Care Home: Sunrise Care Home

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What the care home does well Sunrise Care Home is an established care home. It is situated near the rural village of Little Addington in East Northamptonshire. The property overlooks the countryside and open fields and ideal for people who prefer peace and tranquility. People who are considering using the service and their relatives are encouraged to visit the home. They are involved in the assessment process to find out what help they may need. People who use the service and in some instances their relatives are involved in planning their care arrangements to ensure it is provided in a manner that suits them. People are encouraged to maintain as much independence as practicable and continue making decisions about their daily life, where they are able to do so. People have good access to health care support such as the Community Nurse and the General Practitioner. People receive their medication on time and support those people who wish to continue being responsible for their own medication. People`s individual routine is supported to enable them to continue living their preferred choice of lifestyle. People can take part in the social events and leisure activities arranged by the home. Some people enjoy reading and are offered a range of romantic novels that they like to read. People receive visitors at any time and are able to meet with them in private. Some people often go out with family and friends for meals and to the family home. People are offered a choice of meals that they enjoy and suits their dietary needs. Sunrise Care Home manages and addresses complaints and concerns quickly, in line with the complaints procedure. This shows the management team takes complaints and concerns seriously. People have the use of a range of communal areas, from the main large lounge to the conservatory. All the bedrooms are individually decorated and some have en-suite facilities. People who use the service are consulted about the quality of care and service they receive. These are done through the care plan reviews meetings, the `residents meetings` and the quality assurance surveys. Staff recruitment and training is good. Staff regular updates in training for their specific roles and responsibility and have awareness training to support the people who use the service. This includes training in `dementia awareness` and understanding how dementia affects people in different ways. There is a stable team of staff who understand and knows the needs of the people who use the service. Staff interact and communicate well with the people who use the service. The comments received in the surveys and from our discussions with the people who use the service, visiting relatives and the staff with regards to what the service does well, included: "It seems to me to be a caring place" "The food is lovely" "I think we`re happy here, we are cared for by lovely staff who are very patient" "Good atmosphere - residents seem contented and well looked after" "Always clean, always offered tea or coffee on arrival" "They are very polite and respectful ...." "The meals are enjoyable and you can always have something else if you don`t like it" "I prefer reading novels, the romantic one`s like `Mills and Boon`" "They bring me my medication on time and the nurse is always in to see someone or other" "Here, we know she gets her tablets on time and we have seen such an improvement in her in the short time she`s been here" "The staff and all professionals of the home are responding well to all residents needs" "All service users are treated as individuals and the care they received is centred around them as individuals" "They always get the vacuum our and are cleaning, dusting and wiping down surfaces" "I came for 1 week respite, went home, had a fall and my son said you have to go back, it`s not safe for you at home" "I chose to move when it was recommended to me" "Sunrise Care Home offers dignity, non-discriminatory, personal care, offering a wide range of choices for the residents" What has improved since the last inspection? Sunrise Care Home has improved the quality of the care plans to include more information about how people wish to be supported and their routines. There have been improvements made to the home environment with the creation of the `quiet room`, the conservatory with central heating , the replacement of two windows and a new carpet in one of the bedroom. There is a stair lift installed to access the first floor, a new walk in bath, a sliding door to the shower room and most rooms now have new curtains. Sunrise Care Home now has access to a minibus that is wheelchair friendly and will enable people to go out into the community and on trips.Sunrise Care Home now has a Registered Manager who successfully completed the registration process with the Care Quality Commission. Sunrise Care Home has appointed a company to conduct quality assurance inspections of the home. This shows the service is keen and innovative in improving internal systems of quality assurance. The staff have received updates in training to ensure they maintain knowledge and skills in line with current best practice. Some staff have attended training in dementia awareness to help them understand how dementia affects people and how staff could improve the support they give to people with dementia. The comments from the people we spoke with and the comments received in the surveys with regards to the improvements made, include: "We didn`t realise how bad she was until she moved in here" "I do have my say and the meals have improved of late" "They now do offer toasted sandwiches, which makes a nice change" What the care home could do better: This was a positive inspection of Sunrise Care Home. The information received from the people who use the service, the visiting relatives, the staff and our finding during the site visit demonstrated that Sunrise Care Home continues to maintain a level of stability and quality of care. We identified a few areas that need to be addressed, which we discussed with the Deputy Manager and the manager of the sister home who was assisting us in the absence of the Registered Manager. These included reviewing and updating the `service user guide` and the `statement of purpose` to reflect the staffing and ensure the correct details are included for the CQC. The care plans should include details of any new health care issues and treatment provided such as pressure care management, so staff are informed. The medication records should be completed correctly and consistently in line with best practice to demonstrate people have received medication on time. The staff should receive regular and timely supervision and records should be kept of the meetings. We also made some good practice recommendations, which were discussed during the site visit that would benefit the people who use the service. There were no other significant areas of risk identified during the inspection of Sunrise Care Home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Sunrise Care Home 10 Amen Place Little Addington Kettering Northants NN14 4AU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rajshree Mistry     Date: 1 7 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 42 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 42 Information about the care home Name of care home: Address: Sunrise Care Home 10 Amen Place Little Addington Kettering Northants NN14 4AU 01933650794 Telephone number: Fax number: Email address: Provider web address: veganarainen@aol.com Name of registered provider(s): Type of registration: Number of places registered: Le Flamboyant Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: No residents within the category of DE(E) (dementia) may be admitted to the home where there are already 10 such residents. No residents within the category of OP (Older People) may be admitted to the home where there are already 10 such residents. The 1 existing resident within the category of MD (mental disorder) may remain in the home. The 4 existing residents within the category of PD(E) (physical disability) may remain in the home. The total number of residents must not exceed 20 Date of last inspection Care Homes for Older People Page 4 of 42 Over 65 10 10 0 0 Brief description of the care home Sunrise Care Home accommodates up to 20 older people, some of whom suffer from dementia. The home is owned by Le Flamboyant Ltd and is situated in the rural village of Little Addington in East Northamptonshire. Sunrise