Care Home: St Aubyns

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What the care home does well The arrangements for admitting new residents into the home were satisfactory. Staff carried out an assessment to obtain information about peoples support needs. Prospective residents could visit the home to view the facilities and ask questions about the service. Care records were up to date and reflected peoples care needs. A local GP visits the home regularly to assess residents health and medication needs. Staff maintained good working relationships with other health and social care professionals. Relatives were satisfied with the care provided in the home and said they were always informed about important issues. All medicines were in stock and the records that were kept about the receipt and disposal of medicines were good. Controlled drugs were well managed. Communication between staff and relatives was good. Relatives and friends could visit and spend as long as they wanted in the home. One social care professional said "families feel very welcomed when they visit and are kept informed about their relative". Staff treat residents with respect and maintain their privacy and dignity. The choice and quality of food provided in the home was good. Meals were nicely presented. Complaints were recorded and investigated and addressed promptly. A high standard of cleanliness was maintained. Residents and relatives said the home was always clean and fresh. The home has a stable team of staff and temporary staff were used infrequently. This provides good continuity of care for residents. Regular checks and audits were carried out to monitor staff performance and improve the quality of care that was provided in the home. Equipment was inspected and serviced regularly. The service is run efficiently and delivers good outcomes for residents. What has improved since the last inspection? The amount and type of information that was recorded on the pre admission assessment form had improved. Staff had updated the menu to include more fruit and vegetables and new dishes, and had introduced new snacks for residents that require a soft diet. Most of the staff had attended a safeguarding training update. The water pressure in the first floor bathroom had improved. The front drive was repaved and new dining room and bedroom furniture was purchased. The number of care staff with a recognised care qualification had increased. Records were kept to show how applicants performed at interview. The resident and relatives survey form was reviewed and updated to provide more space for comments. Staff carried out an assessment to identify potential risks, before using bed rails. Regular checks were carried out to ensure bed rails were fitted correctly and were safe to use. What the care home could do better: Residents did not always receive written confirmation that the home could meet their needs. Wound care records did not include photographs or information about the size of the wound. This could make it difficult for staff to evidence improvements. The balance of two medicines that were supplied in boxes and bottles did not correspond with the homes records. Residents were given a plastic apron or towel to protect their clothing during mealtimes. Records were not kept about the activities programme and resident participation. A number of door locks were broken. The carpet in the main lounge was stained and the upholstery on some of the armed chairs was worn. Key inspection report Care homes for older people Name: Address: St Aubyns 35 Priestlands Park Rd Sidcup Kent DA15 7HJ     The quality rating for this care home is:   three star excellent 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: Maria Kinson     Date: 2 4 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 30 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 30 Information about the care home Name of care home: Address: St Aubyns 35 Priestlands Park Rd Sidcup Kent DA15 7HJ 02083004285 02083095435 terri.??@premierchoicebroadband.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Dilipkumar Tanna,Mr Kirtikumar Tanna care home 39 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 who can be accommodated is: 39 The Registered Person may provide the following category 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 category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home St Aubyns Nursing Home is situated in a residential area of Sidcup, near to a mainline rail station, bus routes and Sidcup town centre. The home was first registered in 1988. The building was extended in 1995 and is registered with the Care Quality Commission to provide nursing care for thirty-nine older people. There are nineteen single bedrooms and ten shared bedrooms in the home. Twenty-two of the bedrooms have en-suite facilities. Service users have shared use of the dining room and two lounges. There is a garden at the back of the property and limited parking at the front of the Care Homes for Older People Page 4 of 30 Over 65 39 0 Brief description of the care home home. Care Homes for Older People Page 5 of 30 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: The last key inspection on this service was completed on 11th July 2007. This inspection was carried out over one day in June 2009 and was unannounced. Prior to the visit we reviewed all the information that we had received from, and about the service. This included notifications, information about safeguarding investigations and the annual quality assurance assessment form that homes complete and return to the commission once a year. This information helped us to plan how we would undertake the inspection and what issues we would focus on. We sent surveys to ten residents and their relatives, five members of staff and six health