Care Home: The Limes Care Home

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What the care home does well Potential residents are provided with sufficient information prior to moving into the home and needs assessment are performed to ensure residents needs can be met. Residents are treated with respect and dignity and can participate in a range of recreational activities within the home and the broader community. Residents benefit from the provision of an appealing balanced diet and are able to have snacks and drinks as they wish. Resident`s benefit from a well-maintained environment, which is pleasant, comfortable and clean throughout. There was sufficient, competent and qualified staff to support the residents and planned staff training refresher courses are being implemented. The home`s staff recruitment policies and practices are effective in protecting residents. The home is run and managed by a person who is fit to be in charge. Resident`s financial interests are safeguarded and the health, safety and welfare of resident`s is promoted. Quality Auditing procedures are performed on a frequent basis to ensure resident`s can contribute to developments within the home. What has improved since the last inspection? Accidents are now recorded effectively. What the care home could do better: Risk assessments and care planning processes should be further developed to ensure all residents health and wellbeing is promoted. The recording of complaints should be further developed Medication management processes should be could be further developed to promote the health and wellbeing of residents. The home policies and procedures should be reviewed on an annual basis. Future Annual Quality Assurance Assessments should be in more detail. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Limes Care Home Park Road Mansfield Woodhouse Nottinghamshire NG19 8AX     The quality rating for this care home is:   one star adequate 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: Steve Keeling     Date: 0 3 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 Limes Care Home Park Road Mansfield Woodhouse Nottinghamshire NG19 8AX 01623632681 01623622644 lantraz@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Nazeera Toorabally,Mr Ahmad Ally Toorabally care home 40 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 40 The registered persons may provide the following categories of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - code DE Date of last inspection Brief description of the care home The Limes is a care home providing personal care and accommodation for 40 residents who are over 65 years of age in the category of Older People (OP). The home is owned by Mr and Mrs Toorabally who oversee the conduct of the home. The Limes is a purpose built home with bedrooms and lounges located on both floors. A passenger Care Homes for Older People Page 4 of 30 Over 65 0 40 40 0 Brief description of the care home lift provides access to the first floor. The home is situated in well-maintained grounds in Mansfield Woodhouse close to local shops and amenities. All forty bedrooms are single and ensuite with the opportunity to utilise adjoining doors in two sets of rooms for couples where required. In addition to the ensuite facilities there are two assisted baths, two toilets and one shower on each of the two floors. All rooms have a telephone point available. Bedrooms are tastefully decorated and furnished, they can be personalised where required. Residents have access to sufficient communal space to meet their needs with a choice of lounge including one for smokers and sufficient dining space to accommodate everyone. The manager confirmed that on the day of the inspection, fees range from £290 - £350 per week, this fee does not include hairdressing, chiropody, magazines, escort duties, and personal toiletries. Residents have a copy of the Service User Guide in their bedroom which states that copies of inspection reports are held in the office and are available upon request. 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: one star adequate 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 focus of the inspection undertaken by the Care Quality Commission is upon outcomes for residents who use the service and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. The main method of inspection used is called case tracking which involves selecting residents who use the service and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. The registered manager and members of staff were spoken with as part of the visit and records relating to medication management were also inspected to form an opinion Care Homes for Older People Page 6 of 30 about the quality of care provided. A partial tour of the building was undertaken which included residents bedrooms and the communal areas they frequent to make sure that the environment is homely and safe. We have reviewed all the information we have received about the home since the last key inspection was performed when planning this visit. This included the Annual Quality Assurance Assessment which was provided by the registered manager together with 10 responses to the residents Have Your Say Pre inspection questionnaires, six responses the Have your Say staff survey and one response from a relatives survey. The quality rating for this service is 1 star this means the people who use this service experience adequate quality outcomes. 