Care Home: Sea Breeze

What the care home does well People enjoy living at Sea Breeze and it was evident from our observations that people are happy there. People are supported by a competent, stable staff team and from our observations staff follow good practices when providing care and support. Levels of staff with a National Vocational Qualification (NVQ) at least at level 2 are high, with many staff having achieved level 3. The providers have demonstrated a commitment to supporting staff to achieve further NVQ qualifications at both level 3 and level 4. There is a range of activities in place that are designed to meet people`s wishes and needs and we observed that people evidently enjoyed the activities they took part in. The home encourages and promotes the involvement of family and friends. Relatives told us they are made welcome and are consulted about their relative`s care. What has improved since the last inspection? Since the last inspection there have been significant improvements noted in all areas that we examined. The home is well managed in the interests of the people who live there. All the statutory requirements and good practice recommendations made following the last key inspection have been addressed. The improvements include processes around information, care planning, risk assessments, storage of medication and staff training. The quality of information in care plans and risk assessments is good and overall care records have improved. One particular area that we noted has improved considerably is in the way staff deliver care. We observed good care practices and friendly interactions between staff and people living in the home. The atmosphere was relaxed and people were evidently happy. There have also been significant improvements to the environment of the home. The programme of maintenance and decoration has made the environment much better. There is improved pictorial signage around the home that will help people who are confused or forgetful because of the aging process to have a greater understanding of their surroundings. What the care home could do better: The providers should continue to develop and improve their processes and build on the good standard that they have now achieved. Key inspection report Care homes for older people Name: Address: Sea Breeze 34 Carnarvon Road Clacton On Sea Essex CO15 6QE     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: Ray Finney     Date: 1 4 0 1 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) 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: Sea Breeze 34 Carnarvon Road Clacton On Sea Essex CO15 6QE 01255435515 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Elsie Damien care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The total number of service users accommodated in the home must not exceed 19 persons. Date of last inspection Brief description of the care home Sea Breeze is a care home for older people, situated in a residential area of Clacton, opposite the library and within walking distance of the seafront, town centre shops and amenities. The home is a short walk from the railway station and is also accessible by bus. The property has some off road parking to the front and there is a pay and display car park nearby. The home can accommodate nineteen people; there are seven single rooms and six double rooms, twelve of which have an en-suite facility. Bedrooms, toilets and bathrooms are on the ground and first floor. Access to the first floor is by stairs. There is no passenger lift but there is a chairlift available. Communal areas consist of a lounge and a dining room. The garden to the rear of the property is a small paved area with a detached storage building, raised flower border and garden table and chairs. The home charges £390.39 a week for the service it provides, with Care Homes for Older People Page 4 of 28 19 0 Over 65 0 19 Brief description of the care home additional charges for services such as dry cleaning, chiropody and hairdressing and for personal items including toiletries and newspapers. This information was given to us at the time of the last inspection. 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: A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. The providers completed an Annual Quality Assurance Assessment (AQAA) in May 2009, which is required by law to be completed by the service, with information about the home and sent it to us at the Commission when requested. Information from the AQAA was used in the last inspection report and we did not ask for another AQAA to be completed before this inspection. However, since that time the providers have sent us an improvement plan and information from this can be found throughout this report. Visits to the home took place on 13th and 14th January 2010. On the first day we carried out a tour of the premises, examined documents and had discussions with Care Homes for Older People Page 6 of 28 people living in the home, visitors and members of staff. On the second day of the inspection we also had discussions with the providers. Observations of how members of staff interact and communicate with people living in the home have also been taken into account. On both days we were given every assistance from the providers and staff team. 