Care Home: St Mary`s House Residential Home

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What the care home does well The home has a friendly and homely feel, created by the enthusiasm and concern of the management and staff for the residents. This was emphasised by those we spoke to from outside the home. The numbers of staff on duty are above the minimum standard for the number and needs of the residents, ensuring that residents` needs can be attended to quickly. Care plans are clearly written to enable staff to access and input information about care needs easily. The home has provided specialist equipment for the needs of residents for their safety and comfort. What has improved since the last inspection? The information given out to prospective residents is up to date and complete. Staffing numbers on some shifts have been increased to ensure that residents with dementia care needs can be under supervision at all times. Records and documentation concerning medication and risk assessments are now correctly completed. New staff are properly inducted and supervised. A rolling programme of redecoration and refurbishment has continued. What the care home could do better: The level and range of stimulation and contact for residents in the `new` lounge should be reviewed to ensure that all residents can experience activity to the level of their ability. Professional advice must be sought about the position of the kitchen and laundry doors, and the use of the laundry as an office with a view to the reduction of any risk of cross-infection. Key inspection report Care homes for older people Name: Address: St Mary`s House Residential Home Earsham Street Bungay Suffolk NR35 1AQ     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: John Goodship     Date: 2 6 1 0 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: St Mary`s House Residential Home Earsham Street Bungay Suffolk NR35 1AQ 01986892444 01986895708 cw.farrer@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Christopher Albert Farrer,Mrs W Farrer care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1 The home may accommodate up to one person, aged 60 and over, who require care and accommodate by reason of dementia. Date of last inspection Brief description of the care home St. Marys House Residential Home is registered to provide care for 28 older people. Of these, up to 19 places are for older people with dementia, and 1 place for a person aged between 60 to 65 years of age. The home is situated in the market town of Bungay, close to shops, Post Office, public houses, hotel, library, Doctors surgery, Dentist, Optician, and restaurants. A bus service links it to the main towns, including Norwich and Lowestoft. St Mar?s House is a large adapted Georgian property. Residents bedrooms, toilets and bathrooms are located across all 3 floors. Communal rooms lounges/dining rooms are on ground level, and have doors leading out to the patio and mature gardens. Residents can move around the home by using the passenger lift, platform lift, stair lift, stairs or ramp. A ramp is located to the rear of Care Homes for Older People Page 4 of 28 Over 65 0 28 28 0 Brief description of the care home the home, to enable disabled, or wheelchair users access. There are 7 car-parking bays at the rear of the home. There is also off-street parking, and Pay & Display car park within walking distance. The range of fees at the time of this inspection were £450.00 to £502.00 per week. 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: We visited St Marys House on a weekday for an unannounced inspection. The visit lasted for seven hours. The two owners, one of whom is the registered manager, were present throughout. They produced all the required documentation, and introduced us to residents, staff and visitors. We focussed on the outcomes for residents, assessed against the national minimum standards for older people. We tracked the care of three residents, and looked at aspects of the care of other residents with particular care needs. We spoke to two residents in their rooms, and chatted to a resident in one of the lounges who could respond to us. We also met two relatives who were visiting and an NHS professional. We examined care plans, staff records, medication records and health and safety records. Prior to our visit, we sent out surveys to a sample of residents, staff, and NHS professionals. We received completed forms from six residents, some of them Care Homes for Older People Page 6 of 28 completed with the help of relatives, seven from staff, and two from NHS professionals. The manager also completed an Annual Quality Assurance Assessment (AQAA) which gives the opportunity to describe the improvements made to the home and the care in the last twelve months, and to explain what improvements and changes are planned for the future. Information and data from all these sources have been used throughout this report. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 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 9 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. Prospective residents can expect to be able to decide if the home is suitable for them, and to be assured that the home will only admit those whose care needs it can meet. Evidence: We were shown copies of the information which was given to prospective residents and their families, called the Statement of Purpose.This had been updated in September 2009 to include the latest details of the management and staff qualifications. It gave people information on the range of care needs which the home was intended to meet, how an admission would be assessed and managed, and the facilities provided in the home. This information would enable people to decide if the home was suitable for them. We also saw the service users guide which gave those admitted a guide to how the home worked on a daily basis, and what choices residents had about for example menus, activities and to be consulted. Information on how to make a complaint, and Care Homes for Older People Page 10 of 28 Evidence: what to do in the event of a fire, as well as the structure of fees, was also included. Although the above documents encouraged prospective residents to visit the home prior to making a decision, the manager told us that it was more usual for relatives to visit the home, to assess its suitability for their family member. We examined the records for two residents who had been recently admitted. One admitted last year had a full pre-admission assessment. The other