or social care care professionals that were in regular contact with the home. We received fifteen responses, five from residents, one from a member of staff, three from health or social care professionals and six from relatives. During the inspection we spoke to five residents and three members of staff. Care Homes for Older People Page 6 of 30 The comments we received from residents, relatives, staff and health and social care professionals helped us to form a judgement about the home. Some of their comments are included in this report. During the site visit we examined some of the records that were kept in the home and assessed the management of medicines. We observed staff supporting residents to eat and drink, move around the home, undertake activities and take their medicines. We visited all of the communal areas and viewed a selection of bedrooms on each floor. There were three empty beds at the time of this inspection. The fees charged by the home range from £590.31 to £725 per week. The fees do not include hairdressing, toiletries, activities in the community or newspapers. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The amount and type of information that was recorded on the pre admission assessment form had improved. Staff had updated the menu to include more fruit and vegetables and new dishes, and had introduced new snacks for residents that require a soft diet. Care Homes for Older People Page 8 of 30 Most of the staff had attended a safeguarding training update. The water pressure in the first floor bathroom had improved. The front drive was repaved and new dining room and bedroom furniture was purchased. The number of care staff with a recognised care qualification had increased. Records were kept to show how applicants performed at interview. The resident and relatives survey form was reviewed and updated to provide more space for comments. Staff carried out an assessment to identify potential risks, before using bed rails. Regular checks were carried out to ensure bed rails were fitted correctly and were safe to use. 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. 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 30 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 30 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. An assessment was carried out to establish if the home would be able to meet the persons needs. Written information was provided and people that expressed an interest in the service could visit and spend time in the home. Evidence: Residents said they received adequate information about the service and a contract once they were settled in the home. Staff carried out an assessment before people moved into the home. The assessments that we saw for three residents identified key areas of need and were dated and signed. Additional information was provided by the funding authority. In the period since the last inspection the pre admission assessment form was reviewed and updated to include information about advanced directives and lasting power of attorney. Care Homes for Older People Page 11 of 30 Evidence: Some residents said they visited the home before they moved in but this task was usually carried out by relatives because people were too unwell or very frail. Care Homes for Older People Page 12 of 30 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. Peoples health and personal care needs were identified and guidance was provided in the records about the action that staff should take to meet these needs. Medicines were well managed overall but the balance of two medicines did not correspond with the information that was recorded on the medication chart. Failure to maintain toilet and bathroom door locks could compromise residents privacy. Evidence: We examined the records for three people that had recently moved into the home. All of the files included a pre-admission assessment form, supporting risk assessments, care plans and daily care records. Most of the plans that we saw provided adequate information about the action staff should take to meet peoples needs and maintain their safety. There was some variation in the amount of detail provided in activity or social needs care plans but this aspect of care has improved. One of the files included a care plan for a resident that had a wound. There was clear information in the plan about the arrangements for dressing the wound but the size of the wound was not recorded and there were no photographs. This made it difficult for staff to evidence progress. See recommendation 1. Plans were reviewed regularly, reflecting changes to Care Homes for Older People Page 13 of 30 Evidence: residents needs. This home is used by the local health trust to care for people with continuing care and end of life care needs. None of the residents that we case tracked were on the Liverpool Care Pathway but staff were familiar with this model of care and some of the staff had completed palliative and end of life training sessions. One resident that we spoke with asked the manager to organise an appointment with a local funeral director so that they could make their own funeral arrangements. The manager carried out this task sensitively and advised the resident about the date and time of the appointment. A local GP visits the home once a week to assess residents health and medication needs. All of the residents that we case tracked were registered with a GP and were supported by the homes staff to receive the health care input that they needed. Records were kept about health care professionals visits, referrals and appointments. Residents said they always get the medical care they need. We received written feedback from three health care professionals that were in regular contact with the home. They told us that staff always monitor residents