Care Home: Sunrise Operations Tettenhall Ltd

What the care home does well Staff were observed to be skilled in their approaches with people and gave support with warmth, friendliness and patience People are able to enjoy a range of activities, based on their capabilities and preference. People are supported to exercise choice as far as possible and according to their differing capabilities. People living at Sunrise Operations at Tettenhall benefit from a purpose built care service, furnished to a very high standard and which has appropriate equipment to assist with meeting peoples needs. People are enabled to maximise their independence with the support of staff. Training opportunities for staff are good which ensures that people are cared for by a well-trained and committed staff group who work together to improve people`s quality of life. The management arrangements ensure that the home is safe and run in the best interests for the people who live there. What has improved since the last inspection? We did not make any requirements or recommendations at the last key inspection in April 2008. Within the AQAA the manager, Erica Neal described improvements which have been made to improve quality of care delivery and communication systems since commencing in post. This includes-wider variety of activities, revising individual care plans, greater skill of staff at offering activities that encourage people to maintain their existing skills, greater menu choices and re-introducing family meetings. What the care home could do better: No requirements were made as a result of this inspection. Two recommendations were made, which are as follows:- The home should consider fitting a handwashing sink for staff in the medication room. Staff should be provided with training on newly introduced mental health legislation (Mental Capacity Act 2005), so that staff are aware of the processes to follow if a person is considered to lack mental capacity and to ensure their liberties are not compromised. It is considered that the service is able to identify weaknesses and manage them well. Key inspection report Care homes for older people Name: Address: Sunrise Operations Tettenhall Ltd 73 Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN     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: Rosalind Dennis     Date: 3 0 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Sunrise Operations Tettenhall Ltd 73 Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN 01902774100 01920774101 tettenhall.wsc@sunriseseniorliving.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sunrise Operations Tettenhall Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 25. The registered person may provide the following category of service only: Care Home only To service users of the following gender: either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 25 Date of last inspection Brief description of the care home Sunrise Operations Tettenhall Ltd was first registered with the Commission in October 2007 and incorporates an Assisted Living and Reminiscence neighbourhood-these are registered with the Care Quality Commission as two separate services and are available as two inspection reports. Both services work closely together and this is reflected in the content of the inspection reports. The purpose built service provides spacious accommodation of a high standard. The Assisted Living service is registered to provide accommodation, personal and nursing Care Homes for Older People Page 4 of 29 Over 65 0 25 Brief description of the care home care to seventy older people and the Reminiscence service is registered to provide care to twenty-five older people with dementia. Accommodation is provided in apartment style rooms and each apartment is very well-equipped with its own spacious hallway, kitchenette and en-suite shower and toilet facility. Some of the apartments are shared in that people have their own private bedroom, but they share en-suite facilities, kitchenette and hallway areas. The service is surrounded by well-kept gardens and patio areas, which are easily accessible for people who may have mobility difficulties. There is level access to the main reception area on the ground floor and a lift provides access between the ground and first floor. There is car parking at the rear of the building and a local bus service stops nearby. Information on fees is included within the Residents handbook. Prices vary according to the type of apartment, services and level of care required by the person. The reader is advised to contact the home to obtain up date information on the fees charged. The last key inspection of this service was undertaken on 11th April 2008. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out mainly over one day, but we also met with people and staff on a second day whilst we were inspecting the Assisted Living service which is in the same building. The home did not know we were going to visit. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about events that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment. (AQAA). This is a document that Care Homes for Older People Page 6 of 29 provides information about the home and how they think that it meets the needs of people living there. Three people living in the home were case tracked. This involves establishing individuals experiences of living in the care home by meeting them, observing the care they receive , discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. A sample of care, staff and health and safety records were looked at and we also looked around some areas of the home to make sure it was warm, clean and safe. People who live at the home were not able to comment on the care they receive and so we observed how staff interacted with them. We obtained feedback from visitors and spoke with the manager, Ms Erica Neal and staff on duty. Four staff completed surveys for us during the inspection and provided their views on the home, what has improved and what could be done better. