Care Home: Rosewood Residential Care Home

What the care home does well The home has a friendly and caring atmosphere, and residents said that "they (i.e. the staff) are very good"; "I like it here"; and "everyone helps me" during the visit. The comments book includes many positive remarks from visitors, such as "what a lovely place this is! it is so good to see carers taking such good care of the residents". There are good systems in place for new residents coming into the home. This includes having the same staff to greet new residents on arrival who have been involved with their pre-admission assessments. Medication is well managed, with good procedures in place to prevent errors. The home provides a good range of outings and entertainments. Food is well managed and provides a nutritious diet. What has improved since the last inspection? Care planning has been improved since the last visit, and includes better risk assessments, and ongoing audits to ensure they are up to date. The home has a greater range of activities available. The complaints procedure has been developed into a new format which is easier for residents with dementia to understand. Improvements have been made to the environment, including new decor and soft furnishings in the main lounge and dining room; and an improved shower room. The home has developed a better staff induction programme, and improved staff training arrangements. Dementia care training is now delivered to all staff. What the care home could do better: Care plans have not been signed by residents or their designated relative or representative. It is important that care plans are agreed and are signed and dated appropriately. Care plan reviews should also be agreed. More evidence could be included in care plans to show the levels of mental capacity which residents have; and more information could be included about end of life preferences and wishes. The environment is looking worn in some areas and would benefit from further refurbishment. The flooring in the clean laundry room should be replaced soon. Our discussions with the Director of Care and the Head of Care during the visit gave us confidence to expect that these matters will be addressed, and so no requirements have been given. Key inspection report Care homes for older people Name: Address: Rosewood Residential Care Home Cobham Terrace Bean Road Greenhithe Dartford Kent DA9 9JB     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: Susan Hall     Date: 2 9 0 6 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Rosewood Residential Care Home Cobham Terrace Bean Road Greenhithe Dartford Kent DA9 9JB 01322385880 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.charinghealthcare.co.uk Charing Court Investments Ltd Name of registered manager (if applicable) Miss Rachael Prescott Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 43 The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - DE Date of last inspection Brief description of the care home Rosewood Residential Home is owned by Charing Court Investments Ltd, who have a number of care homes for older people. The home provides accommodation and personal care for up to 43 older people with dementia. The premises are set back from the main road, and there is limited car parking space at the side. There is also on-road car parking available. The home is near to the A2 and the M25 motorway, and the Bluewater shopping complex is nearby. Care Homes for Older People Page 4 of 28 Over 65 0 43 0 3 0 8 2 0 0 9 Brief description of the care home The building is a large, detached older property, with a newer extension. Accommodation is provided on two floors, with a passenger lift for access between the floors. There is a small garden at the front, and a patio area at the side. There are several lounges, and a large dining area. The current fees range from £431.62 - £650.00, depending on the assessed needs of individual service users, and the room being used. NB: Since the inspection we have been informed that the current e-mail address is: rachel@charinghealthcare.co.uk 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 home is assessed as having a rating of Good, 2 stars. This was a key inspection, which includes assessing all of the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. We did not request an AQAA prior to this inspection, as it is less than a year since the last one was completed. We therefore referred to the last AQAA for information prior to visiting the home. We carried out this key inspection as the last inspection rated the home as 1 star, Care Homes for Older People Page 6 of 28 adequate. It was therefore important to ascertain if the home had made improvements since that time. The inspection visit commenced at 10:00, and finished at 16:00. During this time, we (i.e. CQC) viewed all areas of the home; talked with eleven staff, and one relative; and talked generally with five residents. We observed interaction between the staff and residents; and inspected documentation such as care plans, medication charts, staff recruitment files, and staff training. The manager was on leave at the time of the inspection, and we were assisted throughout the visit by the Head of Care, who was very helpful with providing up to date information. The companys Director of Care arrived in the home during the morning, and was available for the rest of the day; and feedback was given to the Director of Care and the homes Head of Care at the end of the visit. We also met care staff, the activities co-ordinator, kitchen, laundry, administrative and maintenance staff. 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. Care Homes for Older People Page 8 of 28 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 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 10 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. The home provides suitable information for enquirers; and ensures that prospective residents are helped with the processes of moving into the home. Evidence: The home provides enquirers and new residents and relatives with detailed information about the organisation and the running of the home. This is contained in the Statement of Purpose and the Service Users Guide. A copy of these documents is kept in a folder in the entrance hall, so that it is easily available for anyone to view. The statement of purpose states that the company are committed to creating a comfortable, homely, friendly and caring environment for the residents. Information is included about the communal rooms available, which includes a separate small lounge on the first floor as well as different lounge and sitting areas on the ground floor. There is also relevant information about details such as meals, laundry services, hairdressing, use of