Care Home: Rottingdean Nursing And Care Home

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What the care home does well There is a detailed and informative Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. Comments received included `I found the information about the home helpful` `Gave me an insight in the home, before I moved in`. Some residents were able to confirm that they were visited by the manager prior to admission to the home and two relatives said they they were involved in the admission process. The menus evidence a well thought out balanced diet with a varied choice of food in line with residents preferences. Comments received included ` Excellent food` ` Wide choice`. Quality assurance systems are in place which enables the service to monitor and improve their service and ensure that the home is run in the best interests of residents. There is an open-house policy which welcomes visitors at all reasonable times. Comments received included ` Always a welcome` `Nice welcome`. Satisfactory arrangements are in place to safeguard residents finances. Staff retainment is well maintained with a robust recruitment practice being followed. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The Comments received from residents and families about what they do well included ` Everything is good` `Do whatever I want them to` `Keeps everything ticking over` `Everything`. The home environment is well maintained, clean and safe for the people who live there and visit. Comments received included `Its Clean and comfortable`. What has improved since the last inspection? There were no requirements made at the last inspection. The AQAA stated that in the past year the home have worked on improving areas identified at the last key inspection and through their own audits. These include: Rewriting and updating all their policies and procedures to reflect legislative changes and good practice guidelines set by various health agencies. Accessing outside training from their local university/learning centre. Managed to retain staff and encourage further staff to undertake National Vocational Training. What the care home could do better: The pre-admission assessment for prospective residents were not consistently completed, therefore not ensuring that the home has the skills and facilities to meet the prospective residents needs. This impacted on the care planning for residents once they are in the home as the home does not undertake a full needs assessment on admission. Shortfalls were identified. These shortfalls were acknowledged and a new system of care planning will be introduced and the shortfalls addressed. Comments received in respect of care included `Not wake me up so suddenly in the morning, They pull all the covers off when I am still asleep` `My position in a chair is not always comfortable, more attention to feet`. Recommendations of good practice have been made in respect of medication administration which will promote the health and safety of the residents. The activities provided in the home are varied, but the care planning and documentation needs to reflect the residents preferences and participation in order to ensure that the home is meeting their social needs. Comments received included `I do get bored` `More activities in the morning`. The staffing levels in the home need to be reviewed and monitored against the residents needs in order to ensure that the staffing levels are appropriate at all times. Comments received included ` More staff needed in the afternoon` ` definitely more staff needed`. Key inspection report Care homes for older people Name: Address: Rottingdean Nursing And Care Home 30 - 32 Newlands Road Rottingdean Brighton East Sussex BN2 7GD     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: Deborah Calveley     Date: 1 1 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Rottingdean Nursing And Care Home 30 - 32 Newlands Road Rottingdean Brighton East Sussex BN2 7GD 01273308073 01273300377 john.olley@ahle.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Jon Breeds,Mrs Carol Breeds Name of registered manager (if applicable) Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home with Nursing - 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 The maximum number of service users who can be accommodated is: 34 Date of last inspection Brief description of the care home Rottingdean Nursing and Care Home is a care home providing care for up to thirty four residents over the age of sixty five. It is registered to provide nursing care to residents and a maximum of twelve places can accommodate residents in receipt of personal care only at any given time. It is located in a quiet residential area in Rottingdean. There is limited car parking available at the home, but free parking is available on the adjacent streets. Local amenities are available at the town centre, a short walk down Care Homes for Older People Page 4 of 28 Over 65 34 0 Brief description of the care home the hill. Rooms are located over three floors. There are twenty eight rooms for single occupancy, of which eleven have en suite facilities and three double rooms with no en suite facilities. There is a passenger shaft lift available at the home to assist residents to access all floors. There are suitable toilet facilities provided throughout the home to meet the needs of residents. There are five bathrooms and one shower room for residents to use. There is a dining room, a good-sized lounge room, a conservatory area and a garden at the rear of the building that is accessible to residents. Weekly fees range between £550 and £625. There are additional fees for hairdressing, chiropody and newspapers. A copy of the Statement of Purpose and Service Users Guide is available from the home upon request. Residents and relatives know about the service through social service referrals and word of mouth or from living in the area. 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Rottingdean Nursing and Care Home will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with residents representatives and visiting health and social care professionals. This unannounced inspection was carried out over 7 hours on the 09 September 2009. There were thirty four residents living in the home on the day of which five were case tracked and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. Care Homes for Older People Page 6 of 28 The purpose of the inspection was to inspect the key standards against the information received from the completed Annual Quality Assurance Assessment (AQAA) and the Care Quality Commission (CQC) surveys A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. During the course of the site visit, three carers, the administrator, three registered nurses, ancillary workers and the cook were spoken with. Telephone contact was made with health and social care professionals following the visit. The information received verbally has been incorporated into this report, along with the information received from resident surveys, staff surveys and the competently completed AQAA. 