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. Care Homes for Older People Page 8 of 30 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. Potential residents are provided with sufficient information prior to moving into the home and undergo a needs assessment to ensure their needs can be identified and met. Intermediated care facilities are not provided at the home. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment stated Prospective residents/relatives have the information they need to make an informed choice about where to live. The Statement of Purpose and Service Users Guide sets out the aims and objectives of the home and the range of facilities and the services it offers to residents. The Have Your Say pre inspection questionnaire asked residents Did you receive enough information to help you decide if this was the right home for you, before you Care Homes for Older People Page 11 of 30 Evidence: moved in. Seven respondents stated yes and three respondents could not remember. All residents at the home are provided, in their bedrooms, with a summary of the homes Statement of Purpose, Service Users Guide and a complaints procedure. It was shown that the address for the Care Quality Commission was out of date but the manager addressed the issue immediately on the day of the inspection. Residents spoken with on the day of the inspection said that they had received enough information about the home to make an informed choice. A resident also confirmed that her son was encouraged to assist her in determining the homes suitability in meeting her needs. Information provided by the registered manager within the Annual Quality Assurance Assessment states All new residents are only admitted on the basis of a full needs assessment undertaken with all the relevant people involved Records were available to support this. Intermediate care services are not provided at the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication management, risk assessments and care planning processes require further development to ensure all the residents health and wellbeing is promoted. Residents are treated with respect and dignity. Evidence: The Have your Say questionnaire asked residents Do you receive the care and support you need, all ten residents stated Always. We asked residents if they felt their needs are being fully met. Responses included The staff are wonderful and caring, and I cannot fault it here, I am very happy The manager stated within the Annual Quality Assurance Assessment Residents health, personal and social needs are recorded and met. On examination of residents care plans and risk assessments, it was evident that they did not in all instances contain sufficient information for staff to carry out the tasks required to meet residents needs. One residents care plan did not contain information Care Homes for Older People Page 13 of 30 Evidence: to address a re-occurring chest infection, urine infections and the management of skin integrity. Another residents risk assessment highlighted a risk of pressure ulcer formation but a care plan was not in place to manage this risk. The manager addressed these issue on the day of the inspection. We discussed the issues highlighted above with the manager and she confirmed that the current risk assessment and care planning procedures are being reviewed in an attempt to make them more person centred and she anticipated that the process will be completed by the end of August 2009. Staff confirmed that they have access to the care plans at all times for guidance and reference. The Have your Say survey asked residents,Does the home make sure you get the medical care you need, nine residents stated Always and one resident stated Usually Records showed and residents confirmed that they have access to external professionals such as Doctors, Social Workers, Dentists, Opticians and Chiropodists . A resident stated We only have to ask to see out GP and its arranged for us. We asked a resident if she get their medication on time. The response was On several occasions I was without some of my medication for as long as a week. The management of medication was examined on the day of the inspection. Staff were observed to be administering medication correctly and medication storage facilities were appropriate. We examined residents Medication Administration Records which showed that when medication was stopped or restarted staff were not recording this appropriately, in addition handwritten entries on residents Medication Administration Records were not signed or dated in all instances. The manager stated that the pharmacy had not delivered some medication on time and so it was not given as prescribed. When asked if this happened frequently the manager said that they had spoken with the pharmacist about it but sometimes if the General Practitioner (GP) prescribed the medication mid month they ran out during the month and the GP surgery did not communicate if medication had to be continued or if it was prescribed as a short course. The Have your Say survey asked residents, Do staff listen and act on what you say, eight residents stated Always and two residents stated Usually. Comments made with the questionnaire included I feel that the home is very good at employing excellent caring staff and I try to be independent, but if I need help it is there for Care Homes for Older People Page 14 of 30 Evidence: me. All residents spoken with, and a residents relative, were very complimentary about the staff at the home, one relative said I come here every three to four weeks, I am very happy with the quality of care, the staff could not be kinder. We looked at other homes in the area but decided on this one, we are very impressed, the manager is wonderful and very approachable. We observed interactions between staff and residents throughout the day. It was shown that all interactions promoted residents respect and dignity. Staff were observed to be knocking on residents doors before entering and speaking kindly to them. Residents were being assisted to have their meals in a kind, considerate and un-rushed manner and staff were offering appropriate assistance when required. 