Care Home: The Close Nursing & Residential Home

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What the care home does well One resident stated: "When fully staffed the home makes me feel I am at `home`." During the inspection visit residents and relatives alike were very positive about the approachability of the staff and manager if they had any concerns. They also felt: "Staff are friendly and helpful." "There are always staff about if I need them. They are always cheerful and have time to stop and talk." Relatives expressed that they were very pleased with the standard of cleanliness and hygiene in the home. Regular visitors stated that at no time did the home smell offensive, only pleasant and fresh. From information obtained through this inspection the people who use the service can be confident that they will obtain a good standard of care and support. They will also be provided with the opportunity to continue to with their daily lives as they wish or are able. They can be certain that their concerns will be listened to and that they will be protected from possible abuse or harm by the systems in place. The service is run in the best interests of the people who live in the home. Information from the whole inspection process shows that the service is managed well and effectively. Comments about the overall service were, "Provides a friendly, caring atmosphere and service." A professional who visits the home regularly stated positively about the managements knowledge of individuals care needs, the atmosphere in the home, and approachable staff. They also commented about the good clear care and activity plans for individuals. What has improved since the last inspection? The nursing and care staff are gradually improving the quality of the care planning records and have introduced a more holistic approach to providing care to individuals. The activities programme provided in the home for residents has been expanded to be available 7 days per week and the purchase of a small minibus exclusive to the home has offered a great variety of experiences for them. The meals and menu planning have been reviewed and developed to ensure that all residents can enjoy the meals equally. The recruitment practices for employing new staff to the home have been reviewed and extended to ensure that it is robust and supports that residents are protected from possibly inappropriate staff caring for them. What the care home could do better: They must continue to improve the development and use of the care planning records to ensure that staff can provide a good consistent standard of support to people in their care. Key inspection report Care homes for older people Name: Address: The Close Nursing & Residential Home The Close Nursing & Residential Home Burcot Abingdon Oxfordshire OX14 3DP     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: Ruth Lough     Date: 1 8 0 1 2 0 1 0 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 30 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 30 Information about the care home Name of care home: Address: The Close Nursing & Residential Home The Close Nursing & Residential Home Burcot Abingdon Oxfordshire OX14 3DP 01865407343 01865407734 closenhome@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cavendish Close Limited care home 97 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 97 The registered person may provide the following category of service : Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Close is situated near to the market town of Abingdon and approximately 6 miles south of the city of Oxford. The home is set in 4 acres of grounds with access to the banks of the river Thames. The current building at the front of the home ws built and completed by the end of 2006. This comprises of a purpose-built two-storey building, with 51 en-suite bedrooms, offices, and kitchen and laundry facilities serving the whole site. The remaining older part of the home to the side and rear of the site has been able to offer accommodation for a further 46 residents in sixteen single and fifteen shared rooms. This older part of the home is under proposal to be demolished and Care Homes for Older People Page 4 of 30 Over 65 97 0 2 8 0 1 2 0 0 9 Brief description of the care home replaced in 2010. The range of fees is from £900 to £980 per week. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection process generated from the adequate findings identified at the last assessment of the quality of the service by the commission in January 2009. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and any returned surveys to the commission before a one day visit to the home. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The AQAA from this service was returned within the required timescales and had been Care Homes for Older People Page 6 of 30 completed satisfactorily. The registered manager was present when we visited the home on 18th January 2010, between 09:200 and 16:50. During the day the records for care planning, recruitment, and administration of the service were assessed. Eight of the people using the service were involved with the inspection process. We met with 8 staff, and 5 relatives who were present in the home. The people who use the service and the staff who provide the support were also consulted about their opinion of what is provided, through surveys. Of the 20 people who are in receipt of support that we contacted, we received 6 responses at the time of writing this report. Of the 58 care and nursing staff employed at the home 10 were also contacted through surveys, of which 5 responded. Five relatives were also given the opportunity to comment about the service, we received one returned survey. Four professionals who have been involved with purchasing services from or visiting the home regularly were also contacted of whom one responded. From this visit it was found that a number of requirements and recommendations that were made to improve the service during the last inspection process have