Care Home: Tang Hall

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What the care home does well The home is well managed in the interests of people who live there and the manager demonstrates a commitment to providing a good quality service for the people who live there. People are treated as individuals and the ethos of care is person centered. People are supported by a competent staff team. People living in the home were complimentary about the way staff provide care. There is a range of activities in place that are designed to meet people`s wishes and needs. The activities co-ordinator is enthusiastic about ensuring people are involved in activities they enjoy. In particular the home is good at celebrating events such as anniversaries, birthdays, Christmas and Easter. The home encourages the involvement of family and friends. Relatives spoken with told us they are made welcome and are involved in their relative`s care. People like living in Tang Hall. What has improved since the last inspection? There has been redecoration and refurbishment of the dining room. As part of the ongoing programme of maintenance and redecoration some individual bedrooms have been decorated. New windows have been put in and upper windows now have restrictors to ensure risks to people who are confused are minimised. The home`s processes around the storage, recording and administration of medication have improved and are now more robust. New facilities for activities were being installed at the time of the inspection, including a new activity room with a range of equipment and a new greenhouse. What the care home could do better: They should continue with the ongoing programme of improving and maintaining the environment, such as improving the walls in the laundry room. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Tang Hall 18 Cottage Grove Bockings Elm Clacton On Sea Essex CO16 8DH     The quality rating for this care home is:   three star excellent 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: Ray Finney     Date: 2 4 0 4 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 28 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 28 Information about the care home Name of care home: Address: Tang Hall 18 Cottage Grove Bockings Elm Clacton On Sea Essex CO16 8DH 01255421304 01255423079 tanghall@abc-care-solutions.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Raju Ramasamy,Mr Inayet Patel care home 20 Number of places (if applicable): Under 65 Over 65 0 20 dementia mental disorder, excluding learning disability or dementia Additional conditions: 20 2 Future admissions to the shared room must be as a result of active choice of service users to share a room Persons of either sex, aged 65 years and over, who require care by reason of a mental disorder (not to exceed 20 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 20 persons) The total number of service users accommodated must not exceed 20 persons Two persons, under the age of 65 years, who require care by reason of a mental disorder Date of last inspection Brief description of the care home Tang Hall is a detached two-storey care home, situated in a quiet residential road in Clacton-on-Sea. The home is within walking distance of local shops and a few minutes Care Homes for Older People Page 4 of 28 Brief description of the care home drive from the town centre and the sea. The property has been extended several times but remains in keeping with the appearance of other houses in the surrounding area. Accommodation is provided on two floors, access to the first floor is by means of a passenger lift. The home has 18 single bedrooms and one double room; many of the rooms have en-suite facilities. Communal areas include a large lounge, dining room, small lobby and a quiet room set aside for meetings or private visits. There is a small and secure garden to the rear of the property, with access via patio doors from the dining room. There are parking spaces to the front of the property. The home charges between £500 and £550 per week with additional charges for toiletries, private chiropody and hairdressing. This information was provided to the commission in April 2009. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. The manager completed an Annual Quality Assurance Assessment with information about the home and sent it to us at the Commission when requested. Throughout the report this document will be referred to as the AQAA. A visit to the home took place on 24th April 2009 and included a tour of the premises, discussions with people living in the home and members of staff. Completed surveys were received from people living in the home, members of staff, relatives and a healthcare professional. Observations of how members of staff interact and communicate with people living in the home have also been taken into account. Care Homes for Older People Page 6 of 28 On the day of the inspection we were given every assistance from the manager and staff team. 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 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 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Through the comprehensive admission process people choosing to live at Tang Hall can be confident their needs will be met. Evidence: The manager stated in the AQAA, Full assessments are carried out prior to residents coming to live at the home and [We have improved by] ensuring professionals provide us with an up to date care management assessment. On the day of the inspection we discussed the assessment process with the manager. She was able to demonstrate a solid awareness of the importance of a thorough assessment process. Records examined contained a range of assessment tools including a Mental Health Assessment and a Waterlow Pressure Sore assessment. It was evident from the records examined that the assessments provide the basis for peoples care plans. A relative who completed a survey was positive about the Care Homes for Older People Page 10 of 28 Evidence: admission process. They stated, [It was] all quite quick in moving into Tang Hall but the information we did get we were happy with. National Minimum Standard 6 does not apply as the home does not offer intermediate care. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can expect their personal and healthcare needs to be identified and to be provided with the support to ensure these needs are met as they would wish. Evidence: The manager stated in the AQAA, [We have] detailed care plans for all residents and excellent liaison with external health care professionals. Records examined confirm there are a range of risk assessments in place including manual handling, falls and nutrition. There are also risk assessments relating to peoples individual and specific needs including injury to others or to self and smoking. The assessments identify the risk or hazard and who is at risk, what precautions are taken to reduce the risk and what further action may be needed. Activities, mood and behaviour are all assessed. There are a range of care plans that have been developed from the assessments to Care Homes for Older People Page 12 of 28 Evidence: meet individual identified needs. Records examined contained care plans relating to maintaining a safe environment, personal hygiene, foot care, activities, mental health needs, mobility and dexterity and dietary needs. Care plans are evaluated monthly and staff spoken with were able to demonstrate a good awareness of peoples needs. They also told us how they ensure any changes are communicated with other members of staff so that people receive continuity of care. A member of staff who completed a survey stated, Report books are filled in regularly and each shift informs the takeover shift of any concerns or changes. Another member of staff said that some of the things they do to ensure good communication are, Handover on each shift. Written progress sheets after each shift. Communication board in staff room. A healthcare professional who completed a survey stated, If any problems are found by myself and reported to the staff then the follow-on care is always well provided and All areas of care are met in a relaxed and friendly environment so that the residents feel very much at home. The care plans examined contained ample evidence of input from a range of healthcare professionals including Dentist, Doctor, Community Psychiatric Nurse and District Nurses. There was also evidence that people are supported to attend hospital appointments when necessary. The manager and senior staff spoken with were able to demonstrate a good awareness of their responsibilities around meeting peoples healthcare needs promptly. During the course of the inspection it was evident that the manager and senior staff communicated well with the local surgery and pharmacy. There have been improvements in recording and storage of medication since the last inspection. The home has an agreement with a local provider for medication to be supplied using a monitored dose system (MDS). The supplier has provided the home with new storage facilities. Medicine Administration Record (MAR) sheets examined were completed appropriately with no missing signatures and a clear audit trail. There were photographs of residents in the MAR sheets file to reduce risk of administering medicines to the wrong person. The manager explained that they have good support from the local pharmacist. We observed good practices around respect and dignity during the course of the inspection. The interactions between staff and people living in the home were appropriate, courteous and friendly. Staff spoken with demonstrated an obvious warmth and affection for the people living in the home. They were also able to demonstrate a good awareness of peoples individual needs, likes and wishes. A visitor who completed a survey told us, We have been visiting the home for about four years Care Homes for Older People Page 13 of 28 Evidence: and have been impressed with the way the staff cope with individual needs and retain the dignity of the residents and a visiting healthcare professional said, If a resident requests that they are treated in the privacy of their own room rather than the treatment room the request is always granted. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 people who live there with variety and choice in their daily lives and peoples expectations and preferences with regard to lifestyle are well met. Evidence: The manager stated in the AQAA that they have appointed an activity co-ordinator and some of the activities are, Take residents out in our 7-seater vehicle for shopping, outings i.e. bowling, seaside, farms etc. She further said, I work with the activity coordinator to ensure residents have a good quality of life. Ensure activities made available are flexible and varied to suit residents expectations, preferences and capacities. The manager stated in the AQAA that over the past year they have made improvements and Added a snooker table and darts board for the younger residents. Bought a Wii consul which all enjoy. Through discussion the manager explained that there is now a full time activities co-ordinator and there is a good range of activities available. Staff were observed doing arts and crafts with people living in the home. One person was colouring in a book. Another person was pleased to show us their pencil portraits, which were of a high standard. People are also interested in helping Care Homes for Older People Page 15 of 28 Evidence: with gardening. A relative who completed a survey told us some of the activities their relative can take part in include, Bingo, bowling, visit to the seafront, visit to the shops, karaoke and a visitor who completed a survey stated, Tang Hall is a caring place. It is a pleasure for me to go in to play pool, dominoes etc with the folk who live there. It has a very happy feeling. Another visitor to the home who completed a survey stated, There is a conscious attempt to make each day different - something to look forward to, e.g today was Italian Day, hence making Pizza and Cappuccino Coffee. The home has been successful in their application for a Quality Grant from the local authority. They applied for this to put in place a programme called the Good Life. This involves installing a workshop/activities room which was in the process of being built at the time of our inspection. The equipment to furnish this room is on order and includes a potters wheel and carpentry equipment. The manager explained that they have arranged for some volunteers to come in who will be working with some of the residents doing carpentry. As part of the Good Life scheme, there is also a new greenhouse being erected so that they can expand and improve on the range of things they can grow. An exercise machine has been ordered and there are plans to have a regular gym day, which will help people to maintain or improve fitness as well as being enjoyable. The manger explained that she has brought in a sewing machine and encouraged one resident to do some sewing. Some staff are attending a training course at a local school to learn pottery so that they can support people living in the home to work on the potters wheel. Staff and residents spoken with were enthusiastic about these new developments