Care Home: Singleton Nursing & Residential Home

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What the care home does well It is evident through us talking to members of staff that the emotional health of the residents is of a high priority to the home and that staff are pro-active in maintaining and supporting residents with their emotional needs in order to maintain their quality of life in accordance to their plan of care. Staff demonstrate their commitment to achieving best outcomes for residents. Staff stated they expressed job satisfaction and confidence in the management of the home. Residents who spoke to us confirmed in their own words that they receive a good quality of care from staff who are courteous, respectful, communicate well, are experienced and deliver care in a individualised and professional manner. Many comment cards received about the home reflected a very positive experience of the home and further evidenced that the home works towards providing a high level of care. A care manager commented that the home "Provides individual care to its residents. I feel they know their residents well and provide person centred support" One relative commented "The care is excellent, staff are always very pleasant and polite and helpful in any situation." another said " kindness, consideration and respect" What has improved since the last inspection? It was evident through the inspection process that the home is taking steps to improve the standards of care. The AQAA showed the home had several more mature staff who have now completed their NVQs after having been resistant to the idea of study in later life for many years. Staff have become more confident, and are familiar with the residents. This means that they are able to detect changes or deterioration within a short space of time. What the care home could do better: The inspection identified several areas that were in need of being addressed. The main areas that were identified were :Not all the care plans were regularly updated on all the examples seen. Daily notes did not follow guidance issued by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting in that they were not completed accurately , with the signature printed alongside the first entry and not include gaps. Some clinical notes were found to be incomplete. The management team need to ensure that staff revising plans of care within the the home ensure that records are completed accurately. The manager stated that this shortfall would be addressed as a priority and that further training would be given in this area. No requirement at this time. A good selection of general aids such as hoists are available at the home. However not all residents benefited from a variable height nursing bed. The home needs to ensure that the provision of beds is assessed to ensure that equipment is individualised for each resident. The home is required to assesses all residents for their needs to have equipment or aids before they move into the home and that these are provided to them on admission and that existing residents are re-assessed.Shortfalls highlighted within this report evidence that the management of the home whilst providing for the best outcomes for residents needs to address these as a priority. The manager has expressed a willingness to work with the Commission and ensure that any shortfalls identified within this report are addressed. Subsequent to the inspection, information has been recieved that the concerns are being addressed. Key inspection report Care homes for older people Name: Address: Singleton Nursing & Residential Home Hoxton Close Singleton Ashford Kent TN23 5LB     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: Robert Pettiford     Date: 2 3 0 6 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: Singleton Nursing & Residential Home Hoxton Close Singleton Ashford Kent TN23 5LB 01233666768 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: singleton.nursinghome@totalserve.co.uk Singleton Nursing & Residential Home Limited care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 36 The registered person may provide the following category of service : 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 category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Singleton Nursing and Residential Home is a 36-bedded purpose built detached building providing accommodation on two floors for Service Users requiring both nursing and personal care. Registered nurses and care staff are employed 24 hours per day 7 days per week to provide for the needs of the residents. The home was first registered in May 1997. The Home is located next to a GP surgery and near a shopping centre. The local village hall and primary school are situated next Care Homes for Older People Page 4 of 28 Over 65 36 0 Brief description of the care home to the Home, allowing residents to participate in any of the activities that may be held in the local hall. The Home is served by a regular bus service with a bus stop nearby. Singleton is about 4 miles from the centre of Ashford. There is ample car parking provided by the main entrance with overflow facilities near the entrance of the Home. Some seating arrangements have been provided but the garden space is limited. Singleton Lake and park are nearby. 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 inspection took place at 8:00AM on 23rd June 2009 We agreed and explained the inspection process with the manager. The focus of the inspection was to assess the home in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older Persons. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. We used a varied method of gathering evidence to complete this inspection, pre inspection information such as the previous report and discussion and correspondence with the registered provider/manager was used in the planning process. This was to support us to explore any issues of concern and verify practise and service provision. The home had completed an annual quality assurance assessment questionnaire Care Homes for Older People Page 6 of 28 (AQAA). This provided us with information relating to What the home considers it does well, What we could do better, What has improved within the last 12 months and plans for improvement. The judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the Commission to be able to make an informed decision about outcome areas. Further information can be found on the Commissions website with regards to information on KLORAs and AQAAs. Documentation and records were read. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. Other areas viewed included risk assessments, pre-admission assessments, rotas, and training records. In addition an environmental tour took place. We identified a sample of residents for case tracking (a review of the level of care and support needed, and if it is being provided in a way that treats them with respect and dignity). 