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. People choosing to live at Sea Breeze can be confident they will be able to make an informed choice based on the information the service provides and their needs will be assessed. Evidence: Following the last key inspection the providers submitted an improvement plan which stated that the homes Statement of Purpose had been amended, drafted in a larger print version and the whole document checked for accuracy. All residents will be provided with a residents information pack on admission to the home detailing the facilities provided. On the day of the inspection we observed that the Statement of Purpose and Service User Guide have been updated as the providers stated in the improvement plan. The information in these documents was examined and appropriately reflects the service being offered at Sea Breeze. The Statement of Purpose and Service User Guide are Care Homes for Older People Page 11 of 28 Evidence: displayed prominently in the hallway leading to the lounge, therefore they are accessible and the information is available for anyone who wishes to know more about the home. The providers told us in their improvement plan, A new pre-admission assessment form is ready for use in the future. The home will carry out our own admission assessments, which will give details of physical ability and dependency needs in personal hygiene, mobility, continence etc. The care management assessments provided by social services highlighting the specific and immediate needs and relevant information for residents will be taken into consideration in assessing the needs. There have been no new admissions since the last key inspection. However, a sample of care records examined contained evidence of the assessment process that is in place. Further details of the assessment and care planning process can be found in the Health and Personal Care section of this report. We discussed the admission process with the deputy manager on the day of the inspection and they were able to demonstrate an understanding of the pre-admission assessment process. 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. People using the service can be confident their personal and healthcare needs to be identified and to be provided with the support to ensure these needs are met as they would wish. Evidence: The providers stated in their improvement plan that the service has invested in a new care plan system which was implemented on 01/11/09 and care plans have been developed according to the individuals care management and pre-admission assessment and the care plans now reflect individually tailored care and person centred care. On the day of the inspection a sample of two care plans was examined in detail. There is now a new format in place which consists of four folders, the Needs Assessment and Care Plan, the Care Plan Diary, an information file and a book for recording peoples food and fluid intake. The needs assessment and care plan starts with a personal profile giving details of the Care Homes for Older People Page 13 of 28 Evidence: persons background, personal relationships and family history. The persons assessed needs are recorded in sections which include Social and Leisure, Physical Health and a range of risk assessments. The social and leisure section covers the persons needs around social activities, interests and hobbies and religious activities. The physical health section covers the persons medical history and current prescribed medication. The providers improvement plan further stated that, Risks are identified and systems are put in place to minimise the risks and to manage the identified risks if any. Care records examined confirm that each person has a mental health risk assessment, which is based on a scoring system to determine the level of risk. There are detailed notes to enable staff to interpret and understand the assessed risk. There are further risk assessments in place relating to moving and handling, behaviour, falls, a nutrition screening assessment and a Waterlow assessment, which assesses the individuals risk of developing pressure sores and skin breakdown. Each section of the assessments examined was completed with sufficient detail to record the persons strengths and needs. Each care plan examined contained details of what assistance is required for personal care and the persons preferences and dislikes about how they receive personal care. Staff spoken with on the day of the inspection were able to demonstrate an understanding of individual strengths and needs. The providers improvement plan also stated, All service users have now a written plan of care according to all aspects of their 24 hour care needs in respect of health and welfare. Needs are identified in the completed assessments and the information is used to devise the persons individual care plans. The sample of care records examined confirmed that care plans are reviewed monthly to take account of peoples changing needs. The care plan diary contains a daily record section where staff document details of what is happening for the person on a day to day basis. Each persons individual care plan diary records details of visits from health care professionals including the doctor or district nurse. There are a range of documents in place that record how peoples health care needs are being met including weight charts, continence charts and evidence that people have had a recent review of medication. Food and fluid intake is documented fully for each individual on a daily basis. The language used in the care plans and related documents was appropriate and respectful. Throughout the inspection we observed that staff were polite in their Care Homes for Older People Page 14 of 28 Evidence: interactions with people and treated them with respect. We also observed good practices from members of staff assisting someone to transfer from their armchair in the lounge to a wheelchair. One member of staff explained to the person what they were doing, encouraged the person verbally and chatted to them as they encouraged the person to mobilise. Both staff demonstrated good interactions with the person