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 Care Homes for Older People Page 8 of 29 order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with clear information about the service, which is made available in a number of formats for people to understand. This helps people make an informed choice as to whether they want to live there. Peoples needs are assessed before they move in, which ensures that people are only admitted if the service is confident it can meet their needs. Evidence: The manager, Ms Erica Neal, described the assessment and moving in process to ensure that individual needs can be met with a focus on achieving positive outcomes for people and an emphasis on maintaining existing life skills and independence. We looked at assessments which had been undertaken prior to admission to the home and this demonstrates that the service seeks information to ensure that peoples needs can be met. These assessments include specific information on the individuals dementia care needs, awareness and judgments. We saw that the information which is obtained is then used to plan peoples care. Care Homes for Older People Page 11 of 29 Evidence: Four relatives spoke of their satisfaction with the admission process and how pleased they have been with the care at Sunrise since their relatives admission. There is a range of information available, including a statement of purpose, which provides clear information on the aims and objectives of the service and a Resident handbook which is informative and easy to read. Both documents can be made available in alternative languages or formats, such as large print so that people with different communication needs can access information about the home. We saw that the manager is looking at ways to personalise individual handbooks, to make them more pertinent to the people for whom they are intended. Information on how Sunrise structures its fees and care packages is included within the Resident handbook as well as information on services which incur additional cost. We spoke with relatives of people who live at the home who confirmed to us their awareness of the fee structure. The home does not provide intermediate care, a form of intensive rehabilitation. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the information they need and a good understanding of how to care and support each person, which should ensure peoples needs are met in a way they prefer. People receive their medication when they need it and medication is stored safely so that people are not at risk of taking medication that is not prescribed for them. Evidence: The people living at the home at the time of this inspection were unable to give their views on the home and the care provided, so most of this inspection is based on observation and looking at documentation to show how peoples needs are met. We observed staff interacting very well with people, providing guidance when necessary and promoting positive reactions. People appeared content and throughout the inspection staff showed they respect people as individuals and there appeared to be a good rapport between staff, people living at home and their visitors. We looked at a selection of care files for the people we case tracked, which shows people have care plans and risk assessments in place, which provide staff with information on how Care Homes for Older People Page 13 of 29 Evidence: people would prefer to have their needs to be met taking into account any risks to the individual. In each care file was detailed information about the person before their illness, their lifestyle and factors which are important to them such as their cultural and religious needs, their likes and dislikes and care plans incorporated this information. Discussions with staff demonstrated their awareness of this information, which helps to ensure people are treated as individuals. One persons care plan described how they like to look and dress and we observed their appearance reflected what was written in the care plan. Another persons care plan described in detail their specific religious needs and how staff are to meet those needs. A risk assessment was present on the file of someone deemed to be a risk of rolling out of bed; we looked at the persons room which showed that strategies were in place to reduce the risk of harm to the person. Four visitors we spoke with confirmed that the home keeps them informed of any changes to their relatives condition and they are pleased with this regular contact. Documentation was present to show that regular meetings take place with families to enable them to be involved with all stages of the care planning process and during reviews of care. We saw that the home contacts health professionals including GPs when there are concerns about peoples health and well-being. Peoples care plans contained information on medication and any side-effects, so that staff know what to look for and take action. Observation of individual medication administration record sheets found these to be completed accurately, with medication signed and accounted for. We observed a member of staff administering medication which showed a safe technique. The room used to store medication was tidy and well-organised. We found that staff are monitoring the temperatures of the medication storage room and medication fridge to ensure that medication is stored at the correct temperature. The room used to store medication did not have a facility for staff to wash their hands, although staff were seen to go to the kitchenette area to wash their hands it is considered good practice to have a hand washing sink in the medication room so that staff are able to wash their hands in between preparing medication. A recommendation is made for a hand washing sink to be fitted. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in activities and events which meet their needs, capabilities and preferences and they are supported to maintain their independence as far as possible. People are offered an excellent choice of meals which meet their dietary, cultural needs and preferences. Evidence: The home aims to offer a choice of at least five activities a day and an activities plan is displayed in the reception area which provides an overview of the activities intended for that week. This includes opportunities for exercise, baking, music therapy, arts and crafts, religious and spiritual observance, as well as opportunities for visits to the wider community. Specific staff are employed by the home to organise and provide activities and we saw training records which demonstrate that all staff attend a training session as part of their induction so that they are aware of the importance of meeting peoples social care needs. Objects placed throughout the unit are designed to promote and encourage responses Care Homes for Older People Page 15 of 29 Evidence: from the people who live here. People were seen rummaging through boxes and drawers and appeared content to do so, prompting discussions on what they were doing. Daily newspapers were available and two people were chatting to each other whilst looking through them. A card game took place during the inspection using specially designed game cards to assist people to recognise what they are and staff were observed to support people to take part. The unit continues to find doll-therapy beneficial and this was seen to be used and monitored appropriately, with people enjoying comforting the doll they were looking after. Each person has an activities record, which details the activities they have participated in. These indicated a range of activities on offer for people, which take into account peoples needs and capabilities. The home has its own minibus, although it is not currently used because there is not a suitably qualified driver. One relative viewed that there is reduced access to community events because of lack of transport, and a staff member commented that the home could improve on trips to locations away from the home. This was raised and discussed with the Executive Director who confirmed that alternative transport arrangements, such as taxis are used so that people are able to access events in the wider community. As two people commented on access to the community the home needs to keep this under review to ensure people will be provided with regular attendance at external events. A Bistro area is located near the entrance to the home, where refreshments are readily available, as well as a selection of newspapers and magazines. People who live on the Reminiscence unit were seen supported by staff chatting with people who live in the Assisted Living service. There is an excellent sensory garden, which provides people living at the home with a safe outside space specifically designed to promote sensory awareness; raised flower beds enable people to smell and touch plants with different textures. There is a room called a snoozleum room, which has comfortable seating and is fitted with sensory and tactile objects to promote relaxation and enhance well-being. The meal served on both days of inspection was well presented and people appeared to be enjoying their meals. A menu is displayed to help people to make an informed choice, supported by staff and alternatives to the menu are always available. The home establishes individual likes and dislikes and keeps records so that staff are aware of these. The home is able to cater for special diets for cultural or medical reasons. We observed staff using good approaches with people who need help with eating and Care Homes for Older People Page 16 of 29 Evidence: drinking and staff were observed providing people with regular drinks and snacks throughout the day. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure, available in different formats, which provides people and their significant others with information so they know how to complain and ensures concerns and complaints are dealt with promptly and professionally. Staff are provided with training to equip them with the skills to safeguard adults from harm. Evidence: The complaints procedure is displayed in the reception area and is also available within the service user guides (Residents Handbook), copies of which are in the process of being updated, but are usually in peoples rooms. People and their significant others receive a copy of the procedure on their admission and sign to confirm receipt, which provides clarity to ensure everyone receives a copy. The procedure provides people with clear information on the process to follow and who to contact if people want to complain. Four relatives we spoke with confirmed they would feel comfortable in raising any concerns with the manager or other staff and felt confident their concerns would be dealt with quickly. We spoke with a member of staff who has the role of Dementia Champion for the home who discussed ways of observing people who are less able to communicate their views to establish their wellbeing and whether they are content with how their needs are being met. The home will then be able to act on these observations. The home informed us it has received two complaints, one of these complaints is not yet resolved. We advised the home Care Homes for Older