telephone, security in the home, and the preCare Homes for Older People Page 11 of 28 Evidence: admission procedures. We viewed one recent pre-admission assessment, and found this to be very comprehensive. It covered all aspects of care, such as the persons ability to understand and communicate; any levels of anxiety or agitation; personal care and health needs; allergies; social, cultural and religious needs; and the current medication. The regional Director of Care stated that the document has been found to be too bulky in practice, and the company are looking at ways to refine this so that the same amount of information is obtained, but in an easier format for the staff. A carer explained that the staff try to ensure that the person who has carried out the pre-admission assessment is available on the day of admission. This is a help for the new resident to see a friendly face which they recognise. A contract is provided for each resident, and this includes a breakdown of the fees, and the terms and conditions of residency. As most residents lack the mental capacity to understand the processes involved, this is usually agreed with their next of kin or with their agreed representative. The home invites prospective residents to visit the premises prior to being admitted to the home; and arrangements are made for them to stay for a day or half a day if it is assessed that this would be helpful to the person concerned. Care Homes for Older People Page 12 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. The care plans demonstrate good levels of personal and health care management, by a team of competent staff. Medication is well managed. Evidence: Care plans are written within two days after admission, based on the pre-admission and admission assessments. They are updated on a monthly basis. Each resident is assigned a carer as their keyworker, and one of the keyworker responsibilities is to ensure the care plan is kept up to date. Care plans are also audited on a monthly basis. The Head of Care said she is currently going through all care plans to ensure they are properly completed and up to date. We inspected three care plans, and found them to be generally well completed. Care plans are stored in individual files, with separate sections for easy access to the required information. Assessments are completed on admission, and are checked and updated each month, and these include risk assessments, a moving and handling assessment, nutrition assessment, and a Waterlow assessment for skin integrity. Risk assessments are included for falls risks, and for items such as disorientation, and Care Homes for Older People Page 13 of 28 Evidence: getting lost or injured through wandering. We found these risk assessments to contain good information; and specifying the action to take to minimise the assessed risks. We found the nutrition assessments to be particularly well completed, showing weekly weights and BMI calculations. Care plans are included for all aspects of daily living, such as thinking and communicating, personal care, eating and drinking, mobility, medication and religious and cultural needs. Additional care plans are written for specific needs such as if a resident has behaviour which may be difficult for other residents to cope with. Care plans contain forms written in simple language and in a large print format, so that residents may be encouraged to take part in their care planning. These include forms for Things I am able to do and Things I need help with. However, we noted that there was no other evidence in the care plans that residents or their assigned representative have agreed to the care plans. These were only signed by staff members, and should be signed and dated by the person responsible for agreeing to the care plan. The Regional Director of Care stated that this would be done, and we are confident in this, and have therefore not given a requirement. There could also be more evidence to show how the Mental Capacity Act 2005 is applied. Although residents have a diagnosis of dementia, it is not always clearly shown that they have some levels of capacity to make day to day decisions. The Director of Care was able to confirm that best interests meetings take place, and applications for deprivation of liberty where applicable. Care plans could also include more details in regards to end of life preferences. We inspected the medication, which is stored in a clinical room on the ground floor. The Head of Care oversees all medication ordering and auditing, and she ensures that every aspect of the medication is audited each week. Most medication is administered via a Boots monitored dosage system. We found the storage to be well managed, with no overstocking, and a complete change of medication every twenty-eight days. This ensures that no out of date items are ever used. Controlled drugs are stored in an approved cupboard, and the controlled drugs register is well maintained. There are no homely remedies kept in the home. All as necessary (PRN) medication is checked and counted each time an item is given, and this is an example of good practice. We viewed all of the Medication Administration Records (MAR charts) and no discrepancies were found. There are two signatures for checking any handwritten entries. Only senior care staff who have completed a detailed medication course and competency checks are permitted to administer the medication. Care Homes for Older People Page 14 of 28 Evidence: We observed staff interacting well with residents, aware of their different needs, and gently encouraging them. Personal care is given with sensitivity to maintaining residents privacy and dignity. Care Homes for Older People Page 15 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. The residents benefit from an increased range of activities and outings. Food is well prepared and provides a nutritious diet. Evidence: The day to day activities are displayed on notice boards in large print, with associated pictures. The activities organiser is on duty five days per week, including one day on alternate weekends. Each resident has an individual assessment for the activities which they like to take part in, or if they prefer to have one to one time. The group activities are being developed to include a wider variety, such as painting, cookery, crafts, board games, exercises, knitting group and bingo. Some residents like to take part in day to day activities in the home, such as folding linen, laying tables, or gardening. The care staff taking part in assisting with different activities, recognising that some residents have a shorter concentration time, and may go from one thing to another. Individual activity records are included in each residents care plans. Regular outings are