health needs and follow their advice. One person said staff know individuals well and answer our questions confidently and another professional said I am always provided with the information that I require. The home employs a private physiotherapist. The physiotherapist visits the home twice a week to carry out assessments and to provide an exercise class for residents. Residents said they usually receive the care and support that they need. One person that had recently moved into the home said a staff member welcomed them when they arrived and told them all about the home. The person said most of what they were told actually happens. Controlled drugs were checked and the stock held matched what was recorded in the CD register. Regular checks were carried out by staff to ensure that the balance of medicines was correct. We looked at three medication charts. All medicines were in stock and good records were kept about the receipt and disposal of medicines. There were no gaps on the medication charts that we looked at but we found two discrepancies when we checked the balance of two boxed medicines against the records. The manager said the balance of medicines was checked during medication audits but this was not evident in the records. See recommendation 2. Care Homes for Older People Page 14 of 30 Evidence: Staff members respected residents privacy and dignity. For example a blanket was placed over a residents lap during a hoist transfer and staff ensured that doors were closed when people were using the toilet or receiving personal care. During the lunch period staff placed a towel or plastic apron over residents clothing for protection. The manager agreed to consider purchasing some material aprons or tabards for residents to wear during mealtimes. See recommendation 3. We observed staff supporting and reassuring residents throughout the day. Staff responded promptly to requests for assistance on all but one occasion when a resident asked a staff member to help them to use the toilet. The staff member acknowledged the request but advised the resident that they must wait. The resident was supported by another member of staff to use the toilet. See requirement 1. The lock in the ground floor toilet and shower room, the first floor bathroom and the en suite door in room 3 were broken. See standard 19. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides some activity and occupation for residents but we could not assess the full extent of this as there were no records. Visiting times were flexible and relatives said they were welcomed by staff. Staff prepared healthy, well presented meals and snacks for residents. Evidence: The home had recently appointed a new activity coordinator. Some of the residents that we spoke with said the new lady had asked them some questions and wanted to know what activities they enjoy. One relative said she saw the activity person doing different activities with residents such as reading the newspaper, which she said helped to break the day up. Two relatives and one visiting social care professional acknowledged the improvements the home had made with activities in recent years but said there was little stimulation for people that were confined to bed or who require one to one attention due to their sensory needs. We have repeated the recommendation that we made at the last inspection about this issue. See recommendation 5. There were no records of recent activities but the activity coordinator told us about some of the sessions she facilitated and about some of the outside entertainers that Care Homes for Older People Page 16 of 30 Evidence: visited the home. See recommendation 4. Some of the residents had enjoyed a belly dancing display, a trip to a local park, hand and foot massage, group games and discussing newspaper articles in recent weeks. On the day of the inspection one resident spent the morning in the garden, whilst some of the other residents watched Wimbledon on the television or listened to the radio. Three residents played games with the activity person. Residents said their family members were able to visit at anytime and one relative said they were made to feel very welcome all the time when I come to visit, even at mealtimes and I am invited to parties held at the home, throughout the year. Relatives said they were always informed about important issues such as accidents. We saw the minutes from a recent relatives and residents meeting. Relatives were informed about changes that had occurred or were planned and there was an opportunity for people to express their views. Residents said they were able to make personal choices. One resident said I can do as I please and gave examples of how they decided where they spent their time, chose what they wore each day and what they wanted to eat or drink. We offered to put the light on for one resident that was in bed in a darkened room. The resident declined and advised us that they liked it this way. In the period since the last inspection the menu was revised and updated. The cook explained that action was taken to increase the fruit and vegetable content of the diet as recommended in the last inspection report. This was achieved by preparing fruit smoothie drinks and fruit platters for residents. Some new Jamie Oliver dishes were added to the menu to provide more variety for residents. Staff also recognised that residents on soft or pureed diets were missing out on snacks such as biscuits and cakes. Action was taken to address this issue by providing small yogurt pots or fromage frais for these residents, between meals. The work undertaken over the past year to improve the nutritional content of the diet and to provide more varied and interesting meal choices for residents is commended. There were two lunchtime meal choices. Residents