been met. There were a few areas that will need to continue to be developed the standards for and experiences of the people they support. A number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The nursing and care staff are gradually improving the quality of the care planning records and have introduced a more holistic approach to providing care to individuals. The activities programme provided in the home for residents has been expanded to be available 7 days per week and the purchase of a small minibus exclusive to the home has offered a great variety of experiences for them. The meals and menu planning have been reviewed and developed to ensure that all residents can enjoy the meals equally. The recruitment practices for employing new staff to the home have been reviewed and extended to ensure that it is robust and supports that residents are protected from possibly inappropriate staff caring for them. Care Homes for Older People Page 8 of 30 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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 wishing to use the service can expect to have their nursing and care needs assessed thoroughly before they are offered a place in the home. Evidence: All six residents who returned a survey to the commission expressed that they thought they had received enough information before the moved in to the home to help them decide that it was the right place for them to live. Relatives we spoke to during the day stated that they were given the opportunity to visit the home before a decision was made to support the person they cared for to live there. They also stated that they found the process helpful and the staff and manager most welcoming. We were provided with the most up to date copy of the homes Statement of Purpose and Service User Guide documents to review the changes that the service has made to them. These documents are used in conjunction with the company brochure to provide information to the prospective and current residents about the home and what Care Homes for Older People Page 11 of 30 Evidence: it can offer. From what we could see further detail has been included in both documents including greater depth about the aims and objectives of the service provision particularly about how the focus for the home is to enhance the experiences of the people living there. Added information has been given to the Service User Guide to make it more, user friendly. Only one person in the returned surveys was able to confirm that they were aware of a written contractual agreement to stay in the home that they had in regard to what would be provided. The others did not. Two records for residents who had been admitted to the home during the last 12 months were reviewed. This was to see if the assessment process carried out by the service assured that they would be able to offer the necessary support and nursing care that they need before they are offered a place in the home. From the information seen, the home manager takes the lead in assessing all new prospective residents and uses information from any referring social services or health practitioners involved with the individuals care. The records reviewed supported that the person concerned was consulted throughout the process, where able, with additional information obtained from their relatives or supporters. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people in receipt of support can be assured that their health and personal care needs will be met. Evidence: All six residents confirmed in the returned surveys that they always or usually obtained the care and support that they felt that they needed. Compliments were made by the relatives and residents we spoke to during the visit to the service about the nursing and care support provided at the home. They expressed that staff were quick to seek medical assistance if required, ensured that treatment was provided, and kept relatives informed of any changes in their condition if they occurred. During the last inspection of the service there were some previous concerns highlighted about the information obtained in the assessment process not been followed through into the care planning for individuals. There also were gaps in the quality of detail and written instruction given to staff to provide the nursing and care Care Homes for Older People Page 13 of 30 Evidence: support for specific health care needs that some residents required. From the information submitted in the AQAA they appear to have continued from this point to focus on improving the care records to ensure staff provide a consistent planned care to the people they support and stated that they had had positive feedback from professionals who have reviewed them. We looked at a sample of 5 residents care planning records to see what is in place and if they are informative and provide staff with clear instruction of how to meet the persons holistic needs. The records were taken from the 3 different areas of the home to look at the consistency of quality of record keeping in the home. Included in this sample of records were those identified for reviewing the assessment of need process and others who had long term highly dependant care needs. It was clear from the records that staff were still in the process of transferring records from one method of storing them to a more flexible file system which allows staff to expand information and include a greater range of records to assist them monitor and provide care. Detail in the majority of the records show that there is a process of moving to a more person centred approach to planning and providing support with personal choices and wishes clearly noted within the different topics of need. The home manager is taking the lead with this and is supporting staff to carry out reviewing the care planning for all residents. In regard to meeting the health needs of residents where there were previous concerns about the instruction and monitoring of these, particularly for one person about Percutaneous