Care Home: St. Rita's Care Home

What the care home does well All parts of the environment were excellent and there was evidence that residents are able to personalise their bedrooms. The atmosphere of the home is friendly and welcoming and record keeping is good. The home is well managed with comprehensive staff training programmes in place in addition to quality monitoring systems and good recruitment practice. People living in the home are encouraged to be independent and all aspects of their health, leisure and welfare are identified and planned for. A wide range of activities are provided in-house and people are encouraged to have as much choice as possible over their daily lives. Comments in returned surveys included: * The care in St Rita`s is a higher standard than many care homes and admin staff are accessible. * The generous and friendly atmosphere is much appreciated and also the very high standard of cleanliness. * The manager is particularly praiseworthy. * More encouragement to participate in activities offered would help and more outdoor walking opportunities, which is dependent on staff availability. * it is traumatic having after 50 yrs of marriage to place ones wife in a care home. The nuns and staff took great care to help me through a very grim period. I cannot speak too highly about them. What has improved since the last inspection? This is a newly registered service. What the care home could do better: No requirements were made as a result of this inspection. Key inspection report Care homes for older people Name: Address: St. Ritas Care Home Ditchling Road Ditchling Burgess Hill Sussex RH15 0SF     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: Gwyneth Bryant     Date: 0 2 1 1 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. Ritas Care Home Ditchling Road Ditchling Burgess Hill Sussex RH15 0SF 01444235874 01444248411 stg@anh.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Trustees of the Order of St. Augustine Name of registered manager (if applicable) Mrs Emma Jane Monaghan Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: (1) The registered person may provide the following category/ies of service only: Care home with Nursing (N) to service users of the following gender Either whose primary care needs on admission to the home are within the following categories: Dementia (DE) (2) The maximun number of service users to be accommodated is: 60 Date of last inspection Brief description of the care home St Ritas Care Home is a purpose built care home and is part of the St Augustinian Care Group and is situated close to Ditchling Common in an area of Outstanding Natural Beauty. The grounds are extensive and include a large lake and pond and newly planted gardens close to the building. Despite the size of the home every effort has been made to ensure it remains homely with small lounges and kitchen areas, in addtion to the main lounge and dining areas. Care Homes for Older People Page 4 of 28 Over 65 60 0 Brief description of the care home The home is split into four units and each unit has its own clinical room and nurse station. There is a passenger lift to facilitate access to al floors and the home has its own hairdressing salon, guest bedroom and shop for use by service users. All bedrooms exceed the minimum size standard and all have full en-suite facilities, call bell point, and tea and coffee making facilities if appropriate. The Home provides care and accommodation for up to 60 service users who need nursing care. The service aims to provide unique, high quality care which enables service users to lead valued and fulfilled lives with freedom to make choices. Current fees are from £650 - £850 with additional charges for newspaper, hairdressing, chiropody and telephone connection in bedrooms. 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: This was an unannounced inspection which began at 08:45 and ended at 14:30. The purpose of the inspection was to check compliance with key standards and other standards. There were fifty-nine people in residence on the day of which four were involved in the inspection. The Registered Manager, one carer, one registered nurse, two activity staff and two visitors were also involved in the inspection. A brief discussion also took place with the Responsible Person at the start of the site visit. A number of documents and records were viewed; including personnel files, medication charts and care plans. Ten bedrooms were visited as were three communal bathrooms, four communal toilets and the communal lounge and dining areas Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some Care Homes for Older People Page 6 of 28 numerical information about the service. This was completed well and returned to us when we asked for it and the information included in this report as necessary. 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 service users benefit from a formal admission process which ensures the home can demonstrate it can meet assessed needs and prior to admission service users and their supporters are provided with information on the services offered. Evidence: The pre admission records for three people recently admitted were viewed and were found to be comprehensive and included information as to how the home will meet assessed needs. There was an intention to transfer residents to St Ritas from another home on the site which was closing. In practice it was good to note that all residents were re-assessed and some were deemed to be better placed in other homes on the site. This demonstrates that residents are treated as individuals and their needs are paramount at all times. All returned surveys indicated that people were provided with detailed information on the services offered prior to admission. In order to ensure residents and their supporters are able to check this information easily copies of the Statement of Purpose, the Service Users Guide and the complaints procedure are Care Homes for Older People Page 10 of 28 Evidence: provided in all bedrooms. 