arranged for five to six residents at a time, and these are tailored to the individual people concerned. Venues may include places such as the seaside, local parks, shopping centres, garden centres and theatre performances. The company has just purchased two mini buses to be used across their group of care homes, and Care Homes for Older People Page 16 of 28 Evidence: this should make it easier to carry out frequent trips for different numbers of residents. The activities organiser also arranges regular entertainment within the home, such as singers, musicians, and film nights. There are small lounge areas as well as a large main area, and this enables to residents to join in with arranged activities or to sit somewhere quieter if they prefer. The manager and activities organiser have plans to alter one of the smaller lounges into a reminiscence room with old style furniture, pictures and items from the past. They are also in the process of making memory boxes for each resident, so that they have a specific reminder of the things that they have enjoyed in the past. These will also help to provide talking points with them for staff and family members. The staff are aware of different cultural and religious needs, and these are evidenced in care plans. This includes residents who may not have English as a first language. Residents are enabled to attend church if they wish to do so and are assessed as able to go out; and a local vicar visits the home on a regular basis. Residents are encouraged to bring in items to personalise their own rooms, and are able to choose their preferred room colours when redecorating is carried out. Some rooms have names or pictures on the doors to aid residents in finding their own rooms. Food preparation and management is overseen by a cook who has many years experience in the home; and the overall catering is overseen by a catering manager for the company. Menus are planned and discussed to ensure that there is a good range of nutrition for the residents; and residents are invited to share ideas for menu changes at residents meetings. There are two main choices for lunch and tea times, and there are hot and cold choices available. Specific diets such as soft or pureed foods, and diabetic diets, are catered for. Each day there is a different cooked breakfast offered, and snacks are available at any time. Afternoon drinks are served with home made cakes. The cook is assisted each day by a kitchen assistant, and the kitchen was seen to be clean and well organised. Care Homes for Older People Page 17 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. Residents are supported in voicing their concerns and complaints. Staff are trained in the recognition and prevention of abuse. Evidence: The complaints procedure is displayed in the entrance hall, and is included in the service users guide. All residents have a copy of this on admission to the home. Clear details are included to show who to go to, and their relevant contact details. The company respond to all formal complaints within seven days, and aim to conclude any investigation and provide feedback within twenty-eight days. The company have recently produced a simplified easy read version of the complaints procedure, with pictures, which is easier for residents with dementia to follow and understand. A copy of this is being put into each bedroom, so that residents can be supported in expressing their concerns. A complaints log is kept, and is audited each month. There have been no complaints during 2010. Previous complaints records show that all concerns and complaints are taken seriously, and are responded to appropriately. The home has a comments book in the front entrance hall, and this is mostly used by visitors to express their appreciation of the staff. However, it does provide the opportunity for anonymous comments if anyone wished to write these. Care Homes for Older People Page 18 of 28 Evidence: Training in Safeguarding Vulnerable Adults and the prevention of abuse is given as part of the induction training, and updates are given on a regular basis. All staff receive this training, and records showed that the home is up to date with this. The home follows the Kent and Medway protocols and procedures for reporting any suspicions of abuse, and a copy of these is kept available for all staff to access. Care Homes for Older People Page 19 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 provides a safe and comfortable environment for the residents. Evidence: The premises consist of a large original old building with a newer extension. Accommodation is provided on two floors, with a passenger lift for easy access. There is a small front garden, which has seating available in a gazebo while the weather is hot. There is also a patio area which has benches and tables, and is attractively presented with flower tubs and hanging baskets. This was being used by many residents on the afternoon of the inspection visit. The home has a large lounge/dining area on the ground floor, and this has been redecorated, and refurbished with new carpets and curtains since the last inspection. A smaller lounge area leads from the other side of the dining room; and there is another lounge on the first floor. Most bedrooms are for single use, and some shared rooms are being let as single rooms. However, it is recognised that some residents wish to share - especially if they have been used to sharing a room for much of their lives - and so some shared rooms will be kept available. Some of the rooms have en-suite toilet facilities. There are sufficient numbers of other disabled toilets on both floors, and baths and showers available. Baths are fitted with integral hoisting facilities. Care Homes for Older People Page 20 of 28 Evidence: We noted that other equipment is available for use, such as hoists, grab rails, slide sheets, and pressure-reliving mattresses. The staff check if any specific equipment is needed at pre-admission assessments, so that the equipment is in place prior to new residents moving into the home. The bedrooms are generally well presented and decorated according to residents choice. Residents own furniture is risk assessed for safety and fire prevention. Some of the building has scuffed paint work in need of general refurbishment, and we were informed that there is an ongoing programme of redecoration and refurbishment. Two maintenance men are employed, and staff inform them of ongoing repairs needed for furniture and decor. The maintenance men carry out routine checks for items such as weekly fire alarm checks, hot water temperatures, and window restrictors. The laundry is situated down a flight of stairs into the basement, and the stairway is protected by a door with a keypad lock. All outside doors