Endoscopic Gastrostomy (PEG) feeding, this has much improved. It was also evident that external support for general eyesight, dental and hearing needs had been obtained and provided with records kept of the outcomes of any consultations or treatment provided. There were no previous concerns about the medication administration and practices but the manager provided information in the AQAA that there have been some issues about omissions for the record keeping which had been identified, rectified and actions put in place to eliminate them. However, reviewing the information for self medication showed that the recorded risk assessment process and the care planning record did not match what actually was in place or the medication policy and procedure. They were advised to revisit this to ensure that the records support current practices and that the person concerned is able to manage this part of their medication treatment. Care Homes for Older People Page 14 of 30 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. The people who use the service are given the opportunity to exercise choice over their lives and are able to maintain their interests. Meals and menu planning meet their health needs. Evidence: One resident put for what they thought the home did well; When fully staffed the home makes me feel I am at home. One resident put in a returned survey about what they thought the service could improve; A separate television room would be a good idea. The majority of the residents in the surveys thought there were always activities provided in the home they could join in with. One member of staff put in a returned survey that they thought the activity programme could be improved especially for the morning periods and for those who Care Homes for Older People Page 15 of 30 Evidence: less able or nursed in bed. Another thought what was currently provided was very good. Findings from the last inspection identified that there were gaps in the support for residents to have social contact or activities as the care plans did not reflect information about needs and wishes from the assessment process had been transferred into the planned care. In the returned AQAA the manager has indicated that they have invested in employing more staff to provide activities which now covers support for 7 days a week. A minibus has also been purchased and trips are now arranged for small groups of residents to go out. We looked at the information included in the sampled care plans about personal wishes for daily routines of living, interests and activities. It was evident in the majority of the documents reviewed that greater information had been sought, where able, about individuals personal wishes and the choices and these had been included in the planned care. Much of the detail gave a good picture of the person concerned and will assist staff with providing consistent care and support that they want. Further development of this would be to record the persons chosen usual pattern of daily routine to aid staff achieve this. Through discussion with relatives and residents involved in the inspection it was apparent that staff were focused on individuals choices and supported them to continue living as they wish. Equally it was also evident that staff encouraged them to participate in the various communal and individual activities and relatives expressed that they were pleased to be invited to join in wherever possible. From looking at the programme of activities on offer and from a discussion with the activities organiser there is a broad range of both practical and entertainment activities provided. There is a weekly and monthly programme developed and put on display in various areas of the home for residents and visitors to read. Activities and events range from craft, musical entertainment, reminiscence and coach trips out. There was a positive response in the returned surveys in regard to the meals and food provided in the home. From discussions with residents and observation of a meal time the food appears to be enjoyed by the majority of the residents. The manager provided information in the AQAA they have updated the menu plans to offer a greater variety of choice and that the chef consults with residents on a daily basis. Through discussion with the chef it was identified that the menu plans have been amended to provide a broader range of moist and softer meals that give those with some swallowing or chewing difficulties greater assistance to eat well. Consequently they have reduced the number of residents requiring puree diets making meals much more Care Homes for Older People Page 16 of 30 Evidence: enjoyable for them. A sample of the main meal supported this. Records in the kitchen show that personal preferences and dietary needs are planned for. Care Homes for Older People Page 17 of 30 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 people who use the service can be confident that their concerns or complaints are listened to and acted upon. The service has systems in place to protect the people living in the home from possible abuse or harm. Evidence: Four of the surveys completed by the residents indicated that they did not know how to make a complaint to the service. However, all did confirm that they felt they were able to speak to someone informally if they were unhappy. During the inspection visit residents and relatives alike were very positive about the approachability of the staff and manager if they had any concerns. The formal complaints process is provided in the Statement of Purpose and Service User Guide documents given to all residents before they come to live in the home. It also could be seen on display in the communal areas of the home. The manager provided information that they had had 4 complaints since the last inspection process of which one was upheld, and one awaiting outcomes. No complaints have been referred to the commission during this period. During the last review of the complaints management by the commission there were some