does have an impact on what activities take place within the home. It was pleasing to hear that activities provided by external organisations are still taking place. This includes the visiting pet therapy dog each week, the extend exercise monthly visits, communion carried out by the local minister and the hairdresser who was visiting on the day of our inspection. We were informed by the registered manager that the Bishop of Shrewsbury recently carried out a confirmation at the home. There are some photographs around the home of people taking part in activities. The home has two resident cats that are popular with most of the people living at River Meadows. There is a well equipped room available for activities including video, DVD and compact disc player for film nights or for individuals that may wish to use it to view their own family celebrations on DVDs for example a family wedding. People told us generally they were happy with the food provided at the home, although variety could be improved. We spoke to the cook who showed us the four week menu, these appeared to be well balanced and offered at least two alternatives for lunchtime and a variety of choices for teatime. Specialist diets are catered for. We observed lunchtime on the West Wing this was unhurried. We saw that the menu was displayed within the dining area. We observed people were being offered choices at lunchtime and in one instance somebody enjoyed a second helping. We also saw a choice of desert being offered to people. People in the West wing dining area told us that they enjoyed the meal. People who required assistance with their meal were given this in a sensitive and professional manner. Discreet protection for those who required it was seen in use along with specialist eating implements to enable people to eat independently. People told us that their relatives can visit as they wish, we saw evidence of this from the visitors book and spoke to one relative who confirmed this. On person told us their son has a long distance to travel and he is given a meal at the home when he visits her. 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 at River Meadows have access to a complaints procedure, which is accessible and ensures the views of people are listened to. Staff receive training so that they have an understanding in adult protection to ensure people they support are protected from abuse, ensuring their well being. Evidence: People we spoke with told us they knew what to do if they were unhappy with the service they receive and reported that they have no concerns of complaints about the home. People have access to a complaints procedure, which we saw during our inspection in the reception area and in the service user guide information book issued to people when they choose to live that River Meadows. There has been one complaint in the last 12 months, this was dealt with through the homes complaints procedure. This was a minor complaint which was dealt with satisfactorily and recorded in the complaints book with details of the investigation and outcome. The complaint was upheld. People told us they feel safe and secure at the home. Staff are trained in adult protection, and discussion with the staff team demonstrated their knowledge of what to do if they suspect any abuse taking place at the home. The manager told us that she is arranging further training in adult protection for which we saw a notice to staff on the notice board. CQC received a notification in May 2009. A notification is Care Homes for Older People Page 17 of 26 Evidence: something that the home is required to tell us about by law. It did not involve the care home directly but a third party. The home did not report the issue into the safeguarding of adults process until instructed by CQC to do so, however, this did did not place the person at risk. The management acknowledge that they have learnt from this situation and will refer immediately into the safeguarding of adult process should any similar incidents arise. They have fully co-operated with the adult protection team, the investigation is still ongoing. Care Homes for Older People Page 18 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. People living at River Meadows are provided with a clean and homely place to live, which is equipped to meet their individual needs and makes them feel safe and secure. Evidence: It was stated by the registered manager that ongoing renewal and maintenance of the home is planned for in an annual development plan. It was stated in the completed AQAA that there are some communal areas which are in need of re decoration. This was seen by us during the tour we took of the home and noted both stairwells, the lounge and dining area and downstairs bathroom on the East Wing should be re decorated to ensure people living at River Meadows live in a well maintained environment. The home has been under occupancy for a period of time. Bedrooms that have been vacant during this time have been re furbished and re decorated. We looked at the bedrooms of the three people we case tracked. These were personalised with their own belongings. They told us I like my room. Another told us I am happy with my room it is always clean and tidy. The home is set in pleasant grounds and in nice weather can be accessed by people if they wish to sit and walk around the garden. Raised flower beds and a gazebo are in place for people to enjoy. 