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. A range of recreational activities are provided to residents and opportunities are available for residents to interact within the broader community. Residents benefit from the provision of an appealing balanced diet and are able to have snacks and drinks as they wish. Evidence: The manager stated within the Annual Quality Assurance Assessment Residents are happy with the lifestyle in the home. The Have your Say questionnaire asked residents Does the home arrange activities that you can take part in if you want, Nine residents stated Always and one resident stated Usually. An activities organiser is now employed over four days a week. Social activities are recorded which details if residents participate and how they enjoyed the activity. An activities timetable is displayed on the wall of the lounge area which clearly shows daily activities such as reminiscence, arts and crafts, chair exercise, foot massage, out and about days, sing a long, plate decorating and flower arranging. A local vicar also provides Holy Communion on a monthly basis which residents can attend if they wish. Care Homes for Older People Page 16 of 30 Evidence: We discussed social activities provision with residents at the home who confirmed that they are very satisfied with the current social activities programme, residents also confirmed that staff respect there wishes if they dont wish to participate. The Have your Say questionnaire for relatives asked What do you think the home does well the response was My mum enjoys the activities provided by the Limes, preventing boredom. The manager stated that an open door policy in relation to relatives and friends visiting the home is encouraged. Residents and relatives visiting the home on the day of the inspection confirmed that visitors are made very welcome by all the staff and they are offered drinks when they arrive. One visitor said The managers door is always open, she is wonderful. The Have your Say survey asked residents Do you like the meals provided, Seven residents stated Always, and three residents stated Usually. One residents commented The meals are nice but could be a little hotter. We discussed the issue with the manager who stated that the issue had been identified through internal auditing processes and the necessary actions have been initiated. At lunch time it was observed that sufficient staff were in attendance to assist residents who needed help with their meal. Residents said there was always plenty of food and there was a choice at lunch. Residents stated that the evening meal could be boring due to an over reliance on sandwiches and soup and said they would like alternatives such as jacket potatoes. Residents said a cooked breakfast is provided on Saturday mornings but otherwise cereal and toast is provided throughout the week which they were happy with. There was no menu displayed in the dining area but a four weekly menu was on display in the lounge area. The menu was in small print and did not provide information as to the choice being offered, although as mentioned earlier in the report, residents did state that they are always offered a choice. We asked people how they knew what was for lunch and they said that sometimes they had forgotten since they were asked the day before what they wanted to eat. Residents spoken with said that they receive plenty of drinks during the day, with juice always being available in the lounge area and hot drinks given with meals. The manager stated breakfast is served at 0800hrs, lunch at 1200hrs, tea at 1600hrs followed by snacks and drinks at 1900hrs, residents confirmed this. Care Homes for Older People Page 17 of 30 Evidence: We spoke to a senior carer who said that people had a food assessment on admission to identify specialist dietary needs, the cook confirmed this information. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents stated they felt safe in the home. Further developments are required in relation to the recording and management of complaints. Evidence: A complaints procedure is displayed in the foyer of the home. The procedure is also supplied in the Service User Guide which is provided to all residents at the home and their relatives on admission. An examination of the Service Users Guide showed the details relating to the address of the Care Quality Commission were out of date, the manager rectified this issue on the day of the inspection. The Care Quality Commission has received one complaint about the service since the last inspection took place. The complaint was referred to the Nottinghamshire Safeguarding Adults team for investigation. Records showed that the complaint was managed effectively. The Have your Say pre inspection questionnaire asked residents Is there someone you can speak to if you are not happy, all ten residents stated Yes. The questionnaire also asked Do you know haw to make a formal complaint, Seven residents stated Yes and three residents stated No. We asked residents if they felt confident in highlighting any concerns or complaints, responses included Yes, very confident and I have nothing to complain about, its