Care Home: Sage

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What the care home does well We have identified some areas of exellence in this report. The home is well managed and provides a high quality of care. People are admitted to the home only after a thorough assessment is made of their needs and they have a contract that details what the fees cover. Individual care plans that involve the resident and their next of kin are used to guide staff in how to meet the persons needs in the manner they prefer. Residents and their represantatives are encouraged to participate in how their care is planned. The home employs its own physiotherapy staff which enables the residents who have mobility problems to be seen promptly. Residents are assured of strict adherance to and observation of, their Jewish faith. The home provides a good range of training for staff which is particularly important for residents who have dementia. The property is well maintained and provides a safe, homely and comfortable home to live in. People who live in the home have access to many stimulating activities within the home and the community. Relatives and the local community are warmly welcomed to visit which provides a very lively and friendly atmosphere. Complaints are taken seriously and responded to in a professional manner. Residents are protected from abuse by clear policies and procedures and by an appropriately trained staff team. Carers are properly recruited, well trained and highly motivated which safeguards residents best interests. What has improved since the last inspection? The home has improved its practice regarding adminstration of medicines, including recording what medication is received from the pharmacy. This enables better auditing of medication. Recruitment procedures have been improved to ensure that no one is employed at the home without first having all the required checks carried out. What the care home could do better: We have made some recommendations in this report as follows. The date of opening of liquid medication should be written on the label to ensure that it is not out of date. Care plans should be completely rewritten after six months to ensure that the identified needs of the person are still current. A book or other such format should be used to record complaints so that they are easy to audit. The responsible person who carries out the monthly monitoring of the service should provide evidence in their reports that they have spoken to residents, visitors and staff, and a review of staffing levels on floors 2 & 3 should be carried out to determine what further support might be provided for the managers. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sage 208 Golders Green Road Golders Green London NW11 9AL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: THOMAS McKERVEY     Date: 0 9 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Sage 208 Golders Green Road Golders Green London NW11 9AL 02082018111 02082018204 polly@thesagehome.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Service To The Aged (SAGE) care home 61 Number of places (if applicable): Under 65 Over 65 0 61 dementia old age, not falling within any other category Additional conditions: 61 0 The Registered Person may provide the following categories 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 - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 61 Date of last inspection Brief description of the care home Sage is a registered charity and the home that it operates is a registered care home with nursing. A major objective of the home is to allow service users to follow the Jewish way of life and it accepts people from the Jewish community who have varying levels of religious observance. The home is purpose built on four floors and was originally built twelve years ago. An additional wing was added approximately six years ago that increased its registered capacity to the current sixty-one places. The ground floor contains the main communal areas with the upper three floors Care Homes for Older People Page 4 of 28 Brief description of the care home accommodating the service user bedrooms, each floor containing an additional lounge and kitchenette. All bedrooms have an en-suite toilet and hand washbasin and approximately two thirds have either an en-suite bath or shower. The home is situated in Golders Green and is close to all the areas shopping and cultural/ religious resources. Relatives and visitors to the home described it as a valued resource by the local Jewish community. The stated objectives of the home are to provide service users with an excellent standard of care, to be treated with respect and dignity and to be able to follow the Jewish way of life. The current scale of charges range from £622 to £1130 per week, depending on the persons needs. A copy of this report is available on the CQC website or/and from the home. 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: 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: This unannounced inspection took place over two days. The inspector was accompanied by an expert by experience. This is a lay person who has experience of care services who can bring an additional perspective to the inspection process. The manager was on leave on the first day of the inspection, but the senior staff in the home were very helpful and cooperated fully with the inspection. The manager was present during the second day of the inspection. The inspector and expert by experience spoke with the majority of the staff, several visitors and approximately twenty residents of the home. The inspector also spoke with the G.P who was visiting at the time. Prior to the inspection, we sent out questionairres to residents and staff to seek their comments about living and working in this care home. We received back eighteeen surveys from residents or their relatives, and five from staff, the majority of which Care Homes for Older People Page 6 of 28 were very complimentary about the home. The manager sent us a very detailed Annual Quality Assurance Assessment, (AQAA) which is a document that care services must send to the Commission every year. This self assessment describes what the home believes it does well and identifies areas where they need to improve. The AQAA also provides us with numerical information about who is living and who is working in the home. We visited all areas of the building and examined residents and staffs records as well as a number of policies and procedures. All of the people we spoke with said they were very happy with the care and support they received. Comments from the AQAA and residents surveys are included in the body of this report. The inspector would like to thank the expert by experience, the manager and her staff for their assistance with this inspection. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering coming to live in this home can be confident that their needs will be thoroughly assessed to ensure that the home is appropriate for them. They can also be assured that they will be provided with full information about the service and what the fees cover. Evidence: In the AQAA, the manager states that the home encourages potential service users to visit the home before admission wherever possible and to eat a meal with their family members so as to get a greater feel for the culture of the home. A preadmission discussion takes place between the manager, the deputy manger and a senior nurse regarding the assessed needs of the individual and specific care needs. On the day of admission the senior nurse discusses the new resident and introduces him/her to the staff. The home provides a wide variety of specialised equipment for people with a variety of disabilities.The homes physiotherapist may involve members from the Care Homes for Older People Page 11 of 28 Evidence: multidisciplinary PCT team about any specialised equipment that is required. The manager stated that additional training may be arranged when a person is admitted with special needs. For example, the advice of a colostomy nurse was sought recently for a resident. We examined the files of five people who were recently admitted to the home, three of whom were privately funding their care. These files contained pre admission assessments which were undertaken by the manager and/or other qualified staff from the home. The assessments were detailed and outlined the physical, emotional, spiritual and leisure interests of the individuals. In the cases of people who were referred by PCTs, needs assessments were documented by healthcare commissioning staff. There was evidence that reviews take place with the person using the service and their relatives after a trial admission period of between four to six weeks. We noted that signed contracts, where appropriate, were in case files. These detailed the allocated room and the fees for the service. There was information about what extras were charged for, for example, hairdressing, newspapers etc. The homes financial controller showed us receipts for these services and explained how residents are informed when sundry expenditure accrues and how people are invoiced. The expert by experience stated; I found Sage to be a happy, well staffed and seemingly efficient home where the residents were always the priority. People who were spoken to by the inspector and expert by experience, said they were satisfied with the arrangements made for their admission and had felt welcomed and supported by the staff team. These findings were further confirmed in the surveys we sent out prior to the inspection. During the inspection we saw people being shown around the home who were considering coming to stay. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can be confident that they have an individualised care plan that clearly sets out their care needs so that staff know how best to support them. Residents receive excellent healthcare from staff and other professionals and they are treated with respect and dignity. The medication procedures are safe and thorough to ensure that residents wellbeing is safeguarded. Evidence: Over the two days of this inspection we observed how staff supported the residents with personal care. The staff exhibited a very caring approach and did so in a cheerful and patient manner. We observed that when staff are attending to residents personal care in their rooms, they knock before entering and a light is illuminated outside the room to prevent people from entering. This protects residents dignity. We examined at random, two care plans from each floor. The care plans contained detailed information about the persons assessed needs and described how these should be met. Each area of need was accompanied by risk assessments, for example the risk of pressure ulcers. Several assessment tools are used in the home, eg, Care Homes for Older People Page 13 of 28 Evidence: Waterlow, Barthel and nutrition assessments. There was evidence that care plans are reviewed on a monthly basis. However, we noted that several had been originally written some years ago we recommend that these plans be completely rewritten at least every six months. This will ensure that care plans are refreshed at appropriate intervals. The home employs three physiotherapy staff which ensures that residents can be assessed and treated quickly. The physiotherapists told us that an important aspect of their role is to advise and educate staff about mobility and safe ways to transfer residents. We saw records to show that residents are weighed monthly or more often if there are concerns about their weight. Many of the residents have varying types and degrees of dementia. We noted that all staff have training in dementia care and during the inspection, one such course was taking place in the home. Through observation and discussion with staff, we were satisfied that the care of people with this condition was good. We saw records of a range of appointments with health professionals, including opticians, chiropodists and speech and language therapists, as well as attending hospitals and clinics. The home regularly