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. The care planning systems ensure that the health, medical and personal needs of those living in the home are identified and planned for in a consistent and comprehensive manner. Evidence: Six care plans were viewed in conjunction with other documents such as medication administration charts, daily notes and discussion with the Manager and staff. The home has a computerised care planning system which enables all staff to add daily notes or any other information but paper copies are also maintained for ease of access during the working day. Each of the plans viewed were found to include good details on the individuals personal and health care needs with clear direction to staff as to what action they need to take to meet care needs. Care plans included detailed information on meeting healthcare needs such as chiropody, hospital appointments, dentists and opticians. The two visitors spoken with both said they felt their relatives were well cared for and that it couldnt be faulted. The care plans clearly outlined individual care needs, such as the need for staff to Care Homes for Older People Page 12 of 28 Evidence: inform the resident when their bed was being adjusted. All plans included the residents preferred daily routines such as times of getting up and food likes and dislikes and where a person had allergies these were clearly documented. It was good to note that there were sufficient staff to ensure residents can have a daily bath or shower if they wish and one resident said they sometimes have their bath in the morning and sometimes in the evening. The home has a key worker system and the carer spoken with had a good understanding of the needs of the people she was responsible for and it was evident that good working relationships had been developed. There are policies and procedures on respecting service users dignity and privacy and all bedroom doors are lockable and staff were seen to knock on doors before entering. Throughout the site visit staff were seen to treat individuals with care and respect and it was evident that comfortable working relationships had been developed. People living in the home are encouraged to remain independent within a riskassessed framework. Risk assessments had been carried out and they clearly identified the hazards and included sufficient detail for the management of risks. Risk assessments also included clear direction to staff as to what action they need to take to ensure residents are safe, especially during transfers. Medication Administration Records were viewed and found to be clear, accurate and up to date ensuring that it is clear whether or not medication has been given. Care plans included information on what medication the individual has been prescribed. Discussion with the manager found that were people are admitted with a high number of medications a review is carried out by the homes GP to ascertain whether or not the person needs all of the medication prescribed. Some residents need to have their medication crushed due to swallowing difficulties but this is only done following consultation with both the GP and relatives. Comments in surveys included: * friendly caring staff, whom I feel enjoy working here. * my mother always looks well kept and happy. * the medical and personal care is superb but even more important it has a family atmosphere and all staff, without exception, are courteous and efficient and treat their patients a people. Care Homes for Older People Page 13 of 28 Evidence: * My mother arrived from another nursing home unable to talk, feed herself or communicate, within a week or two she was a very different lady, walking, eating and talking. She is also much happier. 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 in the home have the opportunity to experience a lifestyle that matches their expectations, choice and preferences in respect of leisure activities and meals. Evidence: People living in the home are offered a comprehensive range of activities, based on their preferences. There is a daily activity programme displayed on the notice board, which includes pictures to facilitate identification of particular activities. Activities are provided three times a day as most of the residents would find a whole morning or afternoon of activities too tiring. Residents are encouraged to both participate and make suggestions for additional activities. Some activities are themed such as a Halloween and one resident said they very much enjoyed the recent Halloween day. Discussion with the two members of staff who are responsible for providing activities found that they both had a good understanding of individual preferences and the need to be flexible if residents prefer to do something other than the planned activity. For example, an art class was planned for the day but the member of staff said it was fine if some residents prefer to just watch the art class or listen to music. Another example was that one member of staff said that they planned a quiz but as a result of the background music it became a sing-a-long. This demonstrates that residents individual Care Homes for Older People Page 15 of 28 Evidence: needs are respected and met whenever possible. One resident spoken with said the food is lovely and they very much they enjoyed the art classes and going to the Church, but they did prefer it in the old home as they could go to the Church every day if they wanted to. There are lay visitors who come to the home to take residents for walks or to have one-to-one chats which is in addition to staff who are expected to spend their time with residents. Care plans included the individual preferences of people living in the home and all of the staff spoken with on the day confirmed that the ethos was that it was the residents home and therefore every effort must be made to ensure they have a good quality of life. Two visitors were spoken with on the day whilst they joined their relatives for lunch. They both confirmed that they are made welcome and often stay for meals. They also said that the home keeps them informed on any issues that arise and there is always someone around to answer any queries they may have. Menus are varied and are designed to provide a balanced and nutritious diet and it was noted that where a pureed diet was necessary, foods were pureed separately ensuring that meals are attractively presented. The homes catering arrangements are based on a cafeteria style with residents encouraged to help themselves from a range of food options. A copy of the daily menu is on each table and on the day there were two meat meals available and one vegetarian option. Additional vegetables are served in a separate dish to enable residents to have as much as they choose. There is also a dessert trolley which facilitates the choice for those residents who are confused. One survey comment was that there was not enough raw fruit and vegetables but there was a bowl of fresh fruit available in the dining room throughout the day. Discussion with the manager found that few residents could easily eat raw vegetables but she would be happy to provide it if a resident or their relative requested it. The home has a policy of ensuring all staff assist at mealtimes to ensure those residents who need assistance receive it. It was good to note that staff who assisted residents with meals demonstrated good practice by making eye contact with residents and engaging with them. The home is separated into four units and each unit has a small kitchen which enables staff to quickly make drinks for residents at any time. In addition there is a water machine in each kitchen and jugs of water in each room. There is a bar area in the dining room which is suitable for social occasions and the Responsible Person confirmed that some residents have wine with their meals instead Care Homes for Older People Page 16 of 28 Evidence: of juice and this was evidenced during the lunch time meal. Meals are served over a period of time with breakfast from 8-10.30am; lunch from 12.30-2pm; afternoon tea from 3.30-5.30pm and dinner from 6-7.30pm. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure with evidence that those living in the home feel that their views are listened to and acted upon. People living in the home are further protected by satisfactory adult protection systems. Evidence: Information in the AQAA demonstrated that there are policies and procedures for both complaints and Safeguarding Adults. There is a copy of the homes complaints procedure in the homes entrance foyer and a copy is also provided in each bedroom. To date the home has not received any complaints although discussion with the manager found that some people have raised queries which she was able to deal with immediately. This was discussed and the manager agreed to record all queries, however minor, as part of the quality monitoring process. There is an on-going staff training programme in safeguarding adults to ensure all staff are familiar with what constitutes poor practice and what to do in the event of an allegation. The carer spoken with had a good understanding of what constitutes abuse and how to report any incidents that may occur. Care Homes for Older People Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment is excellent, providing people living in the home a safe, homely and comfortable environment. Evidence: St Ritas is a purpose built home that has been built to the highest standards, with the comfort and safety of residents paramount. Twelve bedrooms were visited in addition to four communal toilets and communal three bathrooms, in addition to the dining room and lounge. All individual bedrooms exceed the standard in respect of size and are furnished to a very high standard. There was evidence to show that residents are able to bring in their own possessions in order to personalise their rooms. It was good to note that despite the high dependency of some residents the home was very clean and free from offensive odours which demonstrates good cleaning systems and continence management programmes. All individual bedrooms have full en-suite facilities which includes a shower and all residents are provided with their own wheelchair. On the day of the site visit it was of some concern to note that of the twenty people in the dining room at breakfast time, eleven were in wheelchairs. This was discussed with the manager who agreed this was not acceptable and would deal with it on the day. There is a policy to ensure that not all rooms have the same colour scheme for soft furnishings, ensuring that people have a choice over decor in their rooms. The home Care Homes for Older People Page 19 of 28 Evidence: also has a shop which enables residents to buy toiletries and sweets and there is also a hairdressing salon with a hairdresser who visits twice a week. There are patio areas outside the dining and activity rooms and residents are able to have meals in these areas when the weather permits. There is also a guest bedroom which primarily for use when relatives need to stay when a residents health is deteriorating, but can be reserved at other times. The small kitchens in each unit allow staff and residents to make drinks at any time and the small lounges in each unit offer residents a quiet place to sit. There are also seating areas in other parts of the home. One resident chose to sit near the homes entrance foyer, saying she just wanted to watch the people. All communal baths are fully assisted to ensure even the most dependent residents can have a bath. There are hoists and slings available for all residents who need them and all staff are trained in the safe use of all equipment. All visitors to the home are asked to use the antibacterial gel provided in the homes foyer on arrival and on leaving. All communal toilets and bathrooms also had antibacterial hand washing liquid and paper towels. All waste bins were lined and had lids each of which reduces the need for staff to touch contaminated items. All staff are trained in infection control as part of the induction training and the carer spoken with confirmed she had received this training. Comments in returned surveys included: * care and support to (name) is what they do well, also cleanliness of home and friendly and helpful staff. * there are plenty of friendly and helpful staff. * the home is always clean and at the right temperature Care Homes for Older People Page 20 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. There are ample numbers of staff with appropriate skills to meet the needs of those people living in the home and the recruitment practice is also sufficiently robust to safeguard those living in the home Evidence: Discussion with the manager found that there are twelve carers on each daytime shift and at least three registered nurses. Night shift are comprised of four carers and two registered nurses. There are a team of housekeeping staff which includes five on duty for three days a week and four on the other two days. This team undertakes all domestic tasks including laundry which ensures carers duties are wholly based on meeting the care needs of residents. There are also cooks and kitchen assistants and the manager is on duty five days a week. The Responsible Person also confirmed that she visits all of the homes on the site each day to observe and ensure all is well. It was good to note that all members of staff spoken with said how much they enjoyed working at St Ritas and that they felt supported by the management team. There is a comprehensive staff training programme which includes both statutory training and additional training to ensure staff have the skills and knowledge to meet residents assessed needs. The carer spoken with