Care Home is easily accessible by car but there is no public transport to Little Addington. Visitors without a car would have to go by public transport to Irthlingborough then take a taxi to the village. There is car parking to the front of the property. Sunrise Care Home is a large detached house that has been extended. There are eighteen single bedrooms and one double. All bedrooms except two are located on the ground floor and eleven bedrooms have en-suite facilities. Access to the first floor bedrooms is via the stairs or the stair lift. The home and gardens look out over open fields and the countryside. The range of fees were provided by the manager of the sister home who was visiting at the home. The fees start at £400.00 per week to £480.00 per week. There is additional personal expenditure for hairdressing, private chiropody and personal toiletries. People considering using Sunrise Care Home should contact the Registered Manager or the home directly to discuss individual needs and requirements. Full details for Sunrise Care Home and any specific requirements can be obtained in the form of the Statement of Purpose and the Service User Guide. The latest Inspection Report from the Care Quality Commission is available at the home or accessible via our website: www.cqc.org.uk Care Homes for Older People Page 5 of 42 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 quality rating for Sunrise Care Home is 2 star. This means the people who use the service experience good quality outcomes. We as it appears throughout this Inspection Report refers to the Care Quality Commission. Any reference to the Commission for Social Care Inspection (CSCI) should be taken as CQC, who hold the legal responsibilities previously held by CSCI as of 1st April 2009. This key inspection started with the review of the last key inspection dated 11th September 2007 and the Annual Service Review dated 15th August 2008. We looked at the information we had about the management of Sunrise Care Home and the events that affects the well-being of people who use the service, which includes complaints or concerns we may have received. Care Homes for Older People Page 6 of 42 We received from the Registered Manager the completed Annual Quality Assurance Assessment (AQAA) document. This is the homes own assessment of the standards within the home. We sent out 20 surveys to the people who use the service, of which 7 were received. Some surveys were completed by members of the family who advocated on behalf of the people who use the service. The responses and comments received indicated that people were generally satisfied with the quality of care, support from the staff, the service and facilities provided. The responses indicated that people had the opportunity to live the lifestyle of their choice and participate in activities and social events arranged by the home. The responses also indicated people were confident to complain and have had their complaints addressed promptly. The comments received are included in this Inspection Report and supports our findings. We sent out 15 surveys to the staff, of which 13 were returned. The responses indicated staff recruitment was fair and they receive training to meet the needs of the people who use the service . The responses indicated that staff have good information made available to them about the care needs and the support people require and there is good communication between the staff. The comments received are included in this Inspection report to support and supports our findings. We visited Sunrise Care Home on 17th August 2009 starting at 10.30am. The site visit lasted over 7 hours. The Deputy Manager and the manager of the sister home assisted us in the absence of the Registered Manager. The main method of inspecting we used was case tracking. This means looking at the range of health and person care people receive that is met by the staff. We looked at how peoples rights, choice, dignity and independence is promoted by the staff at the home. We selected four people to case track, all having differing needs, level of independence, abilities and included a person that was new to the home. We spoke with those people and other people who use the service. We read their care files containing information about their persons health and personal care needs, lifestyle and how these are met. We made observations of people and how staff treat them with regards to meeting their needs, promoting their well-being and treating them with respect. We spoke with visiting relatives to gather their views about the quality of care provided by the staff at the home, their observations and experiences. We spoke with staff at all levels, roles and responsibilities on the day to ascertain the recruitment process, training, staff skills and the management of the home. We read the staff files that demonstrated the staff recruitment, training and the skill-mix of the staff. We looked at the accommodation offered to people using the service. This included the communal areas, shower and bathing facilities and individual bedrooms, with permission. We also look at the environmental improvements made to the home since the last key inspection of the service. We read the information people receive about Sunrise Care Home. We read some of the key policies and procedures followed by the staff that ensure peoples health, safety and well-being is promoted. We read specific records that demonstrated the day-to-day management of the service, the staff and how people who use the service are informed and consulted about the quality of care they experience. The Care Quality Commission has a focus on Equality and Diversity and issues relating to these are included throughout the main body of this Inspection Report. Care Homes for Older People Page 8 of 42 What the care home does well: Sunrise Care Home is an established care home. It is situated near the rural village of Little Addington in East Northamptonshire. The property overlooks the countryside and open fields and ideal for people who prefer peace and tranquility. People who are considering using the service and their relatives are encouraged to visit the home. They are involved in the assessment process to find out what help they may need. People who use the service and in some instances their relatives are involved in planning their care arrangements to ensure it is provided in a manner that suits them. People are encouraged to maintain as much independence as practicable and continue making decisions about their daily life, where they are able to do so. People have good access to health care support such as the Community Nurse and the General Practitioner. People receive their medication on time and support those people who wish to continue being responsible for their own medication. Peoples individual routine is supported to enable them to continue living their preferred choice of lifestyle. People can take part in the social events and leisure activities arranged by the home. Some people enjoy reading and are offered a range of romantic novels that they like to read. People receive visitors at any time and are able to meet with them in private. Some people often go out with family and friends for meals and to the family home. People are offered a choice of meals that they enjoy and suits their dietary needs. Sunrise Care Home manages and addresses complaints and concerns quickly, in line with the complaints procedure. This shows the management team takes complaints and concerns seriously. People have the use of a range of communal areas, from the main large lounge to the conservatory. All the bedrooms are individually decorated and some have en-suite facilities. People who use the service are consulted about the quality of care and service they receive. These are done through the care plan reviews meetings, the residents meetings and the quality assurance surveys. Staff recruitment and training is good. Staff regular updates in training for their specific roles and responsibility and have awareness training to support the people who use the service. This includes training in dementia awareness and understanding how dementia affects people in different ways. There is a stable team of staff who understand and knows the needs of the people who use the service. Staff interact and communicate well with the people who use the service. The comments received in the surveys and from our discussions with the people who use the service, visiting relatives and the staff with regards to what the service does