areas of the complaints log that did not provide sufficient detail such as noting minor comments or concerns rectified immediately. From the AQAA they have identified this is still an area they wish to improve. Care Homes for Older People Page 18 of 30 Evidence: We looked at how they ensure that residents are safeguarded from possible abuse or harm. Staff are provided with policies and procedures as to ensure that good practices are in place and training for safeguarding, mental capacity and deprivation of liberty is included in the training programme. The AQAA indicated that there has been one safeguarding referral to the local authority and subsequent investigation but no further steps have had to be taken. In regard to deprivation of liberty, a child safety gate was seen to be in place across the doorway of the room of resident with an acquired brain injury. From information given by staff and from that which is recorded in the care plan this was put in place by request from the family as to protect from wandering residents as the person concerned, who remains in bed, is not able to call for help. Agreement from the fire service for this has also been obtained. Care Homes for Older People Page 19 of 30 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. That the majority of the facilities of the home are maintained well and meets the needs of the people who live there. Evidence: The home is situated on the outskirts of the village of Burcott, near Abingdon, set within gently sloping grounds leading to the River Thames at the bottom of the garden. The buildings at the front of the home were built between 2005 and 2006 and can offer residents good sized en suite bedrooms and wide variety of communal lounges and dining rooms to use. To the rear of this is an existing building which has provided accommodation to 46 residents for a number of years. This older part of the home has been identified during a number of inspections to the home as to providing below the expected quality and standard of accommodation and required significant updating and improving. Particular areas of concern were the bathrooms and the use of shared bedrooms. Within the last few months the provider has informed the commission that the two units to the rear of the home are planned to be demolished and rebuilt during 2010. From information given by the provider, residents, relatives and the local social services have been consulted and involved with the planned changes. Alternative accommodation has been found for residents whilst this process is undertaken. At the time of this inspection the provider has 10 residents awaiting transfer to another Care Homes for Older People Page 20 of 30 Evidence: home. The commission has not been in receipt of any expressions of concern about the redevelopment of the home and the impact on the residents living there. All of the residents and relatives that were involved in the inspection process expressed that this was a positive step to improving the quality of life at the home. Reviewing the standard of facilities for the remaining 10 residents in this area, staff have continued to maintain it as comfortable as possible and during this change process. Generally there appears to be a good standard of maintenance, redecoration and refurbishment carried out. Relatives we spoke to were very pleased with the standard of cleanliness and hygiene in the home. Regular visitors stated that at no time did the home smell offensive, only pleasant and fresh. Throughout the buildings staff, residents and visitors are provided with liquid hand soap and paper towels to minimise the spread of infection around the home. Residents and relatives appeared to be happy with the standard and speed of the laundering of personal clothing. Care Homes for Older People Page 21 of 30 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. The people who are receipt of support are assured that the homes staffing levels should meet their and others needs and that they have had the necessary training they may require. The recruitment process is carried out robustly and shows that they have taken appropriate steps to ensure that employees are fit for the roles they do. Evidence: Comments made by residents about the staff were: Staff are friendly and helpful. There are always staff about if I need them. They are always cheerful and have time to stop and talk. One person put for what they thought the home could do better; Have more staff. We looked at the staff compliment and the recruitment practices to see if there are enough suitably skilled and experienced staff providing the nursing and support that the people living in the home require. According to the AQAA and information from the provider, staffing levels in some areas of the home have increased. Some of the staff have been redeployed to other parts of the home as the number of residents living in the home temporarily reduced for the planned rebuild. Care Homes for Older People Page 22 of 30 Evidence: New staff have been employed to develop the activities provided to residents, a waitress to support care and nursing staff, and an increase in registered nurses present in the home for day shifts. The staff rota for the home for the previous two weeks before the inspection were reviewed and these supported that there were sufficient numbers of qualified nurses and care staff at all times in the home. They equally indicated that there were a good team of domestic, laundry, and catering staff on duty. The home employs a full time administrator, receptionist and 2 part time hairdressers who are in the home for five afternoons a week. According to the information provided in the AQAA, 50 of the care staff employed have achieve an NVQ 2 or above. We were also informed during the day that a small number of care staff are presently working towards an NVQ. During the last inspection it was noted that there were gaps in the information held about staff for recruitment and employment practices carried out. A requirement was made to