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: The pre-admission assessment for prospective residents were not consistently completed, therefore not ensuring that the home has the skills and facilities to meet Care Homes for Older People Page 8 of 28 the prospective residents needs. This impacted on the care planning for residents once they are in the home as the home does not undertake a full needs assessment on admission. Shortfalls were identified. These shortfalls were acknowledged and a new system of care planning will be introduced and the shortfalls addressed. Comments received in respect of care included Not wake me up so suddenly in the morning, They pull all the covers off when I am still asleep My position in a chair is not always comfortable, more attention to feet. Recommendations of good practice have been made in respect of medication administration which will promote the health and safety of the residents. The activities provided in the home are varied, but the care planning and documentation needs to reflect the residents preferences and participation in order to ensure that the home is meeting their social needs. Comments received included I do get bored More activities in the morning. The staffing levels in the home need to be reviewed and monitored against the residents needs in order to ensure that the staffing levels are appropriate at all times. Comments received included More staff needed in the afternoon definitely more staff needed. 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 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 prospective residents and relatives with a good level of information about the home its facilities services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission. Evidence: The home has an informative Statement of Purpose and Service Users Guide in place that is available in the reception area of the home and on request. It was confirmed that the Registered Manager has just left and therefore the documents will need to be updated to illustrate the interim management structure of the home until a replacement has been recruited. The terms and conditions of residency are clear and written in clear English. The document contains the information regarding the room to be occupied accompanied by an introduction to the home and the terms and conditions of residency. Care Homes for Older People Page 11 of 28 Evidence: Surveys were sent out by the Care Quality Commission prior to the site visit as part of the inspection process. Ten of the twelve received confirmed that they were given enough comprehensive information about the home and its facilities to make an informed choice of whether its the right place for them. Ten of the twelve also confirmed that they were aware of the contracts and terms and conditions of the home. The pre-admission assessments on all prospective residents are undertaken by a registered nurse in the absence of a registered manager. The pre-admission assessments viewed included the latest admissions to the home and were seen not to be consistently completed with the necessary information included that ensures that the admissions to the home are appropriate. This was discussed in full during the site visit and will be addressed with a review of the care planning system. Therefore whilst the standard is not fully met at this time a requirement has not been made but will be inspected in full at the next key inspection. It was confirmed that the home confirms that having regard to the assessment that the home can meet the assessed needs of the prospective resident. The prospective residents are seen either in their home or hospital before admission and the staff spoken with confirmed that wherever possible the family or representatives are involved. This needs to be more clearly documented on the preadmission documentation. The staff spoken with knowledgeable regarding the registration category of the home and of the level of support they can offer. They confirmed that if there are problems identified in meeting their needs, advice is sought and an alternative placement found. Trial visits to the home can be arranged. It was confirmed that all residents are invited to a trial period to ensure suitability of the home this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Residents spoken with said That the home was one of three I was told about and I liked the location and My family helped me choose. The Statement of Purpose states that the home does not take emergency admissions or residents who require intermediate care however respite care is available 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 home was found to be meeting residents health and general needs with accessed additional specialist support when needed. Evidence: Five of the residents met and spoken with were also selected for care plan review and these included the newest admissions to the home. The review identified that residents are not assessed on admission and the care plans are formatted from the information on the pre-admission assessment. This was not seen to be a thorough process due to the lack of information documented on the preadmission assessments. The care documentation pertaining to residents care and past history are not easily assessable as they are kept in three different areas. Some vital details are locked away in the managers office and therefore not assessable before 9 am and after 5 pm weekdays and not at all at weekends. Care Homes for Older People Page 13 of 28 Evidence: The quality of the care documentation and risk assessments were found to be inconsistent, some were quite detailed and had clear guidelines in place for staff to follow, whilst others were minimal and lacked a personal centred approach. It was highlighted with a registered nurse that the daily notes need to be expanded and include the care actually delivered. The care staff do not document the care they have given, but relay any changes to residents condition to the nurse. It would be beneficial to residents outcomes if care staff document the care they have delivered daily as it then becomes more person centred and picks up changes in mood, capacity and physical changes. As discussed during the site visit, shortfalls were identified and discussed, these were acknowledged by the nurse in charge. It was confirmed by the end of the site visit and a follow up conversation with the providers