well, included: Care Homes for Older People Page 9 of 42 It seems to me to be a caring place The food is lovely I think were happy here, we are cared for by lovely staff who are very patient Good atmosphere - residents seem contented and well looked after Always clean, always offered tea or coffee on arrival They are very polite and respectful .... The meals are enjoyable and you can always have something else if you dont like it I prefer reading novels, the romantic ones like Mills and Boon They bring me my medication on time and the nurse is always in to see someone or other Here, we know she gets her tablets on time and we have seen such an improvement in her in the short time shes been here The staff and all professionals of the home are responding well to all residents needs All service users are treated as individuals and the care they received is centred around them as individuals They always get the vacuum our and are cleaning, dusting and wiping down surfaces I came for 1 week respite, went home, had a fall and my son said you have to go back, its not safe for you at home I chose to move when it was recommended to me Sunrise Care Home offers dignity, non-discriminatory, personal care, offering a wide range of choices for the residents What has improved since the last inspection? Sunrise Care Home has improved the quality of the care plans to include more information about how people wish to be supported and their routines. There have been improvements made to the home environment with the creation of the quiet room, the conservatory with central heating , the replacement of two windows and a new carpet in one of the bedroom. There is a stair lift installed to access the first floor, a new walk in bath, a sliding door to the shower room and most rooms now have new curtains. Sunrise Care Home now has access to a minibus that is wheelchair friendly and will enable people to go out into the community and on trips. Care Homes for Older People Page 10 of 42 Sunrise Care Home now has a Registered Manager who successfully completed the registration process with the Care Quality Commission. Sunrise Care Home has appointed a company to conduct quality assurance inspections of the home. This shows the service is keen and innovative in improving internal systems of quality assurance. The staff have received updates in training to ensure they maintain knowledge and skills in line with current best practice. Some staff have attended training in dementia awareness to help them understand how dementia affects people and how staff could improve the support they give to people with dementia. The comments from the people we spoke with and the comments received in the surveys with regards to the improvements made, include: We didnt realise how bad she was until she moved in here I do have my say and the meals have improved of late They now do offer toasted sandwiches, which makes a nice change 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 set out 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 Care Homes for Older People Page 11 of 42 7535. Care Homes for Older People Page 12 of 42 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 13 of 42 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 receive information about the home and are involved in the assessment process to ensure their needs will be met. Evidence: We wanted to find out what information people receive about Sunrise Care Home and peoples experience of moving into the home. The information we gathered from the self-assessment completed by the Registered Manager stated people are encouraged to have home visits and offered trail stay, and initial assessment of needs and supporting assessment is completed. This indicated that there was a process whereby peoples needs were assessed, encouraged to visit and offered a trial stay to ensure Sunrise Care Home was the right place for them. We read the information people receive about Sunrise Care Home, known as the Service User Guide and Statement of Purpose. This tells people what they can expect from the service including the facilities, the accommodation, menu, social Care Homes for Older People Page 14 of 42 Evidence: activities and the skills and experience of the staff. It also sets out the aims and the objectives of the home, the key policies and procedures by which, the service operates including the complaints procedure. This demonstrated people receive up to date information to help them choose the home. The surveys responses received from people who use the service and their relatives confirmed they and/or their relatives made an informed decision about using the home. This was consistent with comments we received from our discussions with several people who use the home including those we case tracked. The comments received included: I told the manager I would only move to the home if I had this room I came for 1 weeks respite, went home, had a fall and my son said you have to go back, its not safe for you at home I chose to move when it was recommended to me We didnt realise how bad she was until she moved here. Shes so much better, seems happy and is like a new person. Its still early days but weve seen a difference in her The information we gathered from the self-assessment stated that an assessment of needs is completed. This is a process by which individual needs and preference of routines and interests are made known. A visiting relative and a gentleman who uses the service told us they had been involved in the assessment process, saying, they asked me about what help I need, it , its more about me not being steady on my feet and need to use a walking frame and we were asked about how she has managed at home and what concerns we had about her safety. This confirmed people were involved in the assessment process to ensure individual needs and safety issues were considered. We read the care files for the people case tracked. All had a copy of the homes assessment of need that was completed by the Registered Manager before the person moved to the home. The assessment read showed information was gathered about the person and their personal information including key people involved in their well-being such as family and the General Practitioner (GP). Other information gathered related to their medical history, medication, mental and physical well-being and ability, whether they managed their own personal care. There was information about their ability to communicate and any known sensory impairment such as wearing glasses, Care Homes for Older People Page 15 of 42 Evidence: dietary needs, cultural needs and their wishes and preferences. Where the person was unable to express their view due to their level of confusion or dementia, their relatives advocated their needs and lifestyle preferences. As part of the assessment there were risk screening, which looks at any known risk such as the risk of falls, challenging behaviour or self-neglect. This is used to develop a risk management plan for prevention and crisis management. This showed that the assessment process is robust, ensuring individual needs and risks were known and could be met by the staff at the home. The Deputy Manager confirmed that nobody who uses the service had been referred to the local authority in line with the Mental Capacity Act and the Deprivation of Liberty. This means a person that cannot make a decision for themselves or might be able to make some decisions, not others, which is called, lacking capacity. They said the Registered Manager had received information and was aware of the need to ensure the assessment of needs process considers peoples ability to make decisions. We wanted to find out what information staff received about a new person that moves to the home. Staff we spoke with said they have good information made available to them in the care files about the persons care needs and information is shared at the handover meetings. Staff said they benefit from working in a small home with a stable staff team who share information about peoples needs and well-being. This supported the responses and comments received in the staff surveys, which included: Good communication at all times We are told about their needs and its in the care plan We get to know the residents and how best to help them The information we gathered from the self-assessment completed by the Registered Manager stated written contracts are given within the 4 week trial stay. Visiting relatives and a gentleman, confirmed they were given contracts with the terms and conditions