confirmed she had received training and was knowledgeable about meeting care needs. Care Homes for Older People Page 21 of 28 Evidence: One resident has had a diagnosis of Schizophrenia and the manager confirmed that none of the care staff had been trained in dealing with this condition. However, she agreed to find out if any of the registered mental health nurses could provide training to care staff in respect of this condition and if not arrange for formal training. Information in the AQAA showed that of the 59 care staff only 18 have achieved National Vocational Training in care at level 2. However, it should be noted that as it is a newly registered home a high number of staff have been recruited in recent months and there has not been time to register them on appropriate courses but there is a plan to ensure the home meets the required 50 of staff with this qualification as soon as possible. The carer spoken with said she hopes to enrol on this course during November. Although the home currently has approximately 10 of care staff who are agency staff there is a firm plan to recruit more staff to ensure only permanent staff are used in future. The recruitment records for the last three people to be recruited were viewed and these showed that all the required information had been provided including Criminal Record Bureau and Protection of Vulnerable Adults checks, two written references and proof of identity. All new staff have a probationary period which includes induction to ensure they are familiar with the working practices of the home. The registered manager confirmed that all new staff undergo full induction training that meets the Skills for Care guidance. One comment in a survey was that night staff, on the whole, are less well trained than day staff and manage the aggression in dementia less well than day staff which resulted in sedation - it required persistence but was eventually stopped. Discussion with the registered manager found that she was aware of this shortfall and has taken action to ensure additional training is provided for all staff. A staff training matrix is maintained for all staff to ensure they are up-to-date on all training with particular attention to statutory training in manual handling, food hygiene, infection control and fire safety. The registered manager confirmed that approximately 70 of staff have been trained in challenging behaviour and all have been trained in personal hygiene. One of the activity staff said they had completed a nationally recognised course in the provision of activities in care homes, although she said she preferred putting the theory into practice rather than writing about it. Comments from surveys completed by relatives included: * staff are almost invariably pleasant and accessible to relatives and probably to residents. Care Homes for Older People Page 22 of 28 Evidence: * you cannot have many care homes with such high standards but who also treat their patients as people. Responses in returned staff surveys were all positive and comments included: * we care for the service users and the manager makes sure staff are ok and has regular meetings with them. * we give quality care, focusing on activities of daily living. * implementation of the care plans is good. * the St Ritas home is doing very well. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and staff benefit from clear leadership and direction and all aspects of their health, safety and welfare are protected and promoted Evidence: The registered manager is a registered nurse, also holds the Registered Managers Award and has worked in the care industry for a number of years. It is clear she has worked hard to ensure that all records relating to the care of residents are up to date and to build a team of staff who focus on residents wellbeing. She confirmed that she is due to undertake training in the Mental Capacity Act and the Deprivation of Liberty Safeguards but already was able to demonstrate an understanding of her responsibilities in these issues. Discussions with the registered nurse and care staff found that they value the team spirit and that they all found the manager open and approachable. This demonstrates that an open and inclusive ethos has been achieved. Care Homes for Older People Page 24 of 28 Evidence: Residents finances are dealt with by the administration team and a brief discussion with the office administrator found that all resident expenditure is added to the monthly invoice, except for one person who chooses to use their own hairdresser. The relatives of this person provides the money for this each week and although it is a small amount it is held in the homes safe. All bedrooms have a lockable drawer and a small safe can be provided on request should any resident require one. There are a range of quality monitoring systems in place including staff meetings for all staff, which are convened at different times to ensure all staff have the opportunity to attend. In addition separate meetings are held for the housekeeping and nursing teams. The manager said she is working on the best way to convene residents meetings which are more difficult due to the high dependency of a number of residents. Discussion with the registered manager found that she has begun to provide formal one-to-one supervision for staff and is in the process of devising a full programme of staff supervision. One staff survey included the comment: *we spend too much time with users, it would be nice to allow ourselves to get to know the people we are working with. It is good to note that staff acknowledge that they are able to spend a lot of time with residents and that they want to form good working relationships with other members of staff. This comment was discussed with the registered manager who agreed to work on more ways of ensuring staff get to know each other. Although the home is purpose built information in the AQAA showed that regular checks will be made on all electrical and gas appliances and systems, in addition to day to day maintenance as required. Checks are carried out on call bells, water delivery temperatures and emergency fire systems. All staff have been trained in fire safety and as a newly built building it will meet the latest fire safety requirements. Individual accident/incident records are held in individual care plans to facilitate the review process. These records were viewed and found to be accurate and maintained in line with the Health and Safety Executive guidance. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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