People Page 18 of 29 Evidence: that it could improve the recording within its complaints log to show all the action taken in response to a complaint. Prior to the inspection we received an anonymous complaint that some staff take frequent breaks during the night which leaves the home short of staff. We informed the executive director and manager of the need to act and investigate this complaint. During discussion about this complaint it was established that staff are able to smoke within a room designated for residents who smoke and we informed the executive director that this goes against legislation regarding smoking in the workplace and the home needs to rectify this. On commencement of employment staff receive copies of relevant procedures and policies to safeguard adults from the risk of abuse and to support staff to report poor practice (whistleblowing). Information was also available to show that staff receive training in adult protection and abuse awareness so they know their role in keeping people safe. We spoke with a member of staff who confirmed they received training as part of their induction and was able to describe the process to follow should concerns arise with how people are cared for. The manager demonstrates a good knowledge of safeguarding adults and staff have access to a copy of the local area multi-agency adult protection policy, so that staff have guidance to follow in the event of an allegation of abuse. The manager demonstrated good awareness of the Mental Capacity Act (MCA) 2005. The Act governs decision-making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. Training has not yet been provided to staff, therefore the home is advised to provide training as it is important that staff know how to put the Act into everyday practice. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides excellent accommodation, which fully meets the needs and abilities of the people who live there and provides people with the opportunity to maximise their independence wherever possible. Evidence: There are different types of apartments, which vary in size and cost and this flexible approach means that people can choose the apartment type best suited to their needs. Each apartment is very well-equipped with its own spacious hallway, kitchenette and en-suite shower and toilet facility. Some of the apartments are shared in that people have their own private bedroom, but they share en-suite facilities, kitchenette and hallway areas. People who choose to share can use their living space as they wish-for example some people may want to use just one of the bedrooms and use the other bedroom as a lounge area. A partial tour of the home was undertaken and we looked at a selection of bedrooms, bathrooms and communal areas, relevant to the people we case tracked. We found that the furniture, fixtures and fittings in all parts of the home is of an excellent quality and promotes a homely atmosphere. Tactile pictures are displayed along corridors to prompt responses from people. The home is fully accessible to people in wheelchairs: corridors and doorways are wide and there is level access onto the garden and patio areas. The home has a good range of specialised equipment to meet individual assessed need. There are sufficient toilets Care Homes for Older People Page 20 of 29 Evidence: and bathrooms including spa baths-the frequency of accessing this facility may incur additional cost. The home is surrounded by well-kept gardens and patio areas and the sensory garden is fully surrounded by fencing, which ensures that people are kept safe when they are outside. Entry to and from the home is by way of a keypad lock and staff were seen to support people to access the main reception and other parts of the service to provide variety to their day. Observation of training records demonstrates that staff receive training in infection control and observations made at the time of inspection shows that staff put training into practice during everyday activities. All parts of the home were very clean. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who have the skills and knowledge to meet their needs. Recruitment practices safeguard people from the risk of being cared for by staff who should not be working with vulnerable adults. Evidence: We observed the staff working in different parts of the home, looked at staffing rotas and discussed staffing levels with the manager, this indicated that sufficient skilled care staff were on duty to meet the needs of the people currently living at the home. The manager described how the staff team complement each others skill mixes, ages and levels of experience and how they want to make a difference to each residents day and we observed this to be apparent during our inspection. We were informed that the home used agency staff to supplement its own staff for a while but has now successfully recruited more permanent staff. We received two comments from staff who viewed the service had improved in the past six months through an increase in staffing. In addition to care staff the home also employs kitchen, domestic, laundry, maintenance and administrative staff to ensure that all aspects of peoples needs are met. The home has recently increased the availability of laundry staff, which will alleviate care staff from their previous assigned duties of laundering peoples clothes. We looked at two personnel files for staff, one employed on the Assisted Living Unit and one on the Reminiscence Unit. This demonstrated that required pre-employment Care Homes for Older People Page 22 of 29 Evidence: information, such as references, POVA First checks (Protection of Vulnerable Adults) had been sought prior to the staff starting work at the home. A full CRB disclosure (Criminal Records Bureau) had been obtained for one staff member before they started work. The other member of staff started work prior to their full CRB disclosure being obtained, the staff member and the executive director confirmed to us that they are working in a fully supervised capacity until their CRB is obtained-we observed them in their work on the Assisted Living Unit and saw that they did not attend to people un-supervised. We saw documents, which demonstrate the home provides staff with a comprehensive induction. A member of staff recently appointed confirmed they had received an induction and they spoke positively about the support they had received since starting at Sunrise. Half of the staff have attained a recognised qualification in care (National Vocational Qualification) at Level 2, with the remaining staff working towards this qualification or Level 3, which should ensure that care staff have the skills and knowledge to meet peoples care needs. We looked at individual staff training records and the homes training matrix which shows that a wide range of training is provided, this includes training in safe working practices such as fire safety, medication administration as well as more specific training including dementia care. Staff confirmed to us that training opportunities within the home are good. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements ensure that the home is safe and run in the best interests for the people who live there. Evidence: The manager, Ms Erica Neal has worked at the home for just over twelve months and has completed her registration with us. Ms Neal has considerable experience in managing care services for older people and management experience is supplemented by supporting qualifications and an enthusiasm to continually update skills and knowledge. Ms Neal described some of the challenges since coming into post and how the quality of care delivery and communication systems have improved. Ms Neal comments within the annual quality assessment document (AQAA) about supporting the staff team, describing the team as strong and dedicated and how everyone works closely together as a team to enhance the well-being of our residents. Throughout the inspection there was a relaxed, friendly atmosphere and staff were clearly working as a team. We received positive feedback from visitors on how the home is run and staff described how there is good support and teamwork to provide good quality Care Homes for Older People Page 24 of 29 Evidence: dementia care. There are processes in place to monitor quality within the home. Regular meetings take place with people who live at home and their significant others. Quality assurance questionnaires are sent out to people and staff to obtain their views on different aspects of the service and the information is then collated into a report, for action to be taken if necessary. We looked at documents which show meetings are held for staff to keep them informed of changes within the service, implementing good practice and where changes to practice are needed. A representative of the company also monitors quality at regular intervals with monthly unannounced visits, looking at matters including general observations, speaking with staff, checks of medication and whether any complaints have been received. A report is then formulated with the findings of the visit. As noted earlier in this inspection report, a member of staff is looking at ways of measuring well-being and quality through observing people who are less able to communicate their views to establish whether people are content with how their needs are being met. The home will then be able to act on these observations and improve where appropriate. For the purpose of this inspection Ms Neal had responded to a request by the Commission to complete an AQAA-this is an opportunity for providers to share with us areas that they believe are doing well, and where they could improve. Ms Neal provided clear, relevant information of what the home does well, improvements which have occurred and plans for future improvement. Staff are provided with access to formal staff supervision sessions, which provide opportunity for them to reflect on their practice and to discuss training and development needs. We looked at records relating to the management of small amounts of personal monies and the process used by the home appeared robust with receipts kept to show spending and transactions checked by two people, which should ensure peoples money is held safely. Information was provided within the AQAA to confirm servicing and maintenance of equipment is undertaken and policies and procedures are reviewed. Observation of maintenance and servicing records shows a very well organised process to ensure all parts of the home are safe and equipment consistently well-maintained. We saw documentation which showed that a Health and Safety Executive inspector had recently visited the home and were satisfied with how the home protects people through its health and safety arrangements. The manager keeps us informed of the Care Homes for Older People Page 25 of 29 Evidence: occurrence of accidents or incidents. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 A hand washing sink should be fitted in the medication room, so that staff are able to wash their hands in between preparing medication. It is recommended that staff receive training/awareness of newly introduced mental health legislation (Mental Capacity Act 2005) so that they are aware of the processes to follow if a person is considered to lack mental capacity and to ensure their liberties are not compromised. 2 18 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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