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 inspection identified several areas that were in need of being addressed. The main areas that were identified were :Not all the care plans were regularly updated on all the examples seen. Daily notes did not follow guidance issued by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting in that they were not completed accurately , with the signature printed alongside the first entry and not include gaps. Some clinical notes were found to be incomplete. The management team need to ensure that staff revising plans of care within the the home ensure that records are completed accurately. The manager stated that this shortfall would be addressed as a priority and that further training would be given in this area. No requirement at this time. A good selection of general aids such as hoists are available at the home. However not all residents benefited from a variable height nursing bed. The home needs to ensure that the provision of beds is assessed to ensure that equipment is individualised for each resident. The home is required to assesses all residents for their needs to have equipment or aids before they move into the home and that these are provided to them on admission and that existing residents are re-assessed. Care Homes for Older People Page 8 of 28 Shortfalls highlighted within this report evidence that the management of the home whilst providing for the best outcomes for residents needs to address these as a priority. The manager has expressed a willingness to work with the Commission and ensure that any shortfalls identified within this report are addressed. Subsequent to the inspection, information has been recieved that the concerns are being addressed. 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. Residents can feel confident that the care home can support them. This is because there is an assessment of their needs that they, or people close to them, have been involved in. However some improvements in the documentation was requested and a review of the homes equality and diversity policy. Intermediate care is not provided. Evidence: Residents can be confident that 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 where possible and have got full, clear,accurate and up to date information about the home. The AQAA and evidence following discussions with the manager showed the home ensures that whenever possible that the prospective residents visit the home and discuss with them and their families what their needs are Care Homes for Older People Page 11 of 28 Evidence: and address any concerns that they may have. All residents are given a welcome pack (Service User Guide) containing the complaints policy when they arrive, and the management team have an open door policy so that they are available to listen to any problems should they arise. Records held showed that residents have an assessment, which identifies their individual needs prior to or on admission to the home. The information is provided by the residents, their families and health / social care professionals. The assessment focuses on achieving positive outcomes for people and this includes ensuring staffing and specialist services provided by the home meet needs of the individual. However it did not contain all of the elements as required of the standards. The manager stated that the assessment process would be reviewed to ensure compliance. No requirement has been made at this time as the Commission is confident that this shortfall will be addressed. The assessment and care planning process do not fully recognise equality and diversity needs and the importance of promoting such rather than just meeting needs in a reactive manner, in that questions re diversity were not completed or expanded upon. Evidence of this judgement was obtained from reviewing the assessment and care planning systems. The home needs to review it equalities and diversity policy and ensures that all of the information and policies relating to residents are inclusive to all members of the community. It was reccommended that the staff and management team recieve equality and diversity training to ensure that the needs of all groups are recognised and supported. 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. Residents benefit overall from having individual plans that identify their physical and medical needs, but not enough detail was given to ensuring that plans of care are regularly updated and reviewed. Residents can feel confident overall that they are fully supported with their healthcare needs and that their wellbeing will be protected by the homes policy and procedures with regard to the handling and administration of medication. However the home needs to ensure that residents have access to dentistry. Residents can be confident that they will be treated with respect and dignity and their rights to make decisions about their lives and are respected as they wish or their capacity allows. Evidence: We viewed and discussed with the manager the care records relating to five residents at the home. In the care plans viewed there was sufficient detail and guidelines in respect of the support needed to meet their needs. Not all the care plans were Care Homes for Older People Page 13 of 28 Evidence: regularly updated however on the examples seen. Daily notes did not follow guidance issued by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting in that they were not completed accurately , with the signature printed alongside the first entry and not include gaps. Some clinical notes were found to be incomplete. The management team need to ensure that staff revising plans of care within the the home ensure that records are completed accurately. The manager stated that this shortfall would be addressed as a priority and that further training would be given in this area. No requirement at this time as the Commission is confident that the manager is aware of the actions needed to address this issue and has expressed a wiliness to work with the Commission. Whilst it was accepted through discussions with residents, and feedback from relatives they were happy with the standards of care received and generally had a high opinion of the home, the care plan documentation suggested otherwise due to lack of review in some instances being incomplete. DOLS (Deprivation of liberty Safeguards) assessments were seen not to be in place for one resident or agreement by the individual resident. The manager stated that staff are shortly to receive Mental Capacity Act training and that she was aware of this shortfall and that it would be addressed as a priority. No requirement has been made at this time. Evidence was available that residents or relatives where possible were involved in drawing up personal care plans in the documentation and that they are consulted in reviewing and amending such care plans as their capacity allows. Some of the care plans viewed were signed by a resident or a representative. However this was not the case for all care plans viewed. The inspector viewed a sample of care records and specific health care records relating to several residents. Records viewed confirmed that residents had access to a range of health care inputs as and when required, but