liaises with the local tissue viability nurse when required and with Macmillan and hospice staff for advice about palliative care. We spoke to the G.P who was visiting the home during the inspection. The G.P spoke highly of the dedicated care and informed us about regular medication reviews the G.Ps carry out. A typical comment sent to us in our surveys returned to us by residents and their representatives, was - The home provides dedicated and responsive care to all my needs and have dome for all the years I have lived here. The home has enrolled with Barnet PCT on the Gold Standards Framework programme. This scheme is designed to enhance the care of elderly people in care homes, particularly focusing on end of life care through advanced care planning. After a period of training and assessment, homes will receive accreditation from the PCT. The home already provides terminal care for those people who wish to spend their last days in the home and accommodation can be provided for relatives who wish to stay overnight. We noted that peoples wishes in relation to their end of life care were well documented and signed by all parties concerned. We saw several tributes from relatives about the high quality of care provided by the staff. For example; We would like to thank you all for the wonderful care and kindness shown to our dear late father during his three years at Sage. Another relative wrote; We are full of admiration for all that you do. We will always be grateful for the very kind care and attention you gave our dear father. We checked the medication procedures on all floors. The records of the receipt, administration and disposal of medication were all satisfactory. Accurate records were Care Homes for Older People Page 14 of 28 Evidence: maintained for the administration of medication, and records in relation to controlled drugs were accurate. Only the qualified nurses administer medication, and the senior nurse on each floor monitors medication records regularly to ensure they are up to date and accurate. There were documents signed by relatives who have power of attorney, authorising the disguising of medicines where people with dementia refuse to swallow tablets. This is in the best interest of those residents. Each room where medication is stored, is fitted with air conditioning to ensure that medication is stored safely at 25 degrees or below. We recommend that staff put the date of opening on all liquid medications as a check that it has not expired. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can enjoy varied and stimulating activities in keeping with the religious ethos of the home. The residents are able to exercise choice and control over their lives and the home provides a wholesome, appealing balanced diet in pleasant surroundings Evidence: During the two days of the inspection we saw many leisure activities taking place. We saw an activities programme on the wall of the large lounge providing information for residents about what was available. The home employs an activity coordinator who leads many of the sessions but outside entertainers also provide sessions in the home. There is a dedicated room where religious occasions are observed, to which the local communtiy are welcome to attend. The expert by experience stated; The activities were engrossing and varied. They involved hand and eye coordination, social skills, playing instruments and listening to different types of music. She noted that one resident asked for a change of record which showed that residents feel comfortable to ask for changes. People we spoke to said they could choose not to join in activities and could do their own thing. We saw several residents reading nespapers and books and some who stayed in their rooms watching television or listening to the radio. Care Homes for Older People Page 16 of 28 Evidence: During the inspection there were always lots of visitors in the home which provided a lively and stimulating environment. All visitors to the home sign the visitors book, and we noted that hand gel was placed at the entrance and visitors were encouraged to use this when entering and leaving as a precaution to prevent infection. All the relatives we spoke to said staff were very welcoming and they could visit with few restrictions. The home contracts catering services to a private company. There is a strict Kosher kitchen that is appropriately equipped and divided into separate milk and meat areas that are fully colour coded. The kitchen was clean and tidy, the food stored appropriately and was in date and matched what was recorded on the menu. Fridge and freezer temperatures are recorded daily as are the temperature of the meals when they are served and these records were seen and were satisfactory. The menus cover a four week period and there is a choice of main meal and a separate soft food option. We joined the residents for lunch and found the food was well cooked and attractively presented. The dining room was spacious and the tables had a posy of flowers and were covered with cloths, all of which provided a pleasant and relaxing atmosphere. We observed residents being supported by staff to eat who were unable to manage by themselves. The expert by experience states; Carers accompanied residents to the dining room and for those who needed to be fed, gave them time to ensure that it was not a chore on the carers part. Some visitors were seen to help at meal times and it was also evident that this presented an opportunity to socialise. In our surveys, residents and their relatives commented that meals were very good with plenty of choice and variety. 