Care Homes for Older People Page 19 of 30 Evidence: lovely here. We asked a relative visiting the home if she was aware of the complaints procedure and how to make a complaint, the response was I have never made a complaint, but I feel that the manager would address any concerns I have. Records showed that some staff have not had refresher Safeguarding Adults training since 2006. We spoke with staff to determine their understanding of their roles and responsibilities in relation to protecting vulnerable adults. They gave good account of the types of abuse and when they would report it to the manager or the Care Quality Commission. They were also aware of how to deal with a concern or complaint but they did not know how to make a Safeguarding Adults referral to external agencies such as Social Services. One the day of the inspection a resident told us that she had highlighted concerns to the staff and to the manager on four occasions about the noise from a fellow residents television. Her concern was that the volume was very high at night and she was not able to sleep. She said this was making her feel ill during the day and quite upset. Staff had documented her concerns in the residents care plan on all occasions but the issue had not been formally recorded within the home complaints book. We discussed the issue with the manager and asked her why this issue had not been recorded in the complaints book. The manager said she didnt realise she had to record complaints unless they were a formal nature but said that she was going to discuss further options with the resident to try and resolve issue as a matter of priority. 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. Residents benefit from a well-maintained environment, which is pleasant, comfortable and clean throughout. Evidence: The Have your Say pre inspection questionnaire asked people Is the home fresh and clean, nine residents stated Always and One residents stated Usually We asked residents if they were are satisfied with the standard cleanliness in the home, they all said they were. Residents also confirmed that their bedrooms are cleaned on a regular basis, as are the communal areas in the home. We did a partial tour of the building, which included residents bedrooms and communal areas. All areas were safe, well maintained, exceptionally clean, fresh and warm, residents bedrooms were homely, personalised and safe. Staff said that gloves and aprons are worn at all times when providing personal care to promote infection control and we observed that gloves and aprons were available and staff were using them appropriately. A well maintained garden area at the back of the home was found to be insecure which could be a potential risk to people with dementia as the side gates did not have Care Homes for Older People Page 21 of 30 Evidence: a locking facility. This concern was addressed immediately and locks were installed on the gates. A wooded area in the back garden could also be accessible for people as the fence was off poor quality. The manager stated that residents are supervised by staff at all times whilst in the garden area but would explore alternative arrangements to promote residents safety. We briefly examined the laundry facility, the washing machines meet the required standards and the housekeeper, when questioned, gave a good account of infection control procedures. We also spoke to the cleaner, she had a good knowledge of infection control practises and has a National Vocational Qualification in this area. We briefly examined at kitchen area which was clean and tidy. Records also showed that an appropriate record of food temperatures were maintained together with the the temperature monitoring of fridges and freezers. 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. There was sufficient, competent and qualified staff to support the residents and a staff training programme is being implemented. The homes recruitment policies and practises are effective in protecting residents. Evidence: The Have your Say pre inspection questionnaire asked residents Are staff available when you need them, six residents stated Always and four residents stated Usually. There were three staff on night duty when we arrived for the inspection at 0515hrs. Staff spoken with said there used to be two care staff on nights, and that it was very busy, but now there are three staff which is better. Staff also stated and records showed that there are always five care staff on duty during the day supported by the manager who works five days a week. We asked visitors to the home if they thought the staff were confident and competent in performing their duties, the response was The staff are very friendly, the manager always informs us of any developments and the care they give is very good. Residents spoken with also said the staff were very helpful and will do anything for them. Care Homes for Older People Page 23 of 30 Evidence: Staff files showed that recruitment processes are effective in promoting residents safety. Staff files contained, Protection of Vulnerable Adult checks, Criminal Record Bureau Checks, an application form and two written references. Records showed and staff confirmed that an induction process was provided when they commenced employment at the home. The manager confirmed that the old induction process has been recently amended and now utilises the Skills for Care common induction standards. Information provided by the manager within the Annual Quality Assurance Assessment did not specify the percentage of staff who have, or are working towards a National Vocational Qualification (NVQ) in care. Through discussions with the manager it was established that 70 of the care staff have or are working towards the qualification. A clear and well documented staff training matrix showed that some refresher training had not been performed on an annual basis. The manager, in addressing the issue, has arranged for the required refresher training to be performed from an accredited local training agency as a matter of priority. 