Care Home: The Firs

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What the care home does well People are very well supported and assisted in choosing to live at the home and their needs are fully assessed and accounted for withing person centred approach. Peoples health care needs are effectively met via a person centred approach. And their rights to privacy, dignity and respect of successfully promoted. People are well supported in their daily living arrangements in accordance with their known individual lifestyle preferences, expectations and capacities. And they also receive nutritious meals, usually in accordance with these. Comments received from people included, Staff in the Extra Care Unit give one hundred percent. You could not get more caring people. All health needs are attended to. A very professional service. staff are skilled and are always attending training to improve. People can continue to be confident that the home will listen to and take seriously any concerns or complaints they raise. And that they will be suitably protected from harm and abuse. People live in a safe and overall clean and comfortable home, furnished, decorated and equipped in accordance with their needs. People can be assured that their needs will be met from staff that is effectively recruited, inducted, trained and deployed People can be assured that their needs will be met from staff that is effectively recruited, inducted, trained and deployed The home is well managed and run and peoples health, safety and welfare effectively protected and promoted. What has improved since the last inspection? They have met with all of the requirements that we made at our last key inspectoin. This means that, They are up to date with their servicing and maintenance arrangements for all of their systems and equipment at the home. They have notified us in writing as necessary of any significant events that may affect the wellbeing of any resident, including detail as to their action to ensure peoples ongoing safety and welfare. They are ensuring safer storage of peoples medical creams and lotions prescribed andhave are regularly auditing these to ensure correct staff practise. They have included details as to the range of fees charged per week and what they cover within their service information guide for people. They have improved their quality assurance and monitoring systems and to include reports of the monthly visits to the home by the provider representative. What the care home could do better: The home knows what they do well and what they need to improve. We are confident they will continue with their quality monitoring of their service aims and objectives, in consultation with people. They have agreed to consult with the environmental health officer about their arrangements for transporting meals from the main kitchen to people around the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Firs 90 Glasshouse Hill Codnor Ripley Derbyshire Derbyshire DE5 9QT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Richards     Date: 0 4 0 6 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 30 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 30 Information about the care home Name of care home: Address: The Firs 90 Glasshouse Hill Codnor Ripley Derbyshire Derbyshire DE5 9QT 01773743810 01773571531 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Gerald Poxton,Mrs Sandra R Poxton,Mrs Ann Theresa Poxton,Dr Michael G Poxton,Ashmere Care Group,M care home 42 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 30 0 dementia old age, not falling within any other category physical disability Additional conditions: 12 0 2 Ashmere Care Group is registered to provide at The Firs Nursing Home personal care with nursing for service users of both sexes whose primary needs fall within the following categories:- Old age not falling within any other category (OP) (30) Physical Disabilities aged 50 years and over (PD) (2) Dementia aged 55 years and over (DE) DE(E) 12 The maximum number of service users to be accommodated within The Firs Nursing Home is 42 Date of last inspection Brief description of the care home The Firs is situated in the village of Codnor, close to the market town of Ripley and all local amenities and is located on a direct bus route to giving access to local towns and Care Homes for Older People Page 4 of 30 Brief description of the care home villages. There are two units to the home. The main unit provides accommodation, personal and nursing care for up to thirty older people and including two people with physical disabilities aged fifty years and above. The extra care unit provides single room en suited accommodation and personal care for up to twelve people aged fifty-five years and above with dementia. There are a number of environmental aids and adaptations are provided to assist those who may have mobility problems. Including a shaft lift and emergency call system throughout. There are attractive gardens, providing level access and seating areas for people. Each unit has a dedicated staff team comprising of registered nurses and care staff in the main unit, with care staff, including a team leader for the Extra Care Unit. All staff is responsible to the registered nurse manager for the service, with support via external management arrangements. Hotel services are centralised. Fees charged per week via private contract arrangements range between 442.00 to 819 pounds with no additional charges. They are dependant on the individuals category of placement, their assessed needs and the type of room accommodated. Fees charged per week for people funded via local authority arrangements range from 324 to 456.46 pounds per week are determined in the same way. Where applicable and with a negotiable 30 pound top up fee. They do not include the free nursing care payment for those eligible. This is retained by Ashmere. Day care services are 50 pounds per day. Stand alone bathing service is ten pounds per day. 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire, AQAA, which we ask the home to complete on an annual basis in order to provide us with key information about the service. We also received some survey returns from some of the people who use the service, peoples relatives and some staff employed there. At this inspection there were thirty one people accommodated. We used case tracking Care Homes for Older People Page 6 of 30 in our methodology, where we looked more closely at the care and services that three people receive. We did this by talking with them and their representatives, observing staff general interactions and approaches with them, looking at their written care plans and associated health records and by looking at their private and communal accommodation. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the registered manager and the regional manager about the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian religion. What the care home does well: What has improved since the last inspection? They have met with all of the requirements that we made at our last key inspectoin. This means that, They are up to date with their servicing and maintenance arrangements for all of their systems and equipment at the home. They have notified us in writing as necessary of any significant events that may affect the wellbeing of any resident, including detail as to their action to ensure peoples ongoing safety and welfare. They are ensuring safer storage of peoples medical creams and lotions prescribed and Care Homes for Older People Page 8 of 30 have are regularly auditing these to ensure correct staff practise. They have included details as to the range of fees charged per week and what they cover within their service information guide for people. They have improved their quality assurance and monitoring systems and to include reports of the monthly visits to the home by the provider representative. 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 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are very well supported and assisted in choosing to live at the home and their needs are fully assessed and accounted for within a person centred approach. Evidence: at our last key inspection we found that key service information provided for people benefitted the majority, but did not best promote equality of access or meet with any diversity of need. We also found that peoples assessed needs were mostly well accounted for, although their capacity and rights to make key decisions about there lives were not. We made a requirement that the service guide provided for people specifies the range of fees charged. And we also made recommendations about providing key service information in alternative formats as necessary and to develop needs assessment records to account for individuals mental capacity. Care Homes for Older People Page 11 of 30 Evidence: At this inspection we found that the first two were achieved and that work had commenced in respect of the latter. In our annual quality assurance questionnaire completed by the home, they described their comprehensive admission and assessment process for people. And they told us about improvements they have made, which included the improvements in their service information for people and also their introduction of a mental capacity assessment format. They also gave us some statistical information that we asked for about the number, category and dependency needs of people accommodated. At this inspection people told us that they received the information they needed to assist them in choosing the home, including a written contract. And that they receive the care and support they need. One relative of a service user with dementia told us they were confident that the home could meet the service users needs on their admission and we saw that people were provided with written confirmation from the home to this effect. We saw that comprehensive information is provided within the homes brochure, including detailed fee information, a copy of the homes most recent newsletter an independant care comparison questionnaire tool designed for people to complete to assist them in choosing a home. Key service nformation is also provided for people on the homes website, including information about finances and rights and links to further resources on the web. The recorded needs assessment information that we looked at were comprehensive, person centred and accounted for risks to individuals personal safety along with carer family and other social contacts and relationships. Peoples preferrred daily living routines were well accounted for and also for the nursing care they receive where required. Discussions that we held with people who use the service and their representatives, discussions with staff and examination of records tells us that the home is able to effectively meet peoples needs there Care Homes for Older People Page 12 of 30 Care Homes for Older People Page 13 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. Peoples health care needs are effectively met via a person centred approach. And their rights to privacy, dignity and respect successfully promoted. Evidence: At our last key inspection we found that peoples healthcare needs were being met and their dignity and privacy rights promoted. But that arrangements for the storage of peoples medicines creams and lotions did not accord with recognised safe practise guidance. We made a requirement telling the home what they must do to ensure safe practise here. And we found this is achieved at this inspection. At our last inspection also made a recommendation about medicines record keeping and found at this inspection that this was mostly met. We have referred to this below. At this inspection people told us that they receive the care and support they need, including medical support. And we saw that staff were respectful and sensitive in their approaches towards people. Care Homes for Older People Page 14 of 30 Evidence: Comments that we received from people, included Staff give one hundred percent. I would recommend the ECU , you could not get more caring staff. All health needs are attended to. It is a very professional service. Staff are skilled in their work and are always attending training. Care plans that we looked at were person centred, comprehensive and in accordance with peoples risk assessed needs and had regularly recorded reviews. They were also reflective of reognised guidance concerned with the care of older people, including for their nursing care. We found the arrangements for the ordering, storage, administration and disposal of peoples medicines were well managed. Staff administering medicines to people are suitably trained and are provided with the necessary facilities, equipment and information, including policy and procedural guidance to support them in this. We also saw from records held, that medicines systems are regularly audited to determine their effectiveness and to ensure that they comply with recognised guidance concerned with the management and administration of medicines in care homes. Care Homes for Older People Page 15 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. People are well supported in their daily living arrangements in accordance with their known individual lifestyle preferences, expectations and capacities. And they also receive nutritious meals, usually in accordance with these. Evidence: At our last key inspection we found peoples lifestyles at the home continued to meet with their overall expectations. Although we made a recommendation about developing community and social support in respect of younger adults with physical disabilities who may be admitted there. And at this inspection we saw that the