upon moving to the home, which they had signed. The manager from the sister home who came to assist us during the site visit to Sunrise Care Home confirmed contracts with the terms and conditions are given to everyone who moves to the home, including the people who are funded by the local authority. This supported the information received in the self-assessment and the surveys confirming people have a contract in place for their stay. Sunrise Care Home does not provide intermediate care services. Care Homes for Older People Page 16 of 42 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and care needs are met by improving care plans and trained staff; and better recording of medication would ensure their well-being. Evidence: We wanted to find out how peoples health and personal care needs are met. The information we gathered from the self-assessment completed by the Registered Manager stated there is a comprehensive assessment of needs, risk assessments and care plans are in place, continue to review care plans monthly or sooner and assist, encourage and maximise residents independence. It also confirmed there was a key-worker system in place and people who use the service had the support from the Community Health Care Professionals. The self-assessment described how people are involved in developing the care plan to ensure they receive the care that suits them. All the responses and comments received in the surveys from the people who use the service and their relatives indicated they receive the care and support they need. This was consistent with the comments received from our discussion with people Care Homes for Older People Page 17 of 42 Evidence: individually and the group of ladies, all who use the service. Some of the comments received included: It seems to me to be a caring place Good atmosphere - residents seem contented and well looked after I think were happy here, we are cared for by lovely staff who are very patient We spoke with several people including visiting relatives and the spouse of a person who also uses the service. We found that people were involved in developing their care plan and where unable to do so, relatives have been consulted to ensure their needs are met with consideration to their preferences and wishes. People gave us examples of their preferred routines, including one person who not only manages their own personal care but continues to live independently whereby they go to the bank and the shops in the village nearby. This supported our observations with regards to people being supported to live the life of their choice. We read the care files; the care plans, daily records, assessment of risks and records that show the health care support people receive such as the Community Nurse and the General Practitioner. The care plans were individual and reflected individual needs including their strengths and weaknesses. The safety measures identified from the risk assessments is used to develop a prevention plan and crisis management plan, giving clear guidance to staff to support the person. For example, how staff should prompt a person with dementia by placing a wet flannel in their hand and they will wash their face and ... enjoys a shower every Sunday morning. The care plans were simple and clear that enabled staff to support and maintain peoples level of independence and dignity. Staff we spoke with said they key-work for individual people and are responsible for reviewing the care plans on a monthly basis or sooner if necessary. The care files seen all had a record of the reviews carried out, which supported the information we gathered from the self-assessment. Staff demonstrated from our discussions with them, that they know the people who use the service, their needs, routines and what to do if the person is feeling down or becomes upset. Staff demonstrated their understanding of how dementia affects people. Staff told us some people manage their own personal care and require minimal assistance. This showed staff do promote independence. The care files read contained the daily notes made by the staff on duty that reflected Care Homes for Older People Page 18 of 42 Evidence: the well-being of the person and records of any activities they took part in. Other records maintained included the visits and treatment provided by the health care professionals such as the GP, Optician, Chiropodist and the Community Nurse. This supported the comments we received from a group of ladies who said: There are several people that visit the home from the hairdresser, like this morning, the nurse, GP and the chiropodist, all come quite often In fact the nurse comes several times a week We saw the Community Nurse folder kept in one ladys bedroom as she was visited regularly in order to treat the pressure sore. We found no records in the care file to tell us that the lady had a pressure sore; were unable to establish where the pressure sore was and how it was treated. Staff spoken with told us that they do regular checks on the lady and turn her as instructed by the Community Nurse but the daily notes were not reflective of this. We discussed this with the Deputy Manager who acknowledged a record should have been made at the time in the care file for the staff and the treatment managed by the Community Nurse. There was no evidence in the reviews of the improvement of the pressure sore. Therefore, we concluded that whilst people have good access to health care support, records relating the any health issues and treatment should be accurately recorded and monitored. We wanted to know whether the management system for medicines was safe. One gentleman said, they order and collect their medication from the Pharmacy and kept it in locked drawer in their bedroom. They said, I manage all my care and personal needs including medication but I had to sign a form to say so. We read his care file and found an assessment of risk had been completed to ensure the person was fit and able to manage their own medication. This demonstrated that the home supports people to continue managing their own medication. The Deputy Manager described and showed us the medication system and storage. All the medicines are blistered pack and kept in the locked medication trolley in the office. The Deputy Manager confirmed only trained staff administer the medicine and training records viewed supported this. We observed the trained member of staff giving out the medication and signing the medication record sheet individually. This was done in accordance with best practice. Some of the comments received from people who use the service and in the surveys with regards to their medication said: They bring me my medication on time ... Care Homes for Older People Page 19 of 42 Evidence: We get our tablets everyday and they dont forget Here, we know she gets her tablets on time and we have seen such an improvement in her in the short time shes been here We checked the medication and records for people we case tracked. We found a couple of records with missing signatures. One related to a prescribed medication that had been taken and the other missing signatures related to medication to be given if required, known as PRN. There was no reason stated as to whether the person had taken or did not want the medicines on those occasions. We found staff continued to administer medication and had also failed to alert the person in charge that there were missing signatures. In addition, we found a number of records completed with O which indicated other. We asked the member of staff who was administering the medication, what O meant. They said it could be that the person did not need the medication or were asleep. Therefore, it is unclear what O signifies as staff do not record the why the PRN medication was not taken. We brought this to the attention of the Deputy Manager. They acknowledged that staff must complete the medication record and had failed to raise the issue. The medication administration procedure for the home states the medication record should be completed where the person does not want the PRN medication. Therefore, the service must follow the medication procedure and staff should report any errors or omissions immediately. The Registered Manager did advise us after the site visit that he would look into the issue raised, address them with the staff and contact the Pharmacy with regards to improving the medication records that they supply. At present there are no controlled (strong) medicines being taken by people who use the service. The service does have