Mr and Mrs Breeds, that a new care plan system will be introduced, part of which will include a full assessment of needs. This will ensure that all the needs of the residents will be identified and monitored more effectively and this information will be more easily assessable to all staff. As this is to be undertaken, a requirement has not been made at this time but will be reviewed in depth at the next key inspection. The home has clear policies and procedures in place for trained staff to refer to regarding the safe administration, storage, disposal and recording of medication. The AQAA stated that they have recently been updated. Medication Administration Charts (MAR) were found to be in the main competently completed, some gaps were identified and one was a controlled medication, which upon checking further had been signed out by two staff but not signed for on the MAR. Some written orders/directions were scribbled through and therefore not clear as they were not signed and dated. Staff signatures are in place to identify staff and provide an audit trail Recommendations of good practice include updating identification photographs and dating them, staff administering medication need to be encouraged to question and follow up gaps and written changes to prescribed medication should not be scribbled out, and they should be signed and dated. Residents are provided with an opportunity to self medicate based on a risk assessment. There was no one self medicating on the day of the site visit. The interaction between residents and staff was observed to be positive and Care Homes for Older People Page 14 of 28 Evidence: professional. Residents confirmed that staff called them by their preferred term of address and that they felt their privacy and dignity were respected. Residents are supported with their personal hygeine and are encouraged to have their hare done regularly. All residents met and spoken with were dressed in clean clothing with clean nails and hair. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle and meals experienced by residents at this time does not always meet their expectations choices or preferences Evidence: The home employs an activities co-ordinator whom works 4 afternoons a week. She was not working on the day of the site visit so information in respect of activities was taken from the notes available and from talking with staff and residents. The home does not have programme of activities displayed in the home unless there is a planned outing or a booked entertainer. This does not enable residents to make an informed decision on whether to attend or not. The care plans viewed did not evidence residents social interests, past hobbies and preferences therefore there is no guidance for staff to follow in supporting residents to meet their social needs. The activity coordinator does document when residents have attended an activity but this is not consistently completed and does not evaluate the outcomes. Surveys received stated that the home provided Good activities and outings More morning activities please. Residents would benefit from a programme of activities based on their preferences and interests. Care Homes for Older People Page 16 of 28 Evidence: From talking with residents and staff it was confirmed that their everyday lifestyle is fairly flexible and they are supported and enabled to make normal every day choices. From discussion with staff and visitors it was confirmed that there are no restrictions on visiting, although relatives are asked to avoid mealtimes unless they are joining residents for a meal. From the surveys completed it is clear that relatives are made to feel welcome when they visit. Residents who wished were able to move freely around the building and garden. The lunchtime meal was observed and despite there being a dining room the residents were served their meals in the lounge or in their bedroom. When discussed it was said that the residents have a luncheon club twice a week and then use the dining area. This was discussed as the midday meal could and should be an enjoyable experience. From direct observation the meal were served in solitude with very little atmosphere. The layout of the lounge does not help create a positive atmosphere. This was discussed in full with the registered provider who agreed with these observations and is planning to address this. Therefore a requirement was not made. The feedback in respect of the food was positive and the menus viewed evidenced a varied choice of nutritional meals. The food was attractively presented and looked appetising. Soft/pureed food is prepared and served in an attractive way so as too tempt the residents. It was confirmed that Environmental Health visit the home and no concerns have been raised. There are water coolers located throughout the home of which residents are able to use whenever they wish, however not many had plastic glasses. Fresh fruit and drinks are available throughout the day. 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. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff are aware of the importance of safeguarding vulnerable adults and there are systems in place which create an atmosphere for protecting residents from abuse. Evidence: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated to the inspector during her visit to the home. The home has received two complaints since the last inspection and they were responded to within the stated timescales. The home has a complaint, suggestion and comment box by the entrance to the home which enables anyone within the home to express concerns/ideas anonymously. Residents spoken with confirmed that they were confident that any complaints or concerns that they had, would be listened to and responded to effectively. The home has relevant guidelines on the safeguarding of vulnerable adults, these were updated in February 2009. The AQAA states designated staff have received training. This included the manager who has recently left. It was not clear from the training records who else had received the training. It would benefit and protect the residents if all staff receive training in safeguarding, in particular, the senior nurse in Care Homes for Older People Page 18 of 28 Evidence: charge of each shift. It was confirmed that this would be arranged. There have been two safeguarding referrals since the last key inspection, which have been resolved appropriately. 