Care Home: St Audrey`s

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What the care home does well The home provides good quality personal and health care support to meet the individually assessed needs of each service user.The home is effectively managed and staff are well trained and supported to enable them to provide a good level of service within a homely and safe environment. Without exception service users consulted confirmed that they were well cared for .`I am very well looked after here it is so much better than the previous home I was in and I am quite happy `, one told us. A relative commented ` the home does a really good job nothing is ever too much trouble and my relative is cared for with genuine warmth and affection and my needs as a visiting relative are also considered`. The environment is spacious well equipped and well maintained and the home had a noticeable happy and relaxed feel at the time of our visit and provided a welcoming and sociable atmosphere. The ethos of Heritage Care is that the service users views are valued, they are actively involved in the running of the home, and are consulted about their lives.They can take part in activities that are designed to meet their individual tastes and interests. The home retains a stable staff group whose numbers are adequate to meet the needs of the people living there and they were seen to be doing so in an unhurried competent manner. Recruitment procedures for new staff are thorough with evidence that all the required checks are made to ensure the protection of the people who use the service. What has improved since the last inspection? Since the last inspection extra Activity Organizer hours have been employed which has enabled the range and duration of activities to be increased. Additional laundry staff hours have also improved the quality and speed of this service. The care plans have all been reviewed and more detail of peoples early life history and current interests, likes and dislikes included. The home has benefited from various works of redecoration and refurbishment and new beds and seating have been purchased.The dining room has been enlarged and more appropriate dining furniture obtained. The development of a reception area in the entrance hallway where an administrator can work and who is available to meet and greet visitors has added to the welcoming atmosphere of the home. What the care home could do better: The service delivery and quality of care is good but the service must ensure that all the care given is adequately recorded so that it can be fully evidenced that the standards are being met. The Manager and staff have a clear vision of where further developments to the service can be made. The good practice recommendations in this report are to ensure that the good quality of life experience for the residents continues. Key inspection report Care homes for older people Name: Address: St Audrey`s 15 Church Street Hatfield Hertfordshire AL9 5AR     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: Jan Sheppard     Date: 3 1 1 2 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 29 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 29 Information about the care home Name of care home: Address: St Audrey`s 15 Church Street Hatfield Hertfordshire AL9 5AR 01707272264 01707258243 Lynn.Beech@HeritageCare.co.uk www.heritagecare.co.uk Heritage Care Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Noreen Eileen Looney Type of registration: Number of places registered: care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home St Audreys is a large Victorian house that was extended and refurbished in 1996 to provide a care home for 38 elderly people. The home, which is run by Heritage Care, is situated in Old Hatfield and is part of the Hatfield House Estate. The house is close to the amenities of the local shops and the town centre. The main railway station is near by and the area is well served by public transport and major roads. The home is very well appointed and stands in spacious grounds with attractive rural views from many rooms. Accommodation is provided in single bedrooms most of which have en-suite facilities and are sufficiently large to be comfortable bed sitting rooms. St Audreys offers a high standard of residential care for those residents who still value their independence and wish to be comfortable in a caring and safe environment. The home was first registered with the Local Authority Inspection Unit on 30th July 1996 under the Registered Homes Act. Care Homes for Older People Page 4 of 29 0 Over 65 38 Brief description of the care home The Statement of Purpose and Service Users Guide provide information about the home for referring social workers and prospective clients. The current charges range from £457 to £646 per week. Care Homes for Older People Page 5 of 29 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 last inspection of this service was made on January 22nd 2007. The current e mail address for this service is Noreen.looney@heritagecare.co.uk This unannounced inspection took place over eight hours on two weekdays. This was a key inspection that focused on the key standards of the Care Standards Act relating to Older people. This report is written using accumulated evidence gathered prior to the inspection including information contained in the AQAA (Annual Quality Assurance Assessment) completed by the Manager, information given in any pre-inspection questionnaires and also takes account of statutory notifications sent periodically to the CQC (Care Quality Commission) by the home.A tour of the building was made, in depth discussions were held with the homes Manager and staff who were on duty were spoken with. We also met and spoke with a number of people who use the service and with their visitors. Spot checks were made on a number of the homes records and care plans. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 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 Care Homes for Older People Page 8 of 29 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 29 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 29 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 who use this service can expect to have an assessment of their needs prior to entering the home and to have an opportunity to visit and assess the services offered for themselves. They will also have sufficient information about the home to help them make an informed choice about whether or not to seek admission. Evidence: The files of three residents were inspected and it was seen that a comprehensive assessment of their needs and wishes and an assessment of any risks and dependency levels had been carried out before they were offered a place in the home. The manager explained that she and /or the deputy manager visit the applicant either in their own home or in hospital to make this assessment and that when ever possible a second member of staff accompanied them. This staff member would then take the lead in helping them settle into the home after admission. Where ever possible relatives were also involved in this assessment process and all applicants were offered Care Homes for Older People Page 11 of 29 Evidence: a pre admission visit and were encouraged to spend time talking with other residents sharing a meal and possibly taking part in any activities that were going on at that time. The initial care plans are written from the information gathered during this assessment visit and it was seen that they provided appropriate information so that the staff could meet the persons needs. An assessment of the applicants Mental Capacity was seen to also be made at this initial visit and in talking with the managers it was clear that they had a good awareness of the implications of this new legislation and that any concerns they had were raised with social services. The homes brochure information documentation was clear and informative and gave a good insight into life in the home. The Statement of Purpose was up to date and informative containing all the required elements. All the service users have a contract and information concerning terms and conditions of residency. During this visit members of staff were seen to have a good easy relationship with the residents and to be following the homes strong ethos of putting their needs and wishes at the centre of the care that is offered. All the residents spoken with said that they were happy living in the home and spoke warmly of the kindness and consideration given to them by all the staff. Two spoke particularly positively of their admission to the home how the staff had worked hard to make this difficult transition as easy as possible for them. One told us that when I arrived in my room there was even a bowl of flowers to welcome me, it was lovely and the staff were so kind to me and they reassured my daughter too and I was so grateful for that. Care Homes for Older People Page 12 of 29 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 can expect to have their health and personal care needs met in a dignified and respectful manner by staff who have a sound knowledge of their care needs and how these should be met.Detailed care plans are in place for all residents but it could not be evidenced that all the care given was always being fully recorded. The home has safe medication storage arrangements and has good procedures for the administration and recording of medication. However some omissions in these records were found at this visit. Evidence: Detailed person centered care plans are kept for all service users and all the plans seen were found to have been recently updated and put into a new format divided into clearly defined sections which enabled easy access to all the needed information. The manager explained that since the last inspection all the plans had been compiled into this new more person centered format about which staff had received fresh training.The plans gave good evidence of the homes ethos of enabling each resident to retain their own independence as far as is safely possible for them to so do.Comments such as support the resident to improve or help them to maintain this remaining Care Homes for Older People Page 13 of 29 Evidence: ability were common.The residents are encouraged to sign their plans this usally being done after the care plan review which where possible and only with their agreement,was also seen to involve the residents family.The reviews on one care plan although having been carried out had not been fully recorded. All the plans seen contained an excellent life history including details of the residents interests likes and dislikes and an account of their earlier life events. Staff said that this information was very useful in enabling the activity organiser to plan an appropriate and interesting activity programme for each resident according to their wishes. Risk assessments were found on each plan seen and a programme of regular reviews of these is in place.Appropriate liason with a doctor and their family had been recorded for one resident where bed guards had been recommended to ensure their safety. Each care plan has a section relating to the residents mental capacity and one plan seen evidenced that the home had consulted with social services about concerns thay had about a residents capacity. The care plans were also found to contain good information about the residents health needs with appropriate monitoring of specific health concerns and recording of all contacts with medical practioners.Food and fluid monitoring charts are kept and information concerning skin conditions is recorded on body charts. Proper recordings were seen to be made concerning the care of pressure wounds these kept in conjunction with the monitoring visits made by the District Nursing service.However some of the recordings concerning weight monitoring were found not to be consistently or accurately maintained; the manager was already aware of this problem and discussed the training given to assist staff to overcome this. The home maintains very good contacts with four local doctors surgeries, residents can choose their own GP and comments from visiting community nurses and GPs seen during this inspection were all very positive. One Doctor said our surgery has excellent communication and liason with this home they carry out our instructions promptly and seek advice in a timely manner. Another visiting nurse said we work well together staff refer problems to us and we can work together on prevention and delivering good care. Residents and relatives spoken with during this visit all said that they received the care and support they needed including good medical support. One resident told us that all the staff are very kind and caring and they even seem able to anticipate my needs. Staff were observed to be knocking on doors before entering bedrooms and bathrooms. Interactions between staff and residents were relaxed and friendly and several residents spoken with told us that their dignity was not compromised by poor practice. The home offers good end of life