in place the appropriate controlled medication storage and the Deputy Manager described to us the procedure, which was consistent with best practice. Throughout the site visit, we observed staff treating the people who use the service and their visitors with respect at all times. Peoples privacy and dignity is maintained when staff were helping people be seated or being assisted with their meals. The group of ladies that we spoke with all commented upon how well the staff treated them. This was consistent with the responses and comments received in the surveys received from the people who use the service and their relatives. The home environment promotes peoples privacy and dignity as some people have en-suite facilities. The comments received included: They are very polite and respectful Care Homes for Older People Page 20 of 42 Evidence: ... covering you up and knocking on the door before entering They always call me by my preferred name We had our own individual requirement that she has en-suite facilities Staff spoken with also gave us examples of how they support and promote peoples privacy and dignity. This supported the comments received in the staff surveys, which included: Respect their choices and give privacy to them All service users are treated as individuals and the care they receive is centred around them as individuals Sunrise Care Home offers dignity, non-discriminatory, personal care, offering a wide range of choices for the residents Care Homes for Older People Page 21 of 42 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 maintain contact with family and experience their choice of lifestyle; take part in social activities and offered a choice of meals that promotes their well-being. Evidence: We wanted to find out what social opportunities and activities are available to people who use the service. The information we gathered from the self-assessment stated there are various indoor activities and entertainers, encourage residents to maintain active social life and contact with family and friends, computer available to use for games and INTERNET access and newspapers delivered. The service user guide stated there are visits from the hairdresser and chiropodist and people are supported to continue observing and practicing their religious beliefs with visits from the Clergy. The survey responses and comments received from the people using the service, all said the home does arrange activities. This was consistent with the responses in the staff surveys stating the home provides a range of activities that people can take part in. The suggestions we received for improvement were: I feel as though we could offer activities outside the home i.e. day trips to the seaside or a trip to the garden centre for those service users who are able to attend Care Homes for Older People Page 22 of 42 Evidence: One person we case tracked continues to maintain their independence with regards to going out and driving their own car, arranging their medication prescriptions, banking and shopping for small items that they need. They said they like spending time keeping in contact with friends and writes letters on the computer, which they have in their bedroom. The comments received demonstrated that whilst the service is able to look after people who need support, it also supports people to continue to maintain their own independence. During our visit to the home, we found people were using various parts of the home. In the morning, the majority of people were in the lounge watching television. Some people were sitting in the conservatory with the hairdresser whilst others spent time in their bedroom or returning from spending time in their bedroom. In the afternoon, we saw one lady spending time with her relatives in the conservatory. We saw two staff encouraging people to take part in throwing the soft ball into the basket. People seem to be enjoying this game as they were laughing and asking to have another go. We saw a lady going out with their relative to the family home to celebrate her birthday with the family. They told us that they were happy with the way their relative was cared for and that they could still take her home for the day. A group of ladies were still sat at the dining table after lunch who told us about their daily life at the home, from having Holy Communion, enjoying conversation with each other, having entertainers, exercise to music to reading books. Some of the comments received from the people we spoke with individually and collectively indicated that people have an active social life, should they wish to take part. The notice board in the lounge showed the weekly activities planned, which included exercise to music, word/spelling game, skittles and group discussion, books and newspapers. The comments received included: Had a party on Sunday and they said it would finish at 4pm but we carried on dancing I prefer reading novels, the romantic ones like Mills & Boon I dont mind my own company. I keep quite busy keeping in contact with friend here and abroad I like to go to the shops and fetch myself a newspaper Care Homes for Older People Page 23 of 42 Evidence: Some people have family that visit but others are like me, so this is my family and we get by We wanted to find out what information staff receive about peoples interests and choice of lifestyle. Staff said the care files had information about peoples life, interest and hobbies. Staff said they would ask the people they key work what they like doing and try to arrange it. Staff commented that the home is isolated and people who use the service would benefit if they had transport to take people out. We shared the comments received from staff with the Deputy Manager and the manager from the sister home who was assisting us during the site visit. They confirmed that a userfriendly minibus has been purchased, which would be shared by the two services to take people out on trips. The minibus was parked in the car park to the front of the home. This demonstrated the service had already acknowledged people who use the service were isolated and had purchased a minibus to take people out into the local community and places of interest. We wanted to find out what the meals are like. The information we gathered from the self-assessment stated the service promotes healthy diet, offers choice and menu is reviewed every 4 weeks. The surveys responses and comments from the people who use the service and their relatives indicated that the majority of people like the meals. We shared the comments received with the Deputy Manager, as follows: The food is lovely My father would like food to be better - quality and amount A nice menu would be nice Always offered tea or coffee on arrival The kitchen staff told us all the meals are suitable for people with diabetes. The menu was written on the notice board for people to read. Whilst this is suitable for people who are able to read the menu, there was no alternative form of menu to help people with dementia to choose their meals. We discussed with the Deputy Manager various ways of displaying the menu to help people choose their preferred choice of meal, such as the use of picture menus. This was accepted, recognising people may relate to visual pictures more than words. Most of the people we spoke with said they enjoyed the meals and one person said Care Homes for Older People Page 24 of 42 Evidence: the meals had improved recently after they made some suggestions. The comments received about the choice and quality of meals from the people we spoke with, included: I know she eats well now, shes looks well and the staff tells me shes enjoying her meals The meals are enjoyable and you can always have something else if you dont like it The meals were served individually at the dining table or in the lounge with individual tables. The meals were well presented and looked nutritious. We saw some staff assisting people with their meals in a sensitive manner and occasionally the member of staff was seen assisting two people at the same time. In one instance one lady appeared to be bored and pushed the food off the plate with her hands until we asked a member of staff to assist them. On another occasion we saw two staff walking with a lady who appeared to fall asleep at meal times. Whilst most people enjoyed the meals, some consideration should be made to ensuring sufficient staff are available to assist those who need individual support with their meals. Care Homes for Older People Page 25 of 42 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 