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 comfortable, well maintained and safe environment for those living in the home and visiting. Residents are protected by the homes infection control policies and procedures. Evidence: Rottingdean Nursing and Care Home is well maintained and comfortable and the decor within the home is pleasant and attractive. There is a maintenance person who works very closely with the staff team. There were no outstanding requirements from the local environmental health department or the fire safety officer at their last visit. The home has a rolling plan of redecoration and improvement in place, the AQAA states that there are plans for a wet room and to replace carpets in the forthcoming year. There are adequate communal bathrooms and shower rooms in the home with specialist equipment to ensure all residents can have a bath or shower. The home has been assessed by suitably experianced person and specialised equipment is available throughout the home to promote the residents health and independence. During the inspection it was noted that staff were using lifting and supporting equipment Care Homes for Older People Page 20 of 28 Evidence: appropriately. Call bells are provided in all areas and in the main staff were seen to be attentive and ensured residents had access to these. However one comment received in a survey was Call bell is never positioned correctly. The home is fit for its stated purpose and provides with a comfortable, well maintained and safe environment for the people who use the service and those visiting. Polices and procedures for infection control are in place and are updated regularly. The home was clean and free from offensive odours on the day of the inspection. Good practice by staff was observed during the day and there were gloves and aprons freely available in the home. Sluice and laundry areas were found clean and safe. The home provides a good laundry service. Clothes washing machinery ozone system provides appropriate washing cycles for foul or infected items. There is an appropriately secured cupboard for storage in keeping with the Control of Substances Hazardous to Health Regulations and there are handwashing facilities. There are appropriate policies and procedures in place. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A review of staffing levels based on residents dependency levels is needed to ensure there are sufficient staff to meet the residents needs. Residents are supported and protected by the homes recruitment procedures. Evidence: At present there are 34 residents living in the home. The staffing levels were seen to be appropriate to meet the needs of the residents at this time. However some comments from staff and residents during the site visit and from the surveys received indicated that staffing levels are a source of concern and need to monitored and responded to Comments received included Not enough staff More staff Additional staff needed in the afternoon Organise shifts better. The AQAA states that the staffing levels are flexible and if it is required extra staff will be brought in. From discussion with staff it is not thought that this happens very often. Separate ancillary staff for the laundry, cleaning and kitchen duties are employed. There is a good range of in house training, of which there were attendance records in place. Care Homes for Older People Page 22 of 28 Evidence: The home currently employ 20 carers and of those 8 have an National Vocational Qualification(NVQ). Staff spoken with said that NVQ training opportunities at the home are good and they are well supported by the senior staff. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. The manager had introduced a training programme which tracks and identifies the staff training needs, however it was not up to date and did not reflect the current training status. The administrator stated that all staff are required to attend mandatory training. Again the records available did not evidence this and the records need to be brought up to date, so as to ensure that there are suitably trained staff to protect and promote the health, safety and well being of the residents. As it was confirmed that this would be undertaken immediately, a requirement has not been made, but will be followed up at the next key inspection. 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 overall management of this home is good with effective systems in place to protect residents. Evidence: The Registered Manager has just resigned, therefore leaving the managers post vacant. Mr and Mrs Breeds, the registered providers have appointed a registered nurse to manage the service until a new manager is recruited. This person has the necessary experience to manage the home effectively in the interim period. There is a sign at reception advising visitors who is in charge of the home each day so that they know who to speak to if there are any issues to discuss. There are robust quality assurance and quality monitoring system in place. These are undertaken on an annual basis. Residents meetings are offered twice a year and staff meetings are held regularly where discussions take place on any improvements that could be made to the running of the home and any care issues. The comments from staff received from the CQC surveys indicate that there are some issues around Care Homes for Older People Page 24 of 28 Evidence: staffing levels and these do not appear to have been adressed. These identify areas on what they do well and what could be improved within the home. It was discussed that these need to be correlated and the results of the audits published to residents, families and stakeholders. There is suitable insurance in place. The home has been owned by the same providers for a period of time and has given no cause for concern regarding financial viability to date. Records inspected demonstrated that there are suitable procedures in place for the safe handling of residents personal monies. The administrator keeps receipts of all financial transactions. There are some residents that are supported to maintain their own personal allowance and this is regularly reviewed. The AQAA identifies that equipment in use has been tested or serviced as recommended by the manufacturer or other regulatory body and that all relevant policies and procedures are in place. The AQAA states that all policies were updated in February 2009. The records for accidents/incidentsd are competently completed and these are audited monthly with an action plan for those that have recurrent falls. Those residents that have repeated falls were identified for care plan review and evidenced that the home pro actively manage and risk assess their safety. 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 1 9 That all staff who administer medication explore the reasons behind gaps on the MAR. That all changes to medication prescription are clearly signed and dated for safety and clarity. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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