are also protected in this way. The company are in the process of having a stair gate fitted at the bottom of the main staircase, for added safety of the residents. The laundry is equipped with three washing machines and two dryers, and there is a separate room for clean laundry and ironing. A red alginate bag system is used for dealing with soiled laundry items. There are dedicated laundry staff on duty in the home each day. The flooring in the clean laundry room is damaged at the edges, which makes it difficult for cleaning, and this should be replaced soon. The home usually has three housekeeping staff on duty for cleaning, and the maintenance men carry out carpet cleaning on a daily basis as needed. The home was seen to be clean in all areas. Care Homes for Older People Page 21 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. The home has good recruitment procedures; and there is a stable team of suitably trained staff. Evidence: The home usually has five to six care staff on duty each day, as well as either two senior carers, or a senior carer and the Head of Care. The care staff are directed by the Head of Care and the Manager, one or both of whom are usually on duty during weekdays. The Head of Care also works on alternate weekend shifts. The two senior carers have divided responsibilities, with one responsible for medication administration, and one as a shift leader. At night there is one senior carer, and two other carers; and there is an additional carer for a twilight shift, during the busy time of settling residents for bed. This shift is only covered for the five week days, and this could also be considered for weekends. Care staff are supported by other teams of staff. Each day there is a cook and kitchen assistant on duty, three housekeeping staff, a laundry assistant, and a dining room assistant. The dining room assistant ensures that all residents are given the correct food, and assists with feeding and giving drinks. Other staff in the home include administrative and maintenance staff. All care staff commence NVQ 2 or 3 training after successfully completing a Care Homes for Older People Page 22 of 28 Evidence: probationary period, and there were currently 11 care staff working towards this. An NVQ Assessor was in the home during the day of the inspection. There are over 50 per cent of care staff who have completed this training. The home has good recruitment procedures in place. We viewed three staff files to confirm this. All staff files have recently been audited, and the administrative staff are following up where any items are not on file. For example, one recruitment file did not have a photograph of the staff member, but this was already being addressed. All staff are required to provide a full employment history, and have a criminal declaration, a health check, confirmation of previous training, an enhanced CRB (Criminal Record Bureau) check, and two written references. A new staff member confirmed that there is a good induction programme which includes all mandatory training, and basic understanding of dementia. The company use the Learn to Care induction training. New staff shadow experienced staff for the first week or longer if needed. A training matrix evidences all mandatory training (such as fire awareness, health and safety, first aid and infection control) and shows when training is due. This was seen to be up to date. Training is also given in other subjects, such as challenging behaviour and continence care. Care Homes for Older People Page 23 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 manager provides a good lead to staff, and ensures that the home is run in an organised and efficient manner. Evidence: The manager has been in post for several months, and has completed Leadership in Management for Care Services training, and NVQ level 4 in care. She is registered with the Commission. She is assisted by the Head of Care, who concentrates on all care aspects, so that the manager can effectively oversee all the other areas of management. Several staff we talked with spoke highly of the manager, and said she has already made a real impact in the home. The staff find her to be friendly and apporachable, and committed to caring for the residents. One staff member said she is absolutely brilliant! The staff work well together a team and there is a good atmosphere in the home. One staff member said that they get on well inside and outside of work and are used to helping each other. There are regular staff meetings for all levels of staff, and we were Care Homes for Older People Page 24 of 28 Evidence: informed that the staff feel easily able to voice their opinions and ideas. The Head of Care said that communication has improved between staff, and between staff and relatives. Other staff said that there has been a big improvement in staff morale over the past few months. The company have introduced staff long service awards, with recognition of staff who have worked for five or ten years in the company. Meetings for residents and relatives are carried out quarterly, and ongoing feedback is obtained through the comments book, and on a daily basis. The company have quality assurance systems in place, with questionnaires to try and ascertain peoples ongoing views of the home. Monthly Regulation 26 visits are carried out by a senior management representative, and these were seen to be very detailed. The manager is required to make her own monthly reports in respect of items such as accident and incident audits, complaints and environmental alterations. Small amounts of monies are kept in the home on residents behalf, where requested to do so. These are stored individually, and all receipts are retained. A clear record is kept of all credits and debits, and are checked by two staff members. One to one staff supervision sessions are carried out every two months, enabling staff to raise any items of concerns about their work or their training needs. Staff also have yearly appraisals. Policies and procedures are checked yearly by the company; and these are reviewed by the manager to ensure that they are specific to this home where applicable. There are good systems in place for ensuring the ongoing health and safety of staff and residents, including fire training and alarm checks; moving and handling training; accident and incident audits and maintenance checks. Care Homes for Older People Page 25 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 26 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 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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. Re-publishing this information is in breach of the terms of use of that website. 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