care and where ever possible will involve the relatives in this care provision if they so wish. Additional training is being undertaken Care Homes for Older People Page 14 of 29 Evidence: by staff and managers concerning paliative care and bereavement. Part of the medication administration round was observed.Staff were seen to administer medication in a kindly manner working with the resident at their pace. The home uses a MDS monitored dosage system for medication that is supplied from a local pharmacy. The home has appropriate and secure storage trolley facilities for medication including a controlled drugs cupboard and a medication fridge. However no records were being kept of the temperatures within the trolleys and the records relating to the dates of opening of medication in packets was not being recorded consistently.These measures are advised to ensure the safety of medications administered at all times. The MAR medication administration record sheets were with one exception found to be generally well maintained with no signature omissions and evidence of regular management checks of the accuracy of these records could be seen. A record of the audit of the medication received into and disposed out of the home was also seen. The record of the medication administered were generally clear with appropriate identification codes and a written explanation of variations fully recorded on the reverse of the sheet. A check of the controlled medication found that the correct amount of medication measured against the recorded amounts were correct. The recording of creams administered was found to be in some instances incompletly recorded on the MAR sheets and we were told that this was because the creams were kept in the residents rooms and that residents often assisted the staff with the application of their creams. We discussed how more accurate recordings of what was actually happening could be made this to ensure best practice and safety for the resident . We also discussed how best to record where a resident had refused an early morning medication and was then asleep later on when the staff again offered them the medication. Care Homes for Older People Page 15 of 29 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 using this service can be assured that the home will provide them with a good lifestyle that offers choice and meets their assessed social and recreational needs. People using this service are offered a choice of nutritionally balanced home cooked meals. Evidence: Since the last inspection a number of improvements have been made to the provision of activities within the home. Extra activity organiser hours have been employed and an expanded programme of activities offered to meet the expressed interests of the residents.All the people using the service now have a recorded assessment of their activity needs and wishes and it could be seen that records of their attendance at sessions and whether or not they enjoyed these was also recorded. Staff explained that they had spent more time consulting wth service users at their regular residents meetings and asking them what they wanted to do if anything. One resident s wish to stay mostly in their room was respected as was the choice of others not to participate in large group activities. One to one recreational arrangements were found to be better suited to the more frail service users. A programme of activities planned is Care Homes for Older People Page 16 of 29 Evidence: displayed and photographic evidence of recent party events and outings was also seen. The manager said that she intended to increase the number of outings to local places of interest during the summer months. Residents told us that they enjoyed walking around and sitting in the garden and one said there is always something to do if you want to but there is never any pressure to participate unless you want to. Comments from several other residents and from relatives confirmed that the variety of activities had increased and mentioned particular activities that they enjoyed including carpet bowls, arm chair yoga, chess, coffee mornings,art and craft work,and the hand and neck messages offered by a visting therapist. A number of people commented on the friendly and socialable atmosphere in the home, one said I lived alone for so long I do now appreciate having regular company and regular social events in which I can join. The home has an open visiting policy and family and friends are welcomed into the home some even visit daily, and all are consulted about their relatives care. Visitors spoken with during this visit were all very positive about the care that their relative received.They confirmed that they are always kept informed about their relative and the staff were always available to answer any questions. The serving of lunch was observed and we enjoyed sharing this lunch and the sociable atmosphere with the residents .Since the last inspection improvements have been made to the dining area which has been enlarged, new tables and chairs provided and linen napkins and more delicate drinking classes and crockery introduced.The comments about the food were mostly very positive,residents said that they were regularly consulted about the menu planning and the chef would try out new dishes at their suggestion. They confirmed that good choices were always available. Pureed food and special diets are catered for and residents asked confirmed that the food is usually always served at the correct temperature. Food served in the home is home made from fresh ingredients and the chef confirmed that sufficient ingredients of good quality are always available. Cakes are made for special occasions and relatives can eat with their resident if they wish. One comment seen said Thankyou for the lovely dinner we had last night with our relative. We are very happy with the care they are receiving and think that they are very lucky to be in such a wonderful place. Care Homes for Older People Page 17 of 29 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 who live in this home can be sure that their complaints are listened to and investigated. The policies and procedures in place ensure that people are kept safe and are protected from abuse. Evidence: The homes complaints policy and procedure is available in the entrance hallway and gives clear guidance as to how any complaint will be handled. All residents and their relatives are given a copy of this. All complaints received are recorded and it could be evidenced that these were dealt with within the prescribed