they were assisting. The home operates a monitored dose system (MDS) for peoples medication. Storage is in a trolley which is appropriately secured to the wall. The home has a new lockable fridge in the kitchen for medication requiring storage in controlled temperatures, although at the time of the inspection there were no medicines in use that needed to be stored in a fridge. At the time of the inspection there were no controlled drugs in use in the home. However, there is an appropriate cupboard for the storage of medication that requires this level of secure storage should anyone living in the home be prescribed any controlled drugs. There is an accessible folder that staff can consult containing the Royal Pharmaceutical Society of Great Britain (RPSGB) guidelines on safe and appropriate recording on medicine administration charts. We also examined evidence that staff are carrying out medication audits. The home has a policy, procedure and guidance for staff around the use of medication prescribed on an as required basis (usually referred to as PRN medication). Staff also have access to a copy of the latest edition of the local authoritys Workbook for Working with Medication and Related Tasks. Staff spoken with on the day of the inspection were able to demonstrate an understanding of good practices around supporting people with prescribed medication. In particular we discussed protocols in place for the use of PRN medication for one individual and staff showed a good knowledge of when this particular medication is used. Issues raised at previous inspections relating to medication have now been addressed and the processes for the storage, administration and recording of medication are now robust. 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. People living in the home can expect to enjoy a lifestyle that meets their wishes, needs and interests. Evidence: The providers stated in their improvement plan, Staff are consulting service users and arranging activities according to their needs on a daily basis and they do different and varied activities according to each service users interest and capability. Activities are recorded in their daily activity log sheet. Painting, colouring, drawing and other craft works were recently introduced and some residents enjoy this more than others. Each persons care plan diary contains an individual activities log that documents what the person does on a daily basis. One set of care records examined shows that the person enjoys a range of activities including gentle exercise, playing snakes and ladders, playing catch, reading,sing - songs, reminiscence, watching television, listening to music, chatting and colouring. The home also had a Christmas party and relatives were invited. Staff explained that it was a great success and everyone enjoyed the occasion. Care Homes for Older People Page 16 of 28 Evidence: The providers stated in their improvement plan, All current members of staff are sensitive to service users needs, choices and wishes. From our observations on the day of the inspection we noted that staff were demonstrating good care practices. The needs assessment and care plan for one person records that they prefer their own company and are reluctant to join in most group activities but they do enjoy listening to music and watching television. Staff spoken with were able to demonstrate that they have a good awareness of what the person enjoys and what they prefer not to do. On the afternoon of the inspection we observed that people socialised with staff and there was a friendly atmosphere. We noted that people were smiling or joking with staff and people were evidently happy. Staff made suggestions or asked people what they wanted to do. One person told them they didnt want to do any drawing and wanted to watch television. On the second day of the inspection we observed that a member of staff was helping people enjoy a game of snakes and ladders, using a large sized games mat and giant dice. Individual care plan diaries record visits from relatives and other family contact such as telephone calls. On the day of the inspection staff were able to explain the different ways that relatives and friends keep in touch. In the afternoon one person had tea with visiting relatives. Peoples care plans give details of peoples wishes around religious observances. One individual care plan stated that the person enjoys celebrating Christmas, but no longer wishes to take part in church activities or have visits from the church. On the day of the inspection we observed that both hot and cold drinks were available throughout the day; people were offered tea or coffee and there was a jug of squash available. At lunch people were offered a choice of soft drinks with their meal. Lunch was beef casserole and vegetables and one person chose fish as an alternative. Dessert was mince pie and ice cream and one person had sponge and ice cream instead. We examined the food storage and preparation areas on the day of the inspection. There were ample provisions available of fresh and frozen foods. Food stored in the refrigerator was covered appropriately and clearly marked with the date of opening. Throughout the course of the inspection we observed that the member of staff responsible for food preparation that day followed appropriate procedures around hand washing and wearing protective clothing. 