home had taken this forward for one younger adult accommodated there. In our annual quality assurance questionnaire completed by the home, they told us that they continue to promote peoples choice with regard to their daily lives and social activities. They told us about some of the improvements they have made, which include the introduction of more themed events, provision of a newsletter, appointment of a dedicated activities coordinator and by developing the provision of visual aids around the home to promote reminiscence and discussion for people. Care Homes for Older People Page 16 of 30 Evidence: They also told us about ways in which they would like to improve further in this area. This focuses on involving peoples families, friends and advocacates at the pre admission stage for any potential service user. To ensure they collate as much key information as possible about peoples known daily living preferences, choices and routines. At this inspection people told us that there are usually activities they can join in. And that they usually enjoy the meals provided. We did receive some expressed views that variety and quality could be improved, although this was not the majority view. However, we saw that the home periodically asks people their views by way of satisfaction surveys, including as to the quality of food provided. During our visit we observed open plated hot lunches being taken from the main kitchen to the Extra Care Unit and on an open trolley, passing the laundry room. We discussed this with the manager and recommended she consult with the local environmental health officer to determine safe practise here. And we have made a recommendation about this under the Mangement section of this report. We saw staff engaging people in a range of activities throughout the day, in smaller groups or individually. These included soft ball games, dancing, hand manicures and footspa treatments. We looked at progress being made in putting together memory boxes for people in the extra care unit and saw that information about activities is posted for peoples information around the home, including in a picture format to assist people with dementia. And also with information about how to contact local advocacy services. Activities that are regularly organised include, music and movement, reminscence, quizzes, film nights, themed meals, including fish and chip evenings, garden activity and walking, domino club. And with regular entertainments organised, including a visiting accordionist, which people told us they enjoy and also engagement in church services in the home. We also saw that each person has a written lifestory dairy in place, which staff put together from information given by each resident, their relatives, friends and representatives. These provide comprehensive information about their past lives and known daily living choices and lifestyle preferences to assist staff in their care delivery. We also saw that recorded daily living plans are in place for each person and regularly reviewed with them or their representative. And that records as to their daily living choices and engagement in activities are maintained. Lunches were served to people in the dining room, lounge and also in their own rooms Care Homes for Older People Page 17 of 30 Evidence: in accordance with their preferences and choices and we saw that people who required assistance, receive this from staff in a sensitive, calm and unhurried manner. Daily menus were displayed and peoples choices were reconfirmed with them at the point of serving their meal. There are a variety of visual aids to stimulate reminscence and discussion around the home, including large picture photographs of past and present relevant to the local community. Photographs of residents engaging in recent activities at the home and also photograps of them from their younger days, which some residents enjoyed telling us about. People were looking forward to a forthcoming Street Party event organised by the home in celebration of the Queens birthday. And during our visit, a celebratory birthday cake was presented to one resident for their birthday. Care Homes for Older People Page 18 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. People can continue to be confident that the home will listen to and take seriously any concerns or complaints they raise. And that they will be suitably protected from harm and abuse. Evidence: At our last key inspection here we found that people could be confident the home would take their concerns and complaints seriously and that they would be protected from abuse. We made a requirement relating to the need to develop their policy guidance for staff concerned with safeguarding people from harm and abuse and we found this to be met at this inspection. In our annual quality assurance questionnaire completed by the home, they told us that they always ensure that peoples concerns and complaints are listened to, taken seriously and acted on and that they are protected from harm and abuse. They tell us they are always seeking to improve by ensuring that staff receive the information and training they need to effectively safeguard people. The home has also told us in writing about an allegation made of the emotional abuse Care Homes for Older People Page 19 of 30 Evidence: of residents accommodated in the extra care unit by a carer employed to work at the home, including the action they were taking to ensure peoples health, safety and welfare. And further discussion and examination of records at this inspection tells us that the home took the necessary action to protect people. At this inspection people told us that they know who to speak with if unhappy and how to complain. And we saw that people are provided with clear written information about how to complain, both within the homes welcome brochure and also displayed in the home. Staff was conversant with their role and responsibilities concerned with dealing with complaints and responding to and reporting suspected or witnesse abuse of any service user. They also confirmed that they receive regular training for the latter, for dealing with aggression. Care Homes for Older People Page 20 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. People live in a safe, clean and comfortable home, that is overall well furnished, decorated and equipped in accordance with their needs. Evidence: At our last key inspection we found the home to be overall clean and comfortable, although with standards of decor and renewal variable between the two units. And we recommended that action be taken to address this variance for the benefit of people accommodated on the main unit. In our annual quality assurance questionnaire completed by the home, they told us that they provide people with a safe, clean environment, which is redecorated and refurbished on a continuous basis. They