are confident to complain, complaints are addressed quickly and people are protected by trained staff that ensure their safety and protected from harm and abuse. Evidence: We wanted to find out whether people were aware of the homes complaints procedure, confident to complain and whether they feel safe and protected at Sunrise Care Home. The information we gathered from the self-assessment completed by the Registered Manager stated the complaints procedures is displayed, there is a suggestion box and complaints are addressed quickly and record is kept. The complaints procedure was displayed on the notice board in the lounge along with the suggestion box as stated in the self-assessment. The complaints procedure is also included in the information people receive about the service, known as the service user guide. The complaints procedure is clear and includes the contact details for the local authority, Advocacy service and the Care Quality Commission (CQC). We advised the Deputy Manager to update the contact details for the CQC. The surveys responses and comments received from the people who use the service and their relatives all indicated they know how to make a complaint and have had complaints responded to promptly. The people who use the service and the visiting relatives spoken with felt confident to complain and had found the complaint was Care Homes for Older People Page 26 of 42 Evidence: addressed quickly. This demonstrated that the service responds and acts in accordance with their own complaints procedure. Some of the comments received from the people we spoke with included: We dont have any complaints, we would talk to the staff I do say if there is a problem We were told about how to complain when .... moved in The staff surveys and the staff we spoke with said they were confident to receive concerns or complaint, which they would pass to the Deputy Manager or the Registered Manager. This showed staff were also aware of their roles and responsibility should they receive a complaint from the people who use the service or their visitors. The information we gathered from the self-assessment stated the service received no complaints. We read the complaints book and noted the service received 5 complaints. The records detailed the investigation and actions taken to resolve the complaint. We concluded that the complaints procedure was followed and all the complaints were resolved satisfactorily and quickly. The Care Quality Commission received no complaints about Sunrise Care Home. We spoke with the Deputy Manager who confirmed that they have not referred any one to the local authority under the Deprivation of Liberty. This means that a person cannot make a decision for themselves or might be able to make some decisions not others, which is called lacking capacity. They said the Registered Manager has had some information and is aware of the need assess peoples capacity to make decisions. We wanted to find out if staff knew what safeguarding issues meant and how to deal with any suspicions or allegations with regards to abuse. Safeguarding issues means promoting the well-being of people who use the service from harm, risk and abuse. Staff we spoke with demonstrated a good understanding of the various forms of abuse that could occur and were aware of their responsibilities to report concerns to the Registered Manager. Staff were confident to raise concerns with regards to poor care practices, using the homes whistle-blowing procedures. Staff confirmed they had received induction training that included training in safeguarding adults procedures and through the National Vocational Qualifications (NVQ) training. Care Homes for Older People Page 27 of 42 Evidence: The staff we spoke with said they had attended training in dementia awareness as the service looks after some people who have been diagnosed with dementia. Staff spoken with gave us examples of how they support people and put into practice the knowledge gained from attending the dementia awareness training. This supported our findings that staff were aware of their responsibilities with regards to promoting and protecting peoples health, safety and well-being. The staff records viewed, staff surveys responses and from our discussion with the staff, all confirmed they were recruited upon receipt of satisfactory pre-employment checks. These included two references and a criminal records bureau check (crb). This is a check to assess the suitability of the applicant to work with vulnerable people. This demonstrated staff recruitment procedures were followed to ensure people are cared for by suitable staff that promotes their safety and well-being. Care Homes for Older People Page 28 of 42 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 live in a comfortable, clean and tidy home that promotes their health and wellbeing. Evidence: We wanted to find out the type of home and accommodation people live in. The information we gathered from the self-assessment completed by the Registered Manager stated the home maintains a clean and odourless environment, creation of more space, re-decoration and a list of the health and safety checks are carried out. We also received details of when the equipment such as hoists, heating, fire detection and electrical systems were last tested. The self-assessment also identified the improvements made to the service with the new quiet room and the conservatory with central heating, new stair lift, new curtains, a sliding shower door in the shower room and the replacement of two windows. This showed the service continues to make improvements and has systems in place to ensure the routine maintenance and checks are carried out and remain compliant with other regulations. The surveys responses and comments received from the people who use the service and their relatives indicated people were happy with the environment. These comments and responses were consistent with the comments received from the people who use the service, who also commented on the cleanliness of the home. The range of comment received about the home environment including the suggested Care Homes for Older People Page 29 of 42 Evidence: improvements were also shared with the Deputy Manager and included the following: Always clean Better access to and use of the garden area The new extension that overlooks the fields and beyond Id told the manager I would only move to the home if I had this room They always get the vacuum and are cleaning, dusting and wiping down surfaces You see them throw things in the wash everyday, even if you would not wash if after wearing it once - its great They strip down the beds and you have lovely clean fresh bedding We spent time talking with some people in the lounge and the dining room. People said they were happy with the layout of the home, their bedroom that they have personalised, the cleanliness of the home and the laundry arrangements. People told us about the party they had at the home on Sunday, where there was good food, music and dance, making good use of the garden, the conservatory and the lounge for those people that wanted to join in. There was good lighting throughout the home and the communal areas benefited from ample natural light. All the bedrooms are on the ground floor and one person uses the bedroom on the first floor using the new stair lift. The bedrooms are furnished with bedrooms furniture and well decorated. All areas of the home were clean and tidy. We saw people using walking aids such as frames and wheelchairs around the home and benefited from having good level access to the front of the home. Staff were seen assisting people safely when helping people get up off the chair. The bedrooms in the new extension had en-suite facilities that promoted peoples privacy and independence. There were additional toilets, bathroom and a shower room that offered people a choice of bathing facilities to suit them. This comments received and our observations supported the information gathered in the self-assessment completed by the Registered Manager. We also spoke with one person who preferred to spend time in their bedroom, writing letters on the computer. They were happy with their bedroom, it was personalised with photographs and had en-suite facility. They told us the wash hand basin was too small, which they expressed to the manager of the sister home at the time. They said Care Homes for Older People Page 30 of 42 Evidence: they would look into what could be done to providing a larger wash hand basin whereby, they could wash their