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. Complaints are taken seriously and responded to in a professional manner. Residents are protected from abuse by clear policies and procedures and by an appropriately trained staff team. Evidence: The AQAA states; We have a clear complaints procedure which is in every service users handbook and held at reception and on the notice Board. The matron responds very promptly to all complaints either orally or in writing and acknowledges them all. The matron discusses all complaints with the senior management team and informs the Board at our 6 weekly meetings. We have a complaints/suggestions box as a result of a relatives suggestion. We examined the records of complaints made since the last inspection. These were very few and were about minor concerns. We recommend that a book or other format is used to record complaints so that they are easier to follow and can be used as an audit trail to detect trends, frequency etc. The people we spoke to, said they knew the complaints procedure. We were told several times by residents and relatives; You will not find anything wrong here! Indeed, we saw several written complimentary letters and cards from relatives, expressing gratitude and praising the manager and staff for the quality of the service. The staff recruitment and written induction records include questions about how to recognise and deal with suspected abuse. Care Homes for Older People Page 18 of 28 Evidence: The home has an accredited trainer who trains staff about abuse issues and the manager said the home uses role play to demonstrate the importance of treating people with dignity and respect. In our discussions with individual staff and those we met as a group, we were satisfied that they were knowledgeable about their responsibilities to safeguard vulnerable people. We noted that at the time of the inspection, assessments had been carried out for six people under the Mental Capacity regulations. The records showed that in prescribed instances, deprivation of liberty was authorised; for example, not permitting someone to go out unaccompanied who might wander, and the use of seat belts for specific periods to restrain someone who is at risk of falls. In March 2009, three staff were disciplined following a management investigation into serious allegations. The home had immediately alerted the Commission, Social Services and the police when the allegations came to light. The manager told us that the home discourages the giving of financial gifts from residents to staff. However families like to give gifts at Christmas etc and this is carried out quite transparently and is discussed between the family and the floor manager. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives can be confident that they live in a home that is safe, very clean, comfortable and well maintained. Evidence: The manager states in the AQAA; Each room is newly decorated between occupancies. The downstairs lounges have been painted within the last year. New lighting has been put in to enhance the type and strength of lighting as a result of user feedback. All light bulbs have been replaced with low energy bulbs over the last year. Soft furnishings and new arm chairs have been replaced in the last year. The downstairs lounge have new blinds and some upstairs lounges have new curtains. Certain residents have requested their own choice of curtains in their rooms which we provided. Residents have a choice as to how they organise their own bedrooms. All floors and walls, window sills and hand rails are cleaned daily and spillages on carpets are attended to promptly by the domestic team. Our water tanks are regularly inspected and we have temperature maintainence systems in place to prevent hot water from scalding residents. The home has excellent links with our Environment agency and has regular training on prevention and management of infection. When there was an outbreak of Norovirus in the local community and certain other care Homes locally, the Home put into place extra hand washing and infection control procedures with notices in the entrance area to prevent cross infection. This was Care Homes for Older People Page 20 of 28 Evidence: successful and we were not affected by the localised epidemic. We visited all areas of the home including many bedrooms. The expert by experience visited five rooms. She found that some residents chose not to go down for activities and were happy to stay in their rooms. The rooms were clean and people had their own belongings to make their rooms more individual. All interior and extrerior facilities are wheelchair accessible. All bathrooms have specialised equipment to meet the needs of residents with mobility needs. The home is also equipped with hoists. The standard of decoration throughout the home was very good and all furnishings and fittings were in good order.There are ample spaces for residents to see their visitors in private. We noted that each room was clearly labelled in large writing and some residents have a photo of themselves on their doors to aid recognition. In many cases the name of the persons key worker was also on the door so that resatives know who to ask for information about the resident. We were informed that, as a result of feedback and suggestions, the home installed air conditioning in the downstairs lounges and floors which provides a comfortable temperature. The home employs its own maintenance staff. The inspector found that the toilet seat in one ensuite bathroom was missing. When brought to the attention of the floor manager, this was immediately attended to by the maintenance person. There is a team of cleaners in the home. At the time of the inspection the home was very clean and tidy and smelled fresh 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 people who live in this home can be confident that their carers are properly recruited, well trained and highly motivated which ensures residents best interests. Evidence: Each floor has its own staffing establishment, but when residents go down to the ground floor for activities/meals etc, the staff accompany them. We examined all three rotas. These identified the staff who were on duty at the time of the inspection. There is at least one qualified nurse nurse on duty at all times on each floor, and generally, there are two nurses and five carers on the first floor, which is usually the busiest floor. The staffing on the other two floors is usually one nurse and four