told us about some of the improvements they have made to the fabric and facilities in the main unit and their plans for the coming months, which tells us there has been ongoing upgrading and investment there. At this inspection most people told us that the home is usually fresh and clean and we observed the same. We found that a housekeeper was recently employed with responsibility for assessing cleanliness and monitoring areas for refresh and redecoration. And that a full infection control audit had been recently undertaken via the local primary care trust specialist link nurse resulting in some key policy and Care Homes for Older People Page 21 of 30 Evidence: practise changes aimed at promoting food infection control. The overall outcome score of this audit was eighty five percent. When we looked at the private and communal areas accessed by people we case tracked, we found these to be safe, clean, comfortable and overall well furnished, decorated and eqiupped in accordance with peoples risk assessed needs. And we saw that there are suitable laundry and hand washing facilities provided. We also saw that there is an ongoing programme in place for the routine maintenance, repair and renewal of the home. Care Homes for Older People Page 22 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. People can be assured that their needs will be met from staff that is effectively recruited, inducted, trained and deployed. Evidence: At our last key inspection we found peoples needs to be met from a competent staff team that is effectively recruited, inducted and trained. In our annual quality assurance questionnaire completed by the home, they told us they ensure that staff deployment accounts for peoples dependence needs and provides for necessary hotel services support and that they promote flexible family friendly working arrangements for staff and support their training needs. They told us about some developments that they have made to their established training programme, their staff meeting profile and in providing a student learning environment for college placements, along with improved mentoring arrangements. And tell us they aim to continue with the above, to set up a bank of staff to cover for sickness and absence and to continue with their staff training and development programme. They gave us some statistical information that we asked for, which indicates a stable Care Homes for Older People Page 23 of 30 Evidence: staff workforce, with the majority trained to at least NVQ level 2 or above. At this inspection people told us that staff listen and act on what they say, are always avaialable when they need them and seem to have the right skills necessary to care for people there. Staff described satisfactory arrangements for their recruitment, induction, training and deployment and records that we examined were reflected this. 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 home is well managed and run and peoples health, safety and welfare effectively protected and promoted. Evidence: At our last key inspection we found the home to be reasonably well managed and usuallly in peoples best interests. Although with some inconsistencies in monitoring its own effectiveness as to ensuring peoples health and welfare. We made a number of requirements in our report of that inspection. These included for the servicing and maintenance of specified systems and equipment at the home. The provision of reports of the monthly visits to the home that are required from the registered provider. And circumstances under which specified written notification of any event affecting the wellbeing of any service user must be forwarded to the Commission. Care Homes for Older People Page 25 of 30 Evidence: The provider told us what they were going to do to meet with these requirements, which was satisfactory in principle and we found these to have been met at this inspection. In our annual quality assurance questionnaire completed by the home, they told us that they aim to ensure the home is run in peoples best interests, promoting peoples health, safety, welfare and protection. They told us about some of improvements they have made, which focus on staff support and development and record keeping systems. And they gave us satisfactory information as to how they intend to continue to monitor practise to ensure that peoples health and safety is efectively promoted. They also provided us with some statistical information that we asked for, which told us that they ensure the necessary maintenance and servicing of systems and equipment at the home and aim to reguarly review policy and procedural guidance that is in place for staff to follow. At this inspection staff described good arrangements for their supervision and support, including communication with them to assist them in undertaking their duties of care. We saw that the registered manager has continued to ensure she keeps up to date with clinical practise and management practise and with good support from external management. There are effective arrangements in place for ongoing and formal consultation with service users, their representatives, which assists the home in measuring whether they meet their stated service aims and objective. These include regular meetings, satisfaction surveys, one to one consultation and an open door management approach. Effective quality assurance and monitoring systems are in place and audits are undertaken at monthly intervals. A full infection control environmental audit had been undertaken since our last key inspection, via the local primary care trust specialist nurse, with an overall scoring of eight five percent achieved. And with action determining further improvements. The home does not manage monies on behalf of any resident. Safekeeping facilities are provided in each persons own room. And individuals needs assessment records account for their financial arrangements and interests. Staff told described satisfactory arrangements for ensuring safe working practises, including for their training and also the provision of equipment. We saw that overall, the home was free from any observable hazards during our visit. Although we made a Care Homes for Older People Page 26 of 30 Evidence: recommendation here about the transportation of meals around the home, which we have also referred to under the Daily Life and Social Activities section of this report. We also found there is a suitable system in place for the reporting and recording of accidents and untoward incidents. 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 1 38 Consultation should be undertaken with the local environmental health officer regarding the arrangements for the transportation of meals around the home from the main kitchen. So as to determine safe practise, with action as necessary. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!