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. People using the service can be confident that their concerns about how they are treated are listened to and acted upon and they are kept safe. Evidence: The providers stated in their improvement plan, All aspects of complaints are thoroughly and robustly investigated in a timely manner and complaint procedures are displayed on the halls wall all the time with a complaint form. As reported at the last key inspection there is a process in place for dealing with concerns and complaints. We observed that the complaints procedure and forms are readily available and are displayed in the hallway leading to the lounge. One persons care plan states that they are not aware of the homes complaints procedure, however, the persons family is fully aware of it; they visit regularly and are in regular contact with the home. We examined the homes records around concerns, complaints and compliments. There have been no complaints made to the home since the last inspection but ample evidence was examined of compliments and cards with thanks from relatives. Relatives spoken with on the day of the inspection knew the process and they were confident that they would not hesitate to make a complaint should the need arise. Care Homes for Older People Page 18 of 28 Evidence: Staff spoken with understood their responsibilities around keeping people safe. A recent anonymous complaint that led to a safeguarding alert was investigated by the local authority. It was not upheld and there was no evidence to support the allegations. A sample of personnel records examined contained evidence that staff have had Safeguarding of Vulnerable Adults (SOVA) training in the past year. The homes training planner for the coming year states that further SOVA training is planned for February 2010. The providers have been open in providing information and have demonstrated a commitment to making changes and improvements where necessary to ensure people living in Sea Breeze are safeguarded. 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. People can enjoy living in an environment that suits their lifestyle and which is homely, well maintained and clean. Evidence: During the course of this inspection we carried out a full tour of the premises and noted that there have been considerable improvements to the environment at Sea Breeze. Many of the issues identified at the last key inspection have been addressed. The providers now regularly carry out an assessment of the premises room by room to check for damage or potential hazards such as loose cupboard handles. The providers stated in their improvement plan, A maintenance person is on duty every day and New magnet catch, bolt and padlocks were fitted to the COSHH cupboard. Service users never have access to locked COSHH cupboard. We observed during a tour of the premises that one of the most notable improvements is in the way the home is maintained. The maintenance person works in a flexible manner to deal with issues as and when they arise. We noted that some of the identified issues that have improved include radiator covers that have now been securely fixed to walls and the COSHH (control of substances hazardous to health) cupboard in the laundry room has been secured with a new catch and more robust lock. On the day of the inspection the maintenance person had been painting in the Care Homes for Older People Page 20 of 28 Evidence: two downstairs toilets. Individual rooms were clean, tidy and contained evidence of personal possessions, photographs and memorabilia. The home has five double rooms and nine single rooms. The double rooms have privacy curtains or screens. All but one room has en suite facilities, some with a bath or shower. The room without an en suite facility is situated next to a toilet. Each persons room has a call bell to call staff and there are detachable call bells that the person can use if they are not close to the wall mounted switches. Communal rooms were clean and comfortable, the tables in the dining room were laid for lunch with tablecloths and place mats and there were a number of houseplants that added to the homely appearance. There were pictures on the walls as well as large frames containing collages of photographs of people in the home, including some from the recent Christmas celebrations. The providers stated in their improvement plan, The environment meets the needs of people living there, including dementia. Invested in new signage and all are displayed in appropriate places. Signage is clear and appropriate for service users. Our observations confirmed that since the last inspection there have been improvements made in signage throughout the home including pictures on individual bedroom doors and signs on bathrooms and toilets. This will help people who are becoming forgetful as a result of the aging process to make more sense of their surroundings. We observed that staff followed good practices around infection control, including wearing personal protective equipment (gloves and aprons) when carrying our personal care or other tasks. There were paper towels and liquid soap available for hand washing and staff were observed to use them regularly. There were no odours throughout the home and the standard of cleaning was good. 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. People living in Sea Breeze can be confident they are cared for by a competent staff team who can meet their needs. Evidence: Over the course of the two days of this inspection we noted significant improvements in staff practices and interactions with people living in the home. Staff spoken with were knowledgeable and understood their responsibilities. We observed that staffing levels were good with two carers on duty and another member of staff working in the kitchen. In addition the home has a cleaner every day and a maintenance person on a daily basis whose hours are flexible according to what needs to be done around the home. As previously reported, the percentage of staff with a National Vocational Qualification (NVQ) at level 2 or above is good. The providers stated in their improvement plan, All members of staff are appropriately and suitably qualified. 