and a visitor who completed a survey said, The staff are enthusiastic about their intended project to get a greenhouse and large shed for creative activities. The activities co-ordinator showed us the records of daily activities that each individual takes part in. There is evidence of film afternoons, bingo, manicures, walks to shops, beer and nibbles in the garden, game of croquet, football, dominoes, draughts, decorating cakes, listening to music. Since the last inspection they have got a new table tennis table and there is also a snooker table. There is a new 50 inch television on order so that residents can enjoy their cinema afternoons. A member of staff who completed a survey told us, The individual needs of the residents are met. They have regular activities and go out shopping and day trips regularly and what they do well is, Treat clients as individuals and do our utmost to fulfill their needs in a homely atmosphere. A relative who completed a survey was positive about the improvements to their lifestyle and stated, [My relative] has become more sociable over the last year. Care Homes for Older People Page 16 of 28 Evidence: The home makes an effort to celebrate festivals and holidays. All residents had Easter eggs and hot cross buns on Easter Sunday and earlier in Easter week a pastor had come in to deliver an Easter Service for the residents. For St Georges Day they had a party with beer and nibbles in the garden. On the day of the inspection an entertainer came in to sing to the residents for a belated St Georges day party which was followed by a buffet tea. People were dancing in the lounge. Residents birthdays are celebrated with cards, gifts, birthday cake and buffet tea. Records examined and people spoken with confirmed that people are encouraged to keep in touch with relatives and friends. Visitors are made welcome and some people keep in touch by telephone. Records examined show that the activities co-ordinator documents everyones activities on a daily basis. Minutes of a recent residents meeting were examined and confirm that people living in the home are consulted about what they would like. Items discussed included menus, choices of trips out and the new workshop facility. The manager stated in the AQAA, Meals are freshly cooked and menus are renewed 6 monthly with the residents help. All care is taken to ensure wholesome and nutritious diet. On the day of the inspection people were observed to enjoy the lunchtime meal. The cook was spoken with and was able to demonstrate a good awareness of peoples likes and dislikes. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their concerns about how they are treated are listened to and acted upon as stated in the complaints and safeguarding procedures. Evidence: The manager stated in the AQAA that they, Respond to complaints speedily and there have been No complaints in the past few years. As reported following previous inspections, there is an appropriate complaints procedure in place for recording and dealing with complaints. There have been no major complaints recorded in the home or received by us since the last inspection. Minor concerns are dealt with as and when they arise. Through discussions the manager was able to demonstrate an awareness of the importance of dealing with minor concerns promptly, as they can be important to the individual. She said that anything that concerns people living in the home, no matter how trivial it may seem, is taken seriously. People spoken with were confident they could raise any concerns with staff or with the manager. Observations on the day of the inspection confirmed that people were confidently telling staff if they wanted anything or if they preferred not to take part in something. A relative who completed a survey stated, I would always take complaints to Rula. Care Homes for Older People Page 18 of 28 Evidence: Not that we have yet, [there has] not been a situation where concerns have been raised. Another relative told us they, Have had no reason to complain. Staff spoken with were able to demonstrate a good awareness of their responsibilities around keeping people safe. Staff have had safeguarding training (previously referred to as Protection of Vulnerable Adults or POVA), which has been updated since the last inspection. Personnel records examined confirm that staff undergo Criminal Record Bureau (CRB) checks before commencing employment. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can enjoy living in an environment that suits their lifestyle and which is well maintained and clean. Evidence: The manager stated in the AQAA, We ensure the home is kept clean, free of offensive odours and well maintained. We have a maintenance programme in place. A tour of the premises confirmed that there have been improvements in the environment since the last inspection as part of the homes ongoing programme of maintenance. Improvements include new tables and chairs in the dining room, individual bedrooms have been redecorated and the lounge and dining room have also been repainted. New double glazing has been installed. Windows now have restrictors as required at the last inspection of the service. New garden furniture has been ordered and also a new steel kitchen unit is on order. There are further plans for improvements to the bathing facilities. The manager stated, We are looking at changing the main bathroom into a wetroom. We already have one and it works really well. More and more residents prefer the wetroom to the bathroom and they have made suggestions about changing over. The laundry room is separate from the main building. There is a large washing Care Homes for Older People Page 20 of 28 Evidence: machine with a sluice cycle and it has been fitted with a system that automatically feeds the machine with disinfecting washing liquid. The manager explained that they now use dispersible red bags for soiled laundry that go straight into the machine. This practice reduces the risk of the spread of infection. Records examined confirm that staff have received infection control training. The laundry has a floor with a surface that is washable, although the walls could have a more easily cleanable finish. We discussed this with the manager on the day of the inspection and she explained that she is in discussions with the providers around having the walls tiled. On the day of the inspection the home was observed to be clean throughout and there were no unpleasant odours. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident they are cared for by a competent staff team who can meet their needs. Evidence: Staffing levels on the day of the inspection were observed to be good. Peoples needs were being attended to promptly. Staff were observed to take time to interact with people in a relaxed and appropriate manner. The manager stated in the AQAA, We start new staff on NVQ level 2. All training and induction is started straight away. Through discussions with the manager and staff they demonstrated a commitment to achieving the qualification. All staff have attained or are working towards a National Vocational Qualification (NVQ) award at level 2. One senior member of staff is working towards NVQ level 4. From the AQAA dataset the manager provided us with information about numbers of staff with an NVQ qualification. Out of a total of 15 staff, 12 have completed NVQ and a further 2 are working towards the award. A visiting healthcare professional who completed a survey told us, All staff appear to have the required skills and also act in a caring, friendly manner. A relative who completed a survey stated, I dont know what skills or qualifications they have to Care Homes for Older People Page 22 of 28 Evidence: work here but they all seem very helpful. The manager stated in the AQAA, We ensure checks and information is received prior to taking a member of staff on. A sample of three personnel files examined all contained appropriate documentation as required by regulation. This included relevant proofs of identity, two written references, application forms with relevant employment history and Criminal Record Bureau enhanced disclosures. When people have been recruited they receive an in-house induction. The manager demonstrated a commitment to ensuring staff have sufficient information to carry out their role. Staff who completed surveys made positive comments about their induction and training. One person stated, The manager and other staff were very helpful and another told us they, Worked alongside senior member of staff. Comments from staff about training were positive and included, In house Mulberry House training is ongoing. Outside agencies come to home to keep us up to date or new staff trained when needed. Staff and senior members of staff attend relevant courses to keep them updated. Manager is trained to train staff in manual handling and dementia, We have ongoing training and a member of senior staff who concentrates on training courses etc for staff and My manager and other members of staff are very supportive and with the ongoing training I feel confident and supported in my role as carer. Staff spoken with had a good awareness of peoples needs and understood their responsibilities around keeping people safe. Personnel records contained evidence of a range of training including Basic Awareness of diabetes, Dementia Awareness, Food Hygiene, Manual Handling, Infection Control and NVQ certificates. A visitor who completed a survey told us, I think the home runs well and all staff are caring and thoughtful. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately managed in the best interests of people living there. Evidence: The manager has been in post for a number of years and has achieved appropriate qualifications in care and management, including a National Vocational Qualification (NVQ) at level 4 and the Registered Managers Award (RMA). At the time of the last inspection it was reported that the manager had also gained qualifications in dementia care and Moving and Handling to enable her to deliver this training to staff in the home. At this inspection the manager was also able to demonstrate that she continues to develop her skills and knowledge with ongoing training. She, along with other senior staff, has recently attended training around the Mental Capacity Act and Deprivation of Liberty Safeguards. On the day of the inspection the manager was able to speak with knowledge and confidence about the needs of people living in the home and how they are able to Care Homes for Older People Page 24 of 28 Evidence: meet those needs. One of the managers particular strengths is dealing promptly with any improvements recommended or suggested. Requirements and recommendations made at the last key inspection were addressed, although she is still in discussion s with the providers around new tiling for the laundry room. The manager continues to demonstrate a high level of commitment to providing the best standard of care to the vulnerable people living in Tang Hall. The manager stated in the AQAA, We have regular resident meetings and regular staff meetings to ensure all is running well. Through discussions the manager was able to demonstrate that actions are taken to improve issues raised at resident meetings. Specific issues raised by individuals are also followed up by the manager and carers and, where possible, are implemented. As previously reported, there is a process in the home for Quality Assurance. Questionnaires are sent out to residents, relatives, friends and any other interested parties. Comments on the questionnaires were positive about the service including X is being well cared for and happy with the care. Suggestions from relatives in the returned questionnaires such as having more fruit on a daily basis were addressed by the manager who responded by letter and took action to put the suggested improvement in place. A yearly quality audit is carried out by the providers and all information is collated into a report. Through discussions the manager was able to demonstrate that they value the opinions of people using the service and take steps to act on suggestions where possible. As previously reported, there continues to be an appropriate process in place for managing peoples money. Expenditure is recorded and receipts are obtained. A sample of Health and Safety documentation was examined and all found to be in order. This included electrical installation, emergency lighting, gas installation, maintenance of hoists and fire equipment, Portable Appliance Testing (PAT). Staff spoken with on the day of the inspection felt well supported. One person who completed a survey told us they have, Supervisions, appraisals and the manager is very approachable, have discussions almost daily and another stated, The concerns or needs of the staff are also met which makes the home a pleasant place to work. A visitor who completed a survey stated, There is a caring, family attitude and the manager is very supportive. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 19 The providers should consider how they can improve the surface of the walls in the laundry room. Care Homes for Older People Page 27 of 28 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. 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