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. The arrangement for staffing, their support and development ensures that the needs of the people living at the home are met. People have confidence in the staff at the home because checks are done to make sure that they are able to care for them. Evidence: We looked at the files of three staff employed since our last inspection to make sure that pre employment checks are undertaken so that staff are checked as being suitable to work with vulnerable adults. Files were well organised and contained all the checks required under regulation. All people consulted as part of the inspection told us that the staff treat them well and that they are happy with the care and support they receive. We observed staff supporting people throughout the day, they did this with respect and were professional at all times. Staff told us that they are given regular updates about people living at the home during handover on each shift, and supported through updated care plans. Staff we spoke to demonstrated a clear understanding of the peoples needs we case tracked. Some staff feedback was that the home would benefit from increased staff numbers as staff feel they do not have time to sit and chat to people living at the home or do any meaningful activities because their time is committed to care duties. The absence of Care Homes for Older People Page 20 of 26 Evidence: an activities co-ordinator as mentioned earlier is sorely missed by staff and people who live at River meadows. We did meet with the manager before the inspection began and she told us about the recruitment process currently in place for additional staff in the home. She also told us that the occupancy levels have been thirty six and thirty eight people for sometime and assured us that staffing levels are determined by the number and needs of people living at the home and this has been done during the under occupancy period. We saw sufficient staff cover on the day of the inspection. We also examined past duty rotas at random and found these to be satisfactory for the needs of the people living at the home. Training for the staff is good. We looked at training completed by staff and saw the relevant training certificates on staff files. Training included dementia, moving and handling, protection of vulnerable adults, health and safety, and fire safety. The manager stated in the completed AQAA that over 50 of the care staff have obtained a nationally recognised care qualification (NVQ) at level 2 and above. Although staff told us they feel supported by the homes management team we saw no evidence of formal supervision recorded in staff files. The manager acknowledged that supervision has been carried out informally she explained and showed us her plans for rolling out supervision as soon as possible. The home has an induction process, consistent with Skills for Care expectations. Although conducted over a period of time, feedback from staff was that staff that are new to the care sector would benefit from longer than two days shadowing. It was evident through discussion with staff that they are committed to develop the knowledge and skills of new colleagues but in some cases more time is required to achieve good results. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in River Meadows because it is effectively managed in the best interests of the people living and working there. Evidence: The registered manager is suitably qualified to manage the care home and has a number of years experience in the care sector. The staff receive clear guidance on how to perform their role and there is a clear understanding from staff of what is expected of them. This ensures that people living at the home receive consistent care and support of a good standard. People living at the home are regularly consulted in what they think about the service and any improvements that could be made. We were told by people living at the home and their families that they have recently completed a satisfaction questionnaire. It was stated on the completed AQAA that we will publish the results of our satisfaction questionnaire openly and act on the results and continue to listen to our service users through these, the meetings and our service user representative. Care Homes for Older People Page 22 of 26 Evidence: We saw a number of thank you cards from people who had contact with the home. Comments we saw included thank you for the loving care you gave to X, after his long illness it was so pleasing and a comfort to us to see X settle in such pleasant surroundings with excellent care and attention you gave to him, X was so happy in his last few days of his life. I can never thank you enough, you and your staff have been so kind, caring and compassionate to both X, myself and family and friends who visited X during their brief stay. People who are unable to manage their finances are supported through the home. Policies and procedures are in place which give clear guidance on managing peoples money, valuables and financial affairs. All checks required such as of the fire safety systems, lifting equipment and electricity are in place. People are protected through regular maintenance of systems and equipment and records to show this are well organised. We did note on a tour of the home that water temperatures were slightly above the recommend temperatures, records to support regular testing are in place and did exceed on some occasions 43 degrees centigrade. The registered manager agreed to rectify the matter and confirmed by e-mail to CQC that this had been attended to. 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 19 Some areas of the home including, both stairwells, the East wing dining room lounge and downstairs bathroom are in need of re decoration, which would ensure people living at River Meadows live in a well maintained environment. Staff should receive formal supervision six times a year which is clearly documented. This will ensure that staff are supported in their role. 2 36 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. 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