100 members of staff have NVQ 2; all except one have achieved NVQ 3; four of them are currently doing NVQ 4. A member of staff spoken with told us they have just completed NVQ level 4 and there are other staff working on NVQ awards at this higher level. On the first day of the inspection an additional member of staff had come on duty to carry out some NVQ work and was mentored by a senior member of staff. Care Homes for Older People Page 22 of 28 Evidence: Since the last inspection there have been a number of staff changes and we observed that staff on duty during the course of the inspection were interacting well with people in the home. We further observed that the way they provided care to people demonstrated an awareness of good practices. Staff were respectful and chatted to people, even when they were just passing through a communal area. Staff spoken with told us they feel there is good communication between staff, including a good handover of information. Night staff complete a night report book and this information is handed over to the morning staff. A sample of personnel records examined confirmed that staff files are well organised and contain all the information required by regulation. Through discussions the providers were able to demonstrate that they have a thorough and robust recruitment process in place that they follow to ensure people living in Sea Breeze are supported and safeguarded by appropriately recruited staff. The providers stated in their improvement plan, Members of staff have undertaken specific dementia, MCA [Mental Capacity Act], DOLS [Deprivation of Liberty Safeguards] training courses to enable them to address the needs of those service users with cognitive impairment, confusion and short-term and long-term memory loss and We have booked a lot more other relevant training, including care planning, nutrition etc by joining in a training consortium with a few other local care homes. The personnel file of each member of staff contains their individual training matrix with records of completed training. The providers showed us training planned from December 2009 to December 2010, some of which had already taken place. The sample of staff files examined contained evidence that staff training included manual handling, medication, safeguarding, dementia awareness, infection control and health and safety. Further training due to take place in the next three months includes further safeguarding training, care planning, risk assessments, moving and handling, nutrition, continence awareness and first aid. 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. People living in Sea Breeze can be assured it is appropriately managed in their best interests. Evidence: The providers were unavailable on the first day of the inspection, but we discussed the management of the home on the following day. The providers are working as a team, each with their own responsibilities for managing either the business side of the home or the care of people living there. The providers and the staff team gave us every cooperation during the two days of the inspection. A significant number of areas for improvement were identified at the last key inspection in August 2009. Evidence presented at this inspection showed clear improvements in all areas and credit must be given to the providers and the current staff team for the hard work they have put in to provide evidence to support the improvements that have been made. At the last key inspection 25 statutory requirements were made and two good practice recommendations, all of which have Care Homes for Older People Page 24 of 28 Evidence: been addressed. As there have been no new admissions to the home since the last inspection we were not fully able to evidence the requirement made relating to preadmission assessments. However, there was sufficient evidence that there is a robust process in place, therefore we will take a proportionate view that the requirement is not outstanding. As reported at the last inspection, the home has a process in place for auditing the quality of the service they provide. Since the last inspection further questionnaires have been sent to relatives of people living in the home. As before, positive comments were received in these Quality Assurance questionnaires including one person who said, never made a complaint and another who stated, hard working staff. The providers explained that a system of self audit is in place including checks of the medication processes, an audit of the premises and monthly Regulation 26 reports. We discussed with the providers how peoples finances are managed. The home only deals with small amounts of personal spending money and peoples finances are managed by relatives or, where this is not possible, by legal representatives. Each individuals personal spending money is kept separately and is securely locked away. Receipts are kept for any spending and a sample of three peoples records were examined and all found to be in order. The homes maintenance records were examined and all were found to be in order with up to date certificates including maintenance of fire alarm, gas installation, hoists, electrical installation and the stair lift. There is also a range of risk assessments in place relating to health and safety including COSHH (control of substances hazardous to health) risk assessments for cleaning products in use in the home. 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. 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. 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