face without spilling water everywhere. This demonstrated the service listens and wants to resolve any environmental concerns to suit the needs of individual people. The laundry room is located away from the area where food is prepared. People told us they were satisfied with the laundry arrangements, having their clothes returned to them washed and ironed. The staff spoken with said they are responsible for keeping the home clean and tidy and doing the laundry. This showed staff took responsibility in all aspects of the home to ensure people needs and daily requirements were met. We observed staff wearing protective clothing such as gloves and aprons when preparing to assist people with personal care tasks or assisting them with their meals. Staff spoken with demonstrated a good understanding of infection control practice and the measures taken to prevent cross infection. The staff training records showed staff have received regular training and updates in infection control, health and safety and food hygiene. This confirmed staff are trained and are aware of the current best practice that promotes peoples safety and well-being. Care Homes for Older People Page 31 of 42 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 live at the home are protected and supported by staff recruitment process and training that promotes their health, safety and well-being. Evidence: We wanted to find out whether the staff recruitment process, the skill-mix and the staffing levels met the needs of the people who use the service. The information gathered from the self-assessment stated staff recruitment includes pre-employment checks, permanent staff are employed to ensure continuity of care and the majority of staff have attained the National Vocational Qualification (NVQ) in care. It also identified improvements made, which includes increasing the staff to three day shift staff and staff have regular supervision and appraisals. The survey responses from the people who use the service and their relatives indicated that the staff have the right skills and experience to look after the people who use the service. People that we spoke with told us they were happy with the staff with regards to how they are cared for and helped. Some of the comments received that further supported this included: They are very friendly and welcoming I think more staff is needed at times Care Homes for Older People Page 32 of 42 Evidence: My mother loves them all The girls are all very nice, kind and patient We observed staff interacting and engaging with the people using the service in a polite and courteous manner. Staff were not phased by some peoples comments and reaction, partially as a result of their dementia, by being patient and talking with them in tone that was friendly and respectful. This showed staff treated people with respect. We concluded that staff have the right skills to look at the people who use the service. The Deputy Manager described to us their roles and responsibilities. However, the statement of purpose detailed the staffing structure but did not have the role of the Deputy Manager. Therefore, the Registered Manager should ensure the information in the statement of purpose is updated to reflect the staff and their respective roles. We saw the staff rota displayed indicating the staffing levels, roles and responsibility. We had observed that some people needed support from staff at lunch-time to encouraged them to eat and enjoy their meals without being distracted. We discussed this with the Deputy Manager that they should consider how staffing at meals times would benefit the people who need help with their meals. Following the site visit the Registered Manager told us that normally have 3 staff and themselves assisting those people that require help and on the day he was not working. Staff surveys responses and comments received indicated that people have benefited from having a stable staff team that know and understand peoples individual needs. The comments received in the staff surveys with regards to what the service does well included: The staff and all professionals of the home are responding well to all residents needs All service users are treated as individuals and the care they receive is centred around them as individuals All information is always up to date The staff we spoke with described to us the recruitment process they experienced and told us about the pre-employment checks carried out. One member of staff recruited from overseas, confirmed they were also required to have pre-employment checks. We looked at the files for 3 staff. All files contained evidence of the pre-employment Care Homes for Older People Page 33 of 42 Evidence: checks carried out such as criminal records bureau (crb) check and a protection of vulnerable adults (pova) check. This is to assess the suitability of the applicant to work with vulnerable people. Two files out of three contained two satisfactory references. We raised the issue of the references for one member of staff with the Deputy Manager, but they were unable to assist us as they are not responsible for staff recruitment. However, following the site visit the Registered Manager confirmed in writing to us that they did have two satisfactory references in place that member of staff, which was not accessible by the Deputy Manager. We therefore, concluded that staff recruitment procedure was generally good and protects the people who use the service. Staff described to us the induction and training they completed, which is in-house using the Common Induction workbook. Staff told us they have had training in administering medication, dementia awareness, health and safety, moving and handling, fire and infection control. Some staff demonstrated how they have used the information from the dementia awareness training and put it into practice, now having greater understanding of how dementia affects people in different ways. The staff training records viewed showed staff had received training in moving and handling, fire, infection control, dementia awareness, health and safety, safeguarding adults, how to provide personal care, promote dignity and independence and administering medication for staff responsible for the medication. This demonstrated the home continues to improve the knowledge of staff to ensure people continue to receive better care and experience a better quality of life. The information gathered from the self-assessment stated 9 staff had already attained National Vocational Qualification (NVQ) in care level 2 and above. This equates to 75 of staff are trained to NVQ level 2 and above. The Deputy Manager said they had already attained NVQ level 3 in care and were due to start NVQ level 4. This demonstrates staff are encourage to continue learning for their specific role and responsibility. We concluded that staff recruitment is good, there is a stable staff team and trained staff continue to look after and care for the people who use the service. Care Homes for Older People Page 34 of 42 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 benefit from a well-managed home, have opportunities to comment on the quality of service that promotes their health, safety and well-being Evidence: We wanted to find out whether the management of Sunrise Care Home protects and promotes the well-being of the people who use the service. The information we gathered from the self-assessment completed by the Registered Manager stated the service complies with the health and safety regulations, comprehensive procedures, all updated in February 2009, good communication between the manager and the staff and deployment of staff and staffing levels. The improvements made were also identified and included the new Registered Manager who successfully completed the registration process with the CQC. It also stated that the Registered Manager would be attending seminars and training to maintain their knowledge and practice in accordance with the new legislation and best practice. The Deputy Manager and staff spoken with told us the staff have specific duties Care Homes for Older People Page 35 of 42 Evidence: allocated to them from assisting people with their morning personal care tasks, assisting people with meals to doing activities with the people who use the service. Staff spoken with said they had clear roles and responsibilities and the Deputy Manager was responsible in the absence of the Registered Manager. Staff confirmed communication is good and they share information at the handover meetings and records are kept