not as part of regular and part of regular health checks in respect of dentistry. The home ensures Opticians and chiropody etc. The home was requested to review this shortfall. The home also ensures that residents have access to their chosen Doctor for medication reviews in addition to identified specialist health care input. The inspector visited the home at 8:00AM. During the inspection we noted that residents were seen making choices about their lives and were seen to be part of the decision process where possible. A relaxed atmosphere was noted with the residents interacting with staff. We also had the opportunity to speak with many residents who expressed satisfaction with the care offered and given. Care Homes for Older People Page 14 of 28 Evidence: We had the opportunity to observe some of the residents for lunch. During this time it gave the opportunity to explore with the residents spoken with their experiences of living within the home. All spoken with expressed satisfaction of living within the home and the respect and dignity they were treated with. The AQAA showed residents privacy and dignity are of paramount importance and form part of the Philosophy of Care. The home ensures that personal care is given in private, and that clients are given the opportunity to see visitors or to conduct business affairs (financial or legal) in a private place. Doctors or other health care professionals will always see the resident in private. The inspector viewed the storage arrangements and some records including Medication Administration Record (MAR) sheets, and the protocols for the administration of PRN/s Required Medication. The AQAA showed the home has taken steps to improve the management & distribution of medication following an incident reported in August 2008. The home has a clinical / medication room. Medication cabinets and trolley were evident in a dedicated room. The medication record sheets observed, were completed correctly. The disposal of medication brought to the Commission some concerns on how the throughput of medication could be audited to a high standard. It was the view of the Commission that the current system could be open to abuse. We commented on the homes drug disposal policy and asked the manager to review to ensure it meets with current guidance to ensure that it complies with The Royal Pharmaceutical Society of Great Britain (RPSGB) 2007. The Handling of Medicines in Social Care, this provides professional pharmaceutical guidance for staff working in every area of social care to improve the safety and quality of medicines. No requirement has been made at this time as the Commission is confident that this would be addressed. 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. Residents social and recreational interest and needs are provided for with a range of activities organised and are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. Residents nutritional needs are met by a home that Sees food as something to be enjoyed and required to maintain good health. Evidence: The AQAA and evidence shows residents are encouraged to participate in all activities, and go out with their families whenever they wish to. The home provides a range of activities to suit as many people as possible, and it is their choice whether they attend or not, the carers do inform every resident of the activities of the day, and they are promoted. Residents are encouraged to take park in a variety of activities as their interest and capacity allows. The home has sought the views of residents and considered their varied interests and abilities when arranging activities. The activities and plans are resident focused, regularly reviewed. Care Homes for Older People Page 16 of 28 Evidence: Residents are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them to have a drink or a meal. Residents can choose to entertain visitors in their own rooms or perhaps a lounge or garden areas. The AQAA states residents have the opportunity to choose their own routines, and although encouraged to take part in social activities, the home appreciates that it is their right to decide for themselves whether or not they wish to take part in social or leisure activities. Routines of daily living are dictated by the service users, e.g. getting up and going to bed times. If a resident has had a particular interest or hobby, this will be noted and they will be encouraged to maintain their interest. Residents who have religious beliefs will be given every opportunity to attend services if they are able, and ministers are welcomed into the home to visit them at any time. Residents are able to choose their menus, and will be offered an alternative if they do not like/want what is available on the main menu. Residents are encouraged to remain as independent as they are able to, and to exercise their own choices. Details of external advocates are available and detailed in our information packs for those Residents who do not/cannot deal with their own affairs, or whose relatives wish to contact external agencies for help or advice. Personal possessions such as pictures, ornaments, small items of furniture, etc. can be brought into the home so that service users can personalise their rooms. The AQAA states that mealtimes are very important to residents and they are encouraged to socialise and sit with friends. There are some residents who like to eat in their own rooms and this is accommodated. We viewed residents eating their midday meal. From observation, records viewed and comments made by residents it was evident that residents had been offered a choice of menus that met their dietary needs and individual preferences. The food provided for the residents was found to be varied and nutritious and of a good quality. 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 effective complaints system in place and residents and families are aware of its contents. Residents are protected by adult protection policies and procedures. Evidence: The home had a written complaints procedure, which was seen in the foyer. Residents spoken with felt free to voice their concerns. The home has received 3 complaints in the last 12 months all of which were seen to be dealt with appropriately on evidence seen. Following a review of a complaints received from the last inspection the manager confirmed that the home ensures complaints are taken seriously and dealt with in an appropriate manner. The inspector viewed and discussed copies of the Homes Policy for the Protection of Residents and staff Whistle blowing procedure. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training has been provided for staff. More courses are planned to ensure all staff receive the training required to protect residents from abuse. Another training course is planned for 28/07/09 to ensure all staff are trained. Care Homes for Older People Page 18 of 28 Evidence: Criminal Record Bureau Checks (CRB) have been obtained for all staff. The Manager is aware of her obligations with regard to ensuring the safety of Residents and protecting them from abuse. 