carers during the day. We were told that staffing levels are adjusted in accordance with occupancy levels. These levels are also augmented by volunteers who help out at mealtimes and activities. At the time of the inspection the home had several residents vacancies. However, some concern was expressed by two foor managers that they had heavy workloads and would like more qualified staff support. These concerns appeared to relate to the extent of the management tasks they had to perform. We fed these comments back to the manager at the end of the inspection and we recommend that a review of staffing levels on Floors 2 & 3 is carried out. Care Homes for Older People Page 22 of 28 Evidence: We examined the recruitment records of five staff who recently started work in the home, three of whom were nurses. All files contained the information required by Regulation including CRB disclosures and references. There was a copy of the application form, interview questions and a written nduction. The files also contained various certificates of attendance at training courses. We were given a spreadsheet showing all the training that staff had undertaken in the past year. This included the mandatory health and safety subjects, dementia care, challenging behaviour and also training in Jewish culture and tradition. All staff have either already attained the NVQ level 2 or equivalent, or are in the process of dong so. The home has its own NVQ assessor. The staff we spoke to said how much they appreciated the amount of training provided by the home. The expert by experience reported that staff were friendly, motivated and happily involved in their duties to help residents in their day to day activities. They worked well as a team in the lounge during the activities periods and were friendly to all visitors. A relative commented in our questionairre; Even if sometimes their patience is not rewarded, the families know that their loved ones are in kind, good hands. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives can be confident that their home is well managed and they have opportunities to have a say in how the home is run. Residents financial interests are safeguarded and their health and safety is promoted and protected. Evidence: The registered manager has been in post for 3 years and is a first level nurse with 31 years of experience. There is a management structure in place which supports the manager in all aspects of running the service. All the people we spoke to over the two days of the inspection were very complimentary about the manager and how the home was run. For example; a relative told the expert by experience that the manager was very good and ran the home efficiently. This was also confirmed in comments in our surveys and letters and cards we saw in the home. The expert by experience states in her report; If I ever have to visit a relative in a care setting, I would hope it was one that was run like Sage. The Jewish community is lucky to have this facility. The Care Homes for Older People Page 24 of 28 Evidence: managers commitment to maintaining high standards at the home and her professional approach to both staff and residents is to be commended. We observed a happy staff team going about their responsibilities and the staff confirmed to us that their morale was good and they felt supported by senior management. We saw one to one staff supervision records and minutes of staff and relatives meetings There is also a comments box provided in the home. All of these show that staff, residents and relatives have an input into how the home is run. The home does not generally hold money on behalf of residents. We saw residents records where relatives were appointed with power of attorney for those who are unable to manage their own affairs. Residents or their representatives are invoiced monthly for sundry expenses such as toiletries and newspapers. These invoices were detailed and clear audit trails were seen. Documentation was examined in relation to fire safety, gas safety, electrical installation and portable appliances, hot water checks and Legionella checks. All this documentation was satisfactory. Monthly monitoring of the home is carried out by the responsible person. We saw copies of these reports which identify any issues in the home that need addressing. However, we recommend that the monitoring officer interviews some residents or relatives and also staff about the service, and records their comments. This further ensures that any concerns or issues are picked up and can be addressed promptly. The home has a complete portfolio of policies and procedures as required by the regulations. We examined the infection control policy which was updated recently in the light of the concern about swine flu. This provides clear guidance for staff about how this is spread and what precations are necesssary to prevent cross infection. This is good practice and demonstrates the managers awareness of current issues that may affect the wellbeing of residents and staff. Accidents and incidents are recorded on each floor and at reception for downstairs areas. We examined accident records and we were satisfied that these are audited by the manager and appropriate action is taken to minimise risks. The home has a good record of informing the Care Quality Commission about any serious incidents. 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 2 3 7 9 16 Care plans should be completely rewritten every six months to ensure that they are current and fresh. Liquid medication should be dated on the day it is opened to ensure that it has not expired. The home should have a book or other format to record complaints as an easy to follow audit trail. This will facilitate the detection of trends and frequency of complaints. The monitoring officer should interview some residents and staff during their monthly visits to ensure that any concerns or issues are picked up and addressed promptly. 4 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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