up to date about the people who use the service and their well-being. This was consistent with the responses received in the staff surveys regarding the communication systems in place. We wanted to find out what internal quality assurance systems are in place to assess the service. The manager of the sister home who was present during our visit to the home told us they contracted the services of a quality inspection company, to inspect and assess the home. The recent visit and inspection of the home was carried out on 7th July 2009. The report from the visit detailed the findings and actions required to improve the service. This demonstrated the service has good internal quality monitoring systems in place to ensure the service is safe for the people who live there. We wanted to find out how people are consulted with regards to the quality of care, service and accommodation they experience. The people who use the service told us that they take part in the Residents Meeting, where they are told about events or any improvements that are planned at the home. We read the minutes of the recent residents meeting, dated 11th August 2009. The topics discussed included the menus, suggestion of meals from the people who use the service, activities and trips to the garden centre, theatre and day trips. This was consistent with what people told us with regards to the improving meals and the home now having access to a minibus. The information we gathered from the self-assessment completed by the Registered Manager stated there is a quality assurance surveys are carried out. The quality assurance surveys were sent out in June 2009 and we read a number of the surveys received from the people who use the service, their relatives and health and social care professionals. We discussed with the Deputy Manager and the manager of the sister home who was assisting us in the absence of the Registered Manager that we were unable to establish the conclusion from the survey and how the results were shared with the people who use the service. We suggested that they should consider making a report available to suit the people who use the service about the findings from the surveys including any action plans. We also suggested that consideration should be made to measuring the outcome of the quality assurance against the statement of purpose. This would show if peoples expectations and experiences of the service is consistent with what the service had stated in the aims and objectives. Care Homes for Older People Page 36 of 42 Evidence: We wanted to find out how people are supported to manage their own money. One person we spoke with told us they still continue managing their own money. We also spoke with a group of ladies and a visiting relative, who said they have some money held in safe-keeping in the office, which they can have when they need. Some of the comments we received with regards to how people manage their money included: I go to the bank and buy whatever I need when I need it I do worry about what will happen in the future and have looked at what I may need to do At the moment, Im quite happy looking after my own money They keep my money for me and its used to pay for my hairdressing when I need to I much prefer them looking after my money I know its there for me when I need it The member of staff responsible for managing peoples money described to us the system in place and showed us the records that reflect the account balance, including any receipts. We concluded that there is a good system in place whereby, peoples money held in safe-keeping is protected, managed safely and records are in place. The staff surveys stated staff have regular staff meetings whereby the are kept up to date about the needs of the people who use the service, training and changes in practice. Staff told us they have had staff meetings recently. We were unable to read the minutes of the most recent meeting as these had not been typed. Following the site visit the Registered Manager informed us in writing that there had been a delay in typing up the minutes. The staff we spoke with said they do not have staff supervisions regularly. The three staff files viewed only two had records of supervisions taking place dating back to 22.05.08 and 05.01.09, in one file and 25.06.08 and 19.11.08 in the other file. One member of staff had an appraisal on 08.04.08 and no other evidence on file to demonstrate staff supervision and appraisals were taking place regularly. This demonstrated that staff did not have formal timely supervision whereby, they had the opportunity to discuss work issues and training needs. Following the site visit the Registered Manager informed us in writing that staff supervisions had not been regularly documented and they had now delegated this responsibility to the team Care Homes for Older People Page 37 of 42 Evidence: leaders. The Registered Manager informed us in writing after the site visit that the had an inspection from the Environmental Health Officer on 19th August 2009. They said they were accredited with a five star, for the service they provide. This demonstrated the service complies with the environmental regulations. The information we gathered from the self-assessment completed by the Registered Manager detailed the programme of routine maintenance, servicing and testing of equipment in the home. People who use the service told us that they are told when staff are carrying out fire tests and checks on equipment. Evidence of the fire tests and routine safety checks carried out in the home are kept and show these are take place a regular intervals. The care files of the people we case tracked contained assessment of risk for moving and handling. The care plans also reflected the safety measures staff should follow to ensure peoples safety. Staff training records viewed showed staff had received training in moving and handling and how to operate equipment such as hoists, safely. We concluded that the home environment is safe and well-maintained staff are trained to ensure people who use the service are protected and their well-being is promoted. Care Homes for Older People Page 38 of 42 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 39 of 42 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 8 13 The registered person must ensure the care plan includes details of any health issue and treatment provided, which is monitored. This would include pressure care management. This would ensure peoples health care needs are safely met that promotes their well-being. 30/09/2009 2 9 13 The registered person must ensure medication records are completed timely and correctly at all times. This would ensure people health and medication needs have been met that promotes their well-being. 30/09/2009 3 36 18 The registered person must ensure staff receive regular supervision that ensure people receive care from competent staff. 30/09/2009 Care Homes for Older People Page 40 of 42 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 This would ensure staff skills and competency benefits peoples health, safety and well-being. 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 3 To consider reviewing and updating the assessment of needs format to assess the ability and capacity of people to make decisions in accordance with the deprivation of liberty and the Mental Capacity Act. To consider developing menus in an alternative format such as pictorial menus, to help people with dementia continue to choose their meals. To review the staffing levels at meal times to ensure people who require individual assistance at meals times are supported by sufficient staffing levels. To review the information in the statement of purpose with regards to the staffing structure and the inclusion of staff in new positions, roles and responsibilities. To ensure all staff recruitment documentation is available in individual staff files to demonstrate staff recruitment checks carried out. To consider measuring the findings from the quality assurance survey against the statement of purpose to ensure peoples expectation and experience of the service is consistent with the aims and objectives of the service. This would also assist in the review and updating of the statement of purpose. To consider developing a report on the findings from the quality assurance survey that is shared with the people who use the service. 2 15 3 27 4 27 5 29 6 33 7 33 Care Homes for Older People Page 41 of 42 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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