person had moved from a care home in the south of England the day before our visit. No pre-admission visit had been possible, so information had been gathered from a relative living locally to Bungay, and on the phone from the other care home. The forms to set up this persons care plan were ready in the file to be filled in. The manager told us that normally residents came from around Bungay where it was possible to visit them, either in their home, or more and more, in the hospital. The assessment included information about the persons physical and mental health, recreation and social care,safety,communication,falls record, personal care, and any rashes or bruises. The AQAA told us that the home had had no discharges in the last year because of inappropriate admissions or dissatisfied residents or their relatives. All six residents who completed our survey said that they had received enough information to make a decision about the home. Care Homes for Older People Page 11 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 can be assured that their care needs will be identified, and monitored, and they will have good access to medical services. Evidence: The six care staff who replied to our survey said that they were always or usually given up to date information about the needs of the people that they supported and care for. However, one carer said that quite often, we only found out about changes accidentally, not from a senior member or manager. The manager told us they would look into the way handovers were organised to ensure all information was passed to each shift in a timely way. We examined the records and the care of three residents, one admitted the day before our visit, another admitted just over a year ago, and one who was being cared for in bed. Each of these people had either a care plan, or in the case of the newest resident, an on arrival assessment as they had moved from another part of the country. Care plans included information and staff guidance on all aspects of care, such as communication, personal care needs, dressing, eating and drinking, sleeping, Care Homes for Older People Page 12 of 28 Evidence: mobility and recreation needs. The plans contained an assessment of mobility as appropriate and the use of a walking frame. The manager was a qualified moving and handling trainer. There were clear instructions for staff on how to move and handle the individual resident. Waterlow tissue viability risk assessments and nutritional screening assessments were in place where necessary. The AQAA informed us that there had been no instances of pressure areas developing in the previous twelve months. The manager told us that at the time of our visit there was now one case. One residents plan had a risk assessment for bedrails, with the consent form signed by a close relative. We were told that care plans were reviewed and if necessary updated on a monthly basis. This was the case with the plans we saw. One however was being updated more frequently because of the deteriorating health of the resident. Daily records were completed by each shift. The entries we saw gave helpful information about the residents day or night activities and care, and where appropriate gave very specific records of care given, for example, mouth swabs, turning and creaming. All the residents who replied to our survey said that they always(4) or usually(2) received the care and support they needed. All said that the home always made sure they got the medical care they needed. Some surveys had been completed by relatives. On the day of our visit, a GP and district nurse arrived to check on a very ill resident whose physical health had deteriorated quite suddenly. The doctor told us that they had every confidence in the manager and staff of the home. They do a first rate job. Another NHS professional, who visited those residents with dementia told us in the survey that I am always impressed by the care staff and managers comprehensive understanding of their residents care. We inspected the drugs store. The Medicine Administration Record(MAR) sheets were inspected and were fully completed with all administrations signed for. They also held the name of the resident, date of birth and photo, except for the newest admission. We checked the recording and stock of controlled drugs which were stored in an approved manner. The records tallied with the stock remaining. One residents medication had ceased on 9 September but the remaining dispensed items had not yet been returned to the pharmacy. We observed part of the lunch time drug round taking place in the dining room and in another communal area. In one case we noted that the tablets were administered on a spoon to prevent any contamination. The carer explained to the resident what they were doing, and we saw no instances where residents were reluctant to take their drugs. The carer signed that they had been given afterwards. Care Homes for Older People Page 13 of 28 Evidence: Several residents told us that they were happy living in the home. One said: I have never been so happy for years. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect to be offered a range of interesting and stimulating activities, and enjoy nutritious meals. Evidence: The AQAA told us that we take choice as a very serious part of a residents life within the home. The care plans we saw listed where known the preferences of residents for how they wished to spend their day, whether they wished to socialise or stay in their room and where they wished to have their meals. There were two main communal areas in the home. We noted that the most dependent residents were placed in the new lounge together. The more able residents used the other lounge. We visited two residents who chose to spend their day in their room. One had visual and hearing difficulties. They were able to tell us that they were happy in the home, and had all the facilities they needed. We saw that they were reading a book printed in one of the touch systems. They had an audio book machine and a very powerful magnifying glass. The home had bought a pendant call bell to ensure they could summon assistance easily. They were anxious that the manager should come back later to tell them all about a recent holiday. Care Homes for Older People Page 15 of 28 Evidence: We saw one carer in the old lounge singing with the residents, then playing a game with them using bubbles to encourage their movement and mild exercise. We did not see similar activity with the very dependent residents in