improve as the standard seen did not ensure that were suitable for the roles they were employed for or protect the vulnerable people they support. Information in the AQAA indicated that they have reviewed and implemented changes since then to improve practices. We reviewed the recruitment and employment records for 3 staff who had been employed since the last inspection process to assess if these previous concerns have now been eliminated. The records that were seen supported that the whole process of recruitment practices had been reviewed and updated. Detailed information had been obtained about the applicant, copies of documents retained and the necessary checks and more had been carried out to ensure that they were suitable to work in the home. The records were organised well and they were utilising a check list to make sure that the process was as robust as possible. Good planning went into the selection and interview process and the outcomes from these were recorded in detail and the reason to employ was clearly identified. One area that needs further development is the supporting evidence that any professional registration, such as that for the registered nurses, has been checked and reviewed on a regular basis to ensure that there are no changes to their professional status. We looked at staff training programme provided as the AQAA indicated that they now have a training matrix in place to evidence the training provided to staff. They also stated that there is an improved induction and shadowing process for new staff. From what information was made available the training provided to staff during the last 12 months has improved. This has included clinical skills for the registered nurses, such as Percutaneous Endoscopic Gastrostomy (PEG) Nutrition, wound care, and care Care Homes for Older People Page 23 of 30 Evidence: planning. Other training for all the care staff has included the core topics for safe working practices and those for safeguarding, mental capacity and dementia. Care Homes for Older People Page 24 of 30 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 people who live in the home can be confident that the service is run in their best interests, and is managed effectively by a knowledgeable manager and provider. Evidence: A general comment made in a survey in regard to the question of what the home does well was; Most things. A relative also added, Provides a friendly, caring atmosphere and service. A visiting professional also stated positively about the managements knowledge of individuals care needs, the atmosphere in the home, and approachable staff. They also commented about the good clear care and activity plans for individuals. Care Homes for Older People Page 25 of 30 Evidence: One member of staff expressed that they thought the manager was approachable, very helpful, and always available if you need help. From conversations with residents, relatives and staff the registered manager appears valued by them all. Since the last inspection there have been some changes to the senior management team with a new deputy manager employed during the last few months to assist the manager with the day to day running of the service. The registered manager has been working within her role in the home for over 5 years and has come with experience as a Registered Nursing in elderly care and has enhanced her skills with obtaining further degree qualifications in Health Service Management. Since the last inspection process she has continued to update her knowledge in regard to Mental Capacity, Health and safety, and dementia awareness. We looked at the processes the home has in place for quality assurance monitoring including how they seek residents and others opinion of the services provided. The home continues to use periodical surveys and audit checks on record keeping especially those for medication and care planning. Residents, relatives and staff meeting are all planned parallel to supervision and appraisal programme for staff. These records were not reviewed in detail during this inspection process. The manager confirmed that they do not take responsibility for safe keeping or handling of residents money. Any sundries or purchases made on their behalf are invoiced to the person responsible for the residents finances. A sample of the systems in place for safe working practices, were reviewed. This was to see if the areas of weak practices that were seen at the last inspection have improved. These were concerns of the food hygiene practices in the kitchen areas in the home, fire safety for bedroom doors not implemented properly and Control of Substances Hazardous to Health Regulations (COSHH) 1988 not adhered to. All these areas generated a requirement being made. From what could be seen improvements have been put in place. Kitchen areas appeared to be clean and tidy, Control of Substances Hazardous to Health Regulations (COSHH) 1988 items were not left unattended and fire safety practices are adhered to. Only one area of concern was identified during this inspection was that a kitchen assistant utilised inappropriately the hot water boiler for drinks to fill a floor cleaning bucket which compromised food hygiene standards in the kitchen. This was brought to the attention of the chef and home manager and concerns rectified immediately. Additional information was provided before the end of the inspection process that further action and new protocols were to be put in place to prevent the occurrence happening again. Care Homes for Older People Page 26 of 30 Evidence: They should also ensure that the fire risk assessments carried out for individuals safety, show that they have been reviewed regularly as staff have not been recording on the actual document when these have occurred. Care Homes for Older People Page 27 of 30 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 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 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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