time frames.The manager said that she always tried to meet for face to face discussion with anyone who had made a complaint however minor and that very often an amicable solution could be arrived at. In speaking with residents during this visit it was evident that they felt empowered to beable to speak about any matter of complaint with the manager. One resident said when we ( a number of residents who were friends) spoke with the manager about the sudden variation in the quality of the food she took our concerns very seriously and immediately spoke with the new temporary chef and improvements followed quickly. The home keeps records of all compliments received and this folder was read during this visit. The comments included The home is always very welcoming I could not wish my relative to be in a better place. Another said The staff Care Homes for Older People Page 18 of 29 Evidence: work very hard and the quality of care offered and the variety of entertainment is excellent. All the staff have training in the prevention of abuse and staff spoken with were familiar with the homes procedures and of the whistle blowing policy and procedures. Staff were able to describe what their responsibilities would be if they ever had any suspicions or encountered any abuse. All staff spoken with demonstrated a keen awareness concerning all aspects of the protection of service users , physical, mental and emotional. The home engages Advocacy services from Age Concern with a representative visiting monthly to attend a coffee morning and to speak with individuals in private. All the staff have attended training on the implications of the Mental Capacity Act and a number of staff have recently attended training on Equality and Diversity this training to ensure that the residents rights can be fully protected. The homes records and notifications received from the management evidenced that the home deals promptly with any staff disciplinary issue there by ensuring the safety of the service users at all times. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides spacious good quality accommodation which is well maintained and provides an attractive well appointed environment which is comfortable clean and hygienic.The appropriate individual and communal facilities ensure that the residents are able to maximize their independence and live safely. Evidence: St. Audreys is a large detached Victorian House situated in the village of Old Hatfield. The house is surrounded by well kept gardens which adjoin the grounds of Hatfield House. The home is comfortable well maintained and very well furnished. Many of the bedrooms are large providing sufficient space for a bed sitting room arrangement and all have an individual character.Residents are encouraged to personalize their rooms and most had done so with items of their own furniture pictures and ornaments. All residents asked said that they were happy with their rooms and several commented on the help that staff had given them when they first arrived in arranging this private space in a manner that they liked. The home has a rolling maintenance programme and recent redecorations and new carpeting could be evidenced in several corridors.New dining room furnishings, some new beds and easy chairs have also been provided. The entrance hallway is to be refurbished to accommodate the new reception desk facility which had recently been introduced.Wireless internet facilities are to be provided throughout the home. A Care Homes for Older People Page 20 of 29 Evidence: recent Environmental Health inspection had found uneven paving areas in the garden and it could be evidenced that these were to be rectified before the warm weather when several residents like to walk in the garden. Since the last inspection changes have been made to the house keeping arrangements and the home appeared to be very clean and to have no unpleasant odours.Each day the staff shift leader makes a check of all the rooms to decide on any housekeeping needs and to ensure that the existing quality and standards are maintained. The home has good laundry facilities and the manager said that this service had been further improved by the appointment of more laundry hours. Residents spoken with were all very satisfied with the standard of the laundry services and with the speed in which their clean linen was returned to them. Appropriate infection control procedures were seen to be in place in the laundry. The kitchen was found to be tidy and well maintained.It is a compact kitchen that is well appointed and the chef confirmed that all the equipment that is needed is available.However additional covered space for the storage of crockery which is currently stored on open shelves in the adjoining hallway would be an advantage. Care Homes for Older People Page 21 of 29 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 who use this service can be confident that they will be supported by appropriate numbers of skilled and fully trained staff who have been safely recruited to give them protection and who are able to ensure the smooth running of the service. Evidence: During this unannounced visit it was seen that there were sufficient staff on duty to meet the needs of the service users in an individual manner and that the number of staff tallied with the planned staff rota. Information given by the residents and their relatives confirmed that there were always sufficient staff to meet their needs in a timely manner. One commented if there are ever to be any delays they always tell us and the staff are always very helpful and respectful. During this visit staff were observed to answer call bells with in a reasonable time frame and residents said that they were always treated with respect and dignity. Staff were seen to be working well together as a team and to be providing support for the residents in a kindly unhurried manner allowing them to do as much for themselves as it is safely possible for them to so do. Staff were seen to be familiar with the needs of individual residents and a good rapport was seen to exist between them. Only qualified staff are employed to cover the night time duties with waking staff being able to call on a more senior sleeping staff member if needed. The management carries out unannounced spot checks of the night time working arrangements and the manager said that she is very Care Homes for Older People Page 22 of 29 Evidence: aware of the need to make the night time staff feel fully included in the life of the home which in the main occurs during the day. The numbers of staff holding professional qualifications, NVQs at levels two and three ,exceeds the requirement for fifty percent qualified staff. The home aims that all its care staff should hold such a qualification and several staff spoken with are currently studying for this.Staff told us that they get a lot of training and that they were happy with these opportunities. New staff are only appointed on the expectation that they will achieve this qualification with in a certain time limit. The homes training records show that a training needs plan is compiled for each individual to meet their individually assessed training needs and from this an annual training plan is made for the whole home. The recruitment records for three staff recently appointed found that all the required checks had been made these to ensure the safety of the service users. Some of the residents take part in the recruitment of staff and sit on the interview panels. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and the management actively seeks the views of residents and of other involved people in order to ensure that a good quality of service is consistently provided . Residents can expect the home to be run by managers who are appropriately trained and experienced. The residents can also expect that their health, safety and welfare will be promoted and protected by the maintenance of good records and that their managers will responsively address any concerns or worries. Evidence: Since the last inspection a new manager and deputy manager have been appointed.The manager is a qualified nurse and has had many years experience working with older people. The deputy manager who holds an NVQ qualification at level 3 had worked at the home for several years before seeking this promotion. Both managers are currently studying for the NVQ at level 4 leading to a registered Managers Award and both are experienced professionals whose ethos is very clearly to Care Homes for Older People Page 24 of 29 Evidence: put the needs of the residents first. Their confident and calm approach to their work positively influences the homely and relaxed atmosphere in the home where meeting the needs of the residents is the top priority of all the staff. The managers ethos is to operate an open door policy of encouraging feedback and this was evidenced throughout this visit as service users visiting relatives and staff all approached the office to speak with her.Staff told us that they felt well supported by the manager and visitors said that they appreciated her approachable manner. One said this home is a very happy and positive place where the managers help to create a happy relaxed atmosphere. The home has appropriate systems in place to enable good communication between the various groups of staff. Records of staff meetings, residents and relatives meetings and the menu planning meetings all evidenced that these were properly planned and recorded and had a good range of participation and that they covered all aspects of care delivery and personal development. Staff spoken with told us that they felt confident with the homes new management team which they said they felt worked well together. Several spoke of the various changes that had been made and commented that they recognized that these had only further improved the service that they could deliver. Both the new manager and deputy manager told us that taking over their new roles as Managers of St Audreys had involved them in a steep learning curve but that they now felt comfortable with their new management duties and had planned further developments that could be made to the services delivered by the home. They confirmed that they had received good support and training opportunities from the company, Heritage Care, and the notes of the Regulation 26 visits made to the home by the company evidenced this. The home sends residents, relatives, staff and external stakeholders quality assurance questionnaires from which quality monitoring can be carried out. Comments on these questionnaires are shared with all the staff and are used to learn where improvements in their service delivery are needed.The provider company,Heritage Care, compiles an annual report which is available to all residents and to relatives. The home gives good priority to promoting the health safety and welfare of the service users through the maintenance of regular safety checks , staff training and record keeping.During this visit the records relating to the monitoring of water temperatures, safety checks of the homes equipment and fire alarm testing and the fire evacuation plan were examined and found to be properly kept. However the records relating to the care delivered and the reviews of the care plans were found not always to be Care Homes for Older People Page 25 of 29 Evidence: recorded consistently and the manager is aware of the need for regular monitoring of this so as to ensure that all the care given can be fully evidenced on the written records. Staff consulted all reported that they had regular supervision meetings which they found helpful and enabled them to think about their own professional development as well as to talk through any day to day work problems. Spot checks on the records of these meetings found them to be satisfactory but it could not be evidenced that they were all being held at the required frequency , six per year, to meet the standard. Care Homes for Older People Page 26 of 29 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 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The temperatures of areas used to store medication were satisfactory on the day of the inspection but they were not being monitored. It is recommended that the temperatures of all areas used to store medication are recorded regularly and monitored to ensure that they do not rise above 25oC,in order to prevent the risk of administering medication that has deteriorated and is no longer effective. 2 9 The dates of opening of packeted medication were found to be recorded on some but not on all packets. It is recommended that to ensure the full safety for the service users these recordings are made consistently on all packeted medication. 3 37 Gaps were found in the recording of the care given and in the reviews of this care. It is recommended that regular management checks are made of the residents records to ensure that written evidence is made for all the care planned and delivered. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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