told us they could choose what they wanted to eat. It was evident during the lunch period that staff had a good knowledge of residents likes and dislikes and did try to accommodate individual requests. One resident that did not have any gravy on their meal told us that she did not like gravy and said they know what we like. The meal was hot and looked appetising. Most of the residents that we spoke to said they enjoy the food provided in the home and some residents described their meal as excellent or very good. Staff offered to cut residents food up and provided support to eat if necessary. Food was Care Homes for Older People Page 17 of 30 Evidence: pureed and served separately for people that require a soft diet. Care Homes for Older People Page 18 of 30 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. Concerns were investigated and action was taken to put things right, if necessary. Staff were aware of local safeguarding procedures. Evidence: The complaints procedure was displayed in the reception area and there was a summary in the service users guide. Residents said they knew who to speak to if they were unhappy and how to make a complaint. The procedure provides information about how people could raise complaints about the service and about the time that it would take the home to investigate their concerns. Complaint details were recorded in a book. Most of the entries were easy to read and understand but staff had recently started a new book which did not have clear headings. This made it difficult to determine which complaint some information relates to. The manager said she would address this issue. We looked at the action that was taken by the home to investigate and resolve five complaints that were received between January 2008 and April 2009. The records showed that staff acted quickly when concerns were raised and took prompt action to resolve the issue. Most of the concerns raised were about non care issues. We have not received any complaints or concerns about this service. The home continues to let us know about significant events that occur in the home. Care Homes for Older People Page 19 of 30 Evidence: The home follows the local authority Safeguarding Adults Multi Agency Procedures. A copy of the procedure was kept in the office and was accessible to staff. Staff that we spoke with had a good understanding of abuse and knew what they should do if they witnessed or were told about an allegation of abuse. In the period since the last inspection almost all of the staff had attended a safeguarding training session and one member of staff that could not attend said she was briefed by the manager when she returned to work. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well maintained overall and provides comfortable personal and communal space for residents and their visitors. Evidence: We visited all of the communal areas and a selection of bedrooms on each floor. The part time maintenance post was vacant at the time of this inspection. The provider had an interim arrangement with a local contractor to undertake work in the home until a new maintenance person could be appointed. The building was maintained to a satisfactory standard overall but there were several broken door locks. See standard 10 and requirement 2. In the period since the last inspection a tree was removed from the driveway and the parking area was repaved. Some new furniture was purchased for the dining area and residents bedrooms and a new unit was made for storing activity equipment. Some kitchen equipment was replaced. A new pump was fitted to the water system to increase the water pressure in the first floor bathroom and a new boiler was installed. There was an open plan dining room and lounge and a quiet lounge at the front of the property. The lounges were nicely decorated but some of the upholstery on the chairs was worn and the carpet was stained. See recommendation 6. There was a television Care Homes for Older People Page 21 of 30 Evidence: and music system for residents entertainment. Residents were able to bring some of their own furniture and possessions into the home and could arrange their belongings to suit their needs. Most of the bedrooms that we visited were homely and welcoming. All areas were clean and tidy and residents said the home was always fresh and clean. The home has consistently met this standard. Hand washing facilities were provided throughout the home and cleaning materials were stored securely. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has stable team of well qualified staff. Recruitment practises had improved but further checks must be carried out to comply with legislation. Plans were being made to provide additional training courses for staff. Evidence: The home has a stable team of staff. This meant that temporary staff were used infrequently and residents received good continuity of care. We examined the duty roster for the week of the inspection. The number and skill mix of staff was satisfactory. Residents said they receive the support and care that they need and staff were available when they required help. The manager told us that 50 of the care staff have a recognised care qualification and some of the other staff have a overseas nursing qualification. This exceeds the standard set by the Department of Health. We examined the recruitment records for three new members of staff. Some improvements were noted in recruitment practises but there were a few inconsistencies. The files contained all of the necessary documents and checks but some of the references were not verified and there was an unexplained gap on one persons employment history. The manager had introduced a new interview form. See requirement 3 and recommendation 7. Care Homes for Older People Page 23 of 30 Evidence: Records were kept about staff training. In the period since the last inspection some members of staff had attended moving and handling, interview techniques, catheter care, fire safety, COSHH, safeguarding, NVQ and palliative care training sessions. Although the records showed that relevant training sessions were organised for staff, some members of staff did not receive the recommended amount of training. See recommendation 8. One staff member said the home should provide better training for staff. The manager told us about a new training package that was about to be introduced in the home. The sessions are presented by a staff member that has completed a trainers course and include include watching a series of DVDs and discussion of the topic. The staff member completes a test at the end of the session to assess their understanding of the subject matter. The test paper is then sent away for marking. Care Homes for Older People Page 24 of 30 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. The home was well organised and managed. There were systems in place to monitor and improve the quality of care provided in the home and to maintain staff and service users safety. Evidence: The manager was assessed by the commission in April 2007 and was found to have suitable experience and qualifications to manage a care home for older people. The manager is a registered nurse and had attained the registered managers award in the period since the last inspection. Staff said the manager was easy to talk to and was always willing to listen to their views. The feedback that we received from people that use, or were in contact with the service was positive and there was strong evidence that the ethos of the home was open and transparent. One relative said the home was well managed and another relative said the service the home provides is excellent. One resident said their health improved once they moved into the home. Care Homes for Older People Page 25 of 30 Evidence: There were systems in place to monitor and assess the quality of care provided in the home. This included regular medication and record keeping audits, unannounced visits to assess the conduct of the home and a comprehensive annual audit that considers compliance with the national minimum standards. An action plan was developed to address any deficiencies that were identified during audits and to show when the issue was resolved. The home also sent out satisfaction surveys to relatives to obtain feedback about the service. In the period since the last inspection the survey format was updated to provide more space for relatives comments. The manager told us that the home did not store any personal money for residents. Relatives were invoiced for items that were not included in the fees such as hairdressing and chiropody treatment. We examined service reports for the main electrical installation, the passenger lift and gas appliances and compared this information with the data provided in the annual quality assurance assessment (AQAA). Equipment was inspected regularly to ensure that it met safety standards. The home had a fire safety risk assessment. The assessment was not dated but the manager told us that it was completed in 2007. See recommendation 9. Regular checks and inspections were carried out to ensure that the fire detection system, fire fighting equipment and emergency lighting were working properly. Staff attend regular fire safety training updates. We saw staff helping people to move around the home using handling techniques and equipment. Wheelchairs were used appropriately and footplates were used to support residents feet. All of the transfers that we saw were carried out in a caring and professional manner. Hazardous substances were stored securely. Care Homes for Older People Page 26 of 30 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 27 of 30 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 1 10 12 Action must be taken to ensure that all staff respond in a consistent and prompt manner to requests for support. To maintain residents health and wellbeing. 10/11/2009 2 19 23 Door locks must be properly 10/11/2009 maintained. The locks on the ground floor toilet, ground floor shower room, en suite toilet door in room 3 and the first floor bathroom door must be repaired. To maintain service users privacy and dignity. 3 29 19 A full employment history and written explanation about any gaps in the history must be obtained in respect of all employees. To protect people that use the service. 10/11/2009 Care Homes for Older People Page 28 of 30 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 7 Clear records should be kept about the size of wounds. Staff should take photographs of wound(s) with the residents consent. Internal medication audits should include checking that the remaining balance of medicines are correct. An appropriate form of protection should be provided for residents clothing during mealtimes. A copy of the activity programme should be kept in the home and information should be recorded about residents participation. The home should ensure that residents that choose to remain in their rooms or are confined to bed have access to activities. The chairs in the lounge with worn covers and the stained carpets in the main lounge and room 3 should be replaced. References should be verified to ensure that they are genuine. Each staff member should receive three paid training days each year and have an individual training and development assessment and profile. The fire safety risk assessment should be updated when changes are made to the home or annually. 2 3 4 9 10 12 5 12 6 7 8 19 29 30 9 38 Care Homes for Older People Page 29 of 30 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. 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