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. Residents benefit from living in a home that provides for a homely environment which provides safe access to comfortable indoor and outdoor communal areas. The standards of internal and external decoration were found to be of a good quality overall with some some additional equipment and carpet needing to be ordered if required by assessment or need. Residents health is protected by the homes infection control procedures. Evidence: The management and staff encourage residents to see the home as their own home. Personal items were found in many of the residents rooms to make them feel more at home. It provides a very well maintained, safe, comfortable home. As well as a good selection of general aids such as hoists. However not all residents benefited from a variable height nursing bed. The home needs to ensure that the provision of beds is assessed to ensure that equipment is individualised for each resident. The home is required to assesses all residents for their needs to have equipment or aids before they move into the home and that these are provided to them on admission and that existing residents are re-assessed . The manager stated that assessments would be carried out and beds replaced on a priority basis with the intension of replacing all of the required beds within 8 months. All staff members are Care Homes for Older People Page 20 of 28 Evidence: trained in the safe use of aids and equipment. There is a selection of communal areas, according to the numbers of residents, this means that residents have a choice of place to sit quietly, meet with family and friends or be actively engaged with other residents. The home was found to be is well lit, clean and tidy and smell fresh at the time of inspection and well decorated. some carpet areas in high traffic areas were in need of some degree of replacement or refurbishment. The wardrobes in the residents bedrooms were not secured to the wall. It was strongly recommended that this was done to minimise the risk of injury. The manager stated that the risk would be assessed and appropriate actions taken. The management has a proactive infection control policy. Staff wear protective clothing (gloves and aprons) when providing personal care or handling soiled linen. There are separate staff hand washing facilities in the staff room and the service kitchen. Laundry facilities are comprehensive and meet the needs of residents and current guidance. 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. Residents can feel confident that their care, social and emotional needs are promoted by the employment of care staff in sufficient numbers to meet their needs. However shortfalls in training were noted. Evidence: The ratios of care staff to residents are determined according to the assessed needs of residents. Following discussions with the manager, a review of the rota and observations made during the inspection. The Commission is of the opinion that sufficient care staff were on duty to support residents with their needs. Residents spoken with were happy and content with the level of support provided. Relatives who had completed comment cards confirmed this in that they felt that their relatives were adequately supported with their needs. The home employs a number of ancillary staff who work as cleaners, laundry, gardener, maintenance staff. Thus allowing care staff the time to meet the needs of residents. The staff training records indicated undertaken training. Individual and group staff training needs had been identified. From documentary evidence seen the standard of staff training was adequate overall with the majority of staff completing basic courses, but however shortfalls were noted with regard to basic courses. Care Homes for Older People Page 22 of 28 Evidence: Evidence confirmed that the home currently meet with the required standards with regard to achieving an NVQ National Vocational Qualification Level 2 or above care qualification. The manager was able to confirm that the home has a development programme for all new staff, which meets Sector Skills Councils workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of residents, and that all members of staff receive induction training to specification. The home showed that it undertakes a recruitment practice at the previous inspection and this standard was met. The standard relating to recruitment on this occasion has not been inspected. 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. Residents and or their relatives can be confident that their views and opinions effect how the home is run and that the home is managed appropriately and the home provides good quality care overall. However management needs to address the issues identified within this report. Evidence: Shortfalls highlighted within this report evidence that the management of the home whilst providing for the best outcomes for residents needs to address these as a priority. The manager has expressed a willingness to work with the Commission and ensure that any shortfalls identified within this report are addressed. Quality assurance was discussed and the views and opinions of many of the residents relatives sought. They confirmed a great deal of satisfaction in living within the home and felt confident that their views and opinions were valued by the staff and management. The manager confirmed that the home does undertake quality assurance by means of asking residents, relatives to complete questionnaires in Care Homes for Older People Page 24 of 28 Evidence: addition to health care professionals. This practice enables the home to ensure it is meeting the goals that are set out in the Statement of Purpose. The registered provider of the home does visit the home regularly and complete what is known as a Regulation 26 visit (Statutory documented visits by the provider to monitor standards within the home). This requires the provider to assess the quality of care within the home and ensure that it is meeting with the required National Minimum Standards. A requirement was made at the previous inspection that the registered person shall ensure that records regarding information about service users must be kept securely and confidentially. Evidence has been supplied to the Commission subsequent to this inspection that this requirement has now been met. The Commission viewed records relating to Health and Safety Procedures, maintenance and servicing, and risk assessments. The Commission was able to evidence that checks and servicing of fire safety equipment and emergency lighting had been undertaken at the required. However the manager stated that the environmental rist assessment was in need of updating. The Manager stated that this would be addressed. 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 1 19 16 The registered person 23/02/2010 demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of residents. To ensure that the equipment provided by the home meets the needs of residents 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). 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