the new lounge whose communication and comprehension levels were very low. One had a bird in a cage next to them, to which they responded by smiling when we asked them about it. The level of stimulation in this room was low with staff popping in and out on task related matters. A visitor had commented that there was only one call bell in this room and it was out of reach of all the people there. However we were told by a staff member that none of the residents there were capable of knowing when they needed assistance or using a call bell. This does emphasise the need to review how staff are instructed to cover this room and develop ways of providing appropriate stimulus for those residents. The AQAA told us that the home constantly reviewed their entertainment programme to ensure it met the varied preferences of residents. We saw the calendar of activities for October which included several singers and musicians, a puppet show, Halloween fancy dress party and then fireworks on November 5th. Five of the residents who replied to our survey told us that the home always or usually arranged activities that they could take part in if they wished. One wrote: Advised of activities, but do not wish to participate. The home had been awarded a 5 star rating by a national organisation for being pet friendly in allowing residents to bring pets into the home if feasible. All the respondents to our survey told us that they always or usually liked the meals at the home. On the day of our visit, the main choice at lunch was egg and bacon flan, with sweetcorn and leeks and potatoes, followed by apricot sponge and cream. The manager showed us some picture menu cards but warned that staff still needed to be aware of residents preferences to ensure that inappropriate choices were not made. The manager told us that residents chose their menu during the morning so that it was fresh in their minds. We noted that three residents were being supported to eat in the main dining room.This support was given in an unhurried and friendly way, encouraging residents to feed themselves if able. One person was eating a liquidised meal. This had been made to look appetising with clearly separated ingredients of different colours. We asked a resident who always had their meals in their room about the service. They confirmed that the food was always hot enough when it was brought in to them. Care Homes for Older People Page 16 of 28 Evidence: 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. Residents can expect to have access to a proper complaints procedure and to be protected from abuse. Evidence: All the residents who responded to our survey told us that they knew how to make a formal complaint, and that there was always someone they could speak to if they were unhappy. All the carers who replied to our survey told us that they knew what to do if someone had concerns about the home. The AQAA told us that the complaints procedure was displayed in the main hall, which we saw was above the visitors book. There was also a complaints and suggestions page attached to the visitors book. The manager also told us that tear off slips were now part of each monthly fees invoice asking for comments, suggestions and complaints. Although the AQAA listed no complaints received in the past year, there had been a letter expressing a number of concerns from a visiting organisation. The home had replied within their policy timetable, accepting some of the points made about staff levels in the afternoon, and the marks left by the dishwasher on some plastic cups. As nothing further had been heard, the manager assumed the complainant was satisfied. The AQAA told us that all residents were registered for postal voting. The home had also contacted a local solicitor to visit two residents who needed legal advice. Care Homes for Older People Page 18 of 28 Evidence: The AQAA told us that all staff received training in the safeguarding of vulnerable adults. We saw evidence of this in the staff files we examined, and when we spoke to staff. One person had an understanding of the types of abuse and indicators of abuse, and they were clear they would take any concerns immediately to the manager or senior person on duty. The manager was aware of the proper referral route for safeguarding concerns. She had also attended a training session on the Deprivation of Liberty Safeguards. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can expect to live in a clean, well-maintained environment, with as many of their personal belongings as they wish. Evidence: The AQAA told us that the home employed a full time and a part time maintenance person, and a part time gardener. A large proportion of the maintenance personnels time is spent cleaning carpets, resulting in an atmosphere free of offensive odours. The residents who replied to our survey all told us that the home was always or usually fresh and clean. A relative told us that their family members room was always clean. The home manager was the link person for infection control and attended regular updating meetings at the local hospital. Protective gloves and aprons were available throughout the home for staff. It had been noted in a previous report that the kitchen door and the laundry door were opposite each other and were permanently open using closers which operated on the sound of the fire alarm. It had been recommended that this arrangement should be reviewed from the point of view of potential cross infection. This situation was still in operation. In addition, the laundry housed the carers office and care plans. Between the two doors was the door to the drug cupboard. We make a requirement that the manager seeks advice from the local infection control nurse with responsibility for residential homes as to the safety of this arrangement. Care Homes for Older People Page 20 of 28 Evidence: In the previous twelve months the AQAA told us that the home had converted a room into a wet room for the safe showering of residents, had bought new laundry equipment, and a new set of dining room chairs suitable for their residents. A new television had also been bought for the main lounge. The AQAA told us that residents were encouraged to personalise their rooms. We saw examples of this in the rooms we visited. One person had brought in their own wardrobe, a wall cupboard containing their glassware, and two recliner chairs. The bathroom on the top floor was fitted with a ceiling mounted hoist and couch for the more comfortable care of some residents, and the safety of staff. The home had been inspected by the environmental health officer in October 2008. Some requirements were made concerning cleaning, the fitting of flyscreens, and decoration. We saw that these had been actioned. 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 expect to be cared for by competent staff who have been safely recruited and in sufficient numbers to meet their needs. Evidence: On the day of our visit, there were eight carers on duty in the morning, with four on in the early part of the afternoon, then five from teatime onwards. Three carers were rostered each night. The manager told us that an additional carer had been added to the late afternoon shift to ensure that there was always a carer available to supervise residents. The ratio of carers to residents was higher than the minimum recommended in the national minimum standards, however carers also had cleaning duties to do. Of the staff who replied to our survey, six said that there were always or usually enough staff on duty to meet the individual needs of all the residents. One said only sometimes were there enough. We interviewed a carer who found that the numbers on duty were sufficient for all the duties. They also explained that some day staff now worked on the night shift as this had improved understanding between day and night staff. The AQAA told us that ten residents needed the support of two carers during the day to help with their care, and nine at night. These numbers had increased from six and five respectively since the last key inspection. It emphasised the managers assessment that residents were becoming frailer and more dependent. All the Care Homes for Older People Page 22 of 28 Evidence: residents who replied to our survey told us that there were always staff available when they needed them. We examined the recruitment records for three staff who had started employment in the previous twelve months. All the required identification and employment check documents were in the files. These included full application forms, two references, POVA First checks and the full Criminal Records Bureau(CRB) certificate. None had started employment before the POVA First checks were received, and one of them told us how they had been supervised until their CRB certificate arrived. This persons file also held their Common Induction Standards log. They told us that they would be studying for an NVQ Level 2 shortly. The AQAA told us that 15 out of 29 care staff currently held NVQ Level 2 or above. All seven staff who replied to our survey told us that they were given training that was relevant to their role, helped them to understand and meet the needs of residents, and kept them up to date with new ways of working. Six of them said that that the manager gave them enough support and met them regularly to discuss how they were working. The training records and certificates for staff were held in their personal files. We saw examples of these which showed that staff had attended courses in the mandatory subjects such as moving and handling, first aid, food hygiene, fire procedures, and dementia training either using a distance learning course or in-house trainer. 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 can expect the home to be run in their best interests, with a committed and approachable management team. Evidence: The owners and registered providers were both closely involved in the day to day running of the home. Mrs Farrer had been the registered manager for some years. She was a registered nurse and also held the Registered Managers Award. She was also a qualified trainer in moving and handling. The owners told us that although they no longer live on the premises, they did live close by and were available quickly out of hours when on-call. The manager had attended a training session on the new Deprivation of Liberty Safeguards that came into force in April 2009. No-one had been identified at the home as needing to be referred under these safeguards. The homes certificate of registration was clearly displayed, although it still contained a variation for a former resident that was no longer required. The manager agreed to ask for a replacement certificate. Care Homes for Older People Page 24 of 28 Evidence: The manager told us about the methods they used to maintain and improve the quality of care experienced by the residents. The main way was to talk to residents and relatives to keep aware of any issues. This was evident by the knowledgeable way the residents were described to us, both as to their care needs and their life stories. We observed how relatives were welcomed into the home and how comfortable the relatives were in talking about their family member. The manager explained to us that they did audit the care plans and check the daily records to ensure appropriate and up to date information was available to staff. Three of the staff in our survey told us that the ways they shared information about the residents with other carers and the home manager worked well always. Four said it worked well usually. The manager told us they also checked the drug recording sheets. It would be good practice to evidence these checks by signing when they were done. Residents personal finances were not dealt with by the home. Families or an appointed representative were responsible. Residents were invoiced monthly for fees and any additional expenditure incurred such as hairdressing. These monthly invoices include a tear off slip for any feedback from families about the home. The maintenance personnel maintained the required health and safety records and did the regular checks, on, for example, fire equipment and hot water temperatures. We examined the record of accidents and noted that there had been a small number of falls of residents. However these covered several residents and there was no pattern to them. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 13 Infection control advice 31/12/2009 must be sought about the area containing the kitchen, laundry and drug room door, and the use of the laundry as an office. Residents must be protected from the dangers of infection, toxic conditions and the spread of infection at the care home. 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 12 The level and range of stimulation and contact for residents in the new lounge should be reviewed to ensure that all residents can experience activity to the level of their ability. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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