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 run and managed by a person who is fit to be in charge. Residents financial interests are safeguarded and the health, safety and welfare of residents is promoted. Quality Auditing procedures are performed on a frequent basis to ensure residents can contribute to developments within the home. Evidence: The Have your Say survey asked residents What does the home does well. Comments included There is nothing in my opinion that the home could do better,The home does very well with catering, cleaning, care and medical attention which are the essentials and visitors are always made very welcome by friendly staff and carers. I am always spoken to nicely and properly. I am bathed regularly and kept clean and fresh. My room and bed is always immaculately clean, I am very happy and content, the manager is always more than happy to deal with anything that arises. The manager who is registered with the Care Quality Commission has been in post for the past six years and has appropriate qualifications to manage a residential home Care Homes for Older People Page 25 of 30 Evidence: such as a degree level Registered Managers Award and a National Vocational Qualification (Level 4) Residents and staff employed at the home praised the manager and felt confident in her abilities in providing and safe and efficiently run service. Staff said that the manager is very supportive and approachable at all times. A relative of a person who uses the service said We visited several home before deciding on this one, its got a friendly atmosphere, the staff are lovely, and the care is excellent. The manager stated and records showed that a formal quality assurance systems are in place such as residents meetings which provide residents with the opportunity to discuss issues relating to service provision at the home. In addition to the residents meeting the manager ensures that annual quality assurance questionnaires are distributed to residents and their relatives to identify any potential shortfall in service provision. We examined comments made by residents and relatives within the homes Annual Quality Assurance Questionnaires, they included I am very satisfied with the care and treatment I receive, The staff are very helpful and good to me,I receive excellent care and dad is always happy, satisfied and looked after, all the staff are approachable, polite and very helpful. Secure facilities are available for residents to store their spending money and valuables in their own bedrooms. A facility is available to residents to have their spending money stored securely within the home. We examined the records relation to residents monetary transactions and they were found to be well maintained and accurate. Information provided by the manager within the Annual Quality Assurances Assessment showed that routine maintenance is performed effectively to promote the health and wellbeing of residents. The information provided by the manager within the Annual Quality Assurance Assessment would benefit from being in more detail to fully inform the inspection process and to fully evidence that the home is meeting its aims and objectives. In addition it was documented that the homes policies and procedures had not been revised for over a year in some instances. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 132 Ensure the systems in place for the management of medication are safe and protect service users from harm 31/07/2008 Care Homes for Older People Page 27 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 1 7 15 The registered provider 31/07/2009 must ensure that that the revised risk assessments and care planning documentation address all the needs of residents in the home. To promote the health and wellbeing of residents and to demonstrate that residents needs are being met. 2 16 22 The registered provider 31/07/2009 must ensure that all concerns and complaints are recorded and responded to effectively. To demonstrate that concerns and complaints are managed effectively 3 16 18 The registered provider must ensure that all staff receive the planned refresher training in the protection of vulnerable adults 31/07/2009 Care Homes for Older People Page 28 of 30 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 To promote the health and wellbeing of residents at the home. 4 30 18 The registered provider must ensure that the planned refresher training is completed To ensure that staff recieve appropriate refresher training to promote the health and wellbeing of residents at the home. 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 31/08/2009 1 15 The menu could be displayed in a more prominent position in the home and specify all the choices available to residents thus further promoting residents choice. The boundary fence at the back of the build would benefit from being more secure. The registered provider could ensure that all the home policies and procedures are reviewed on an annual basis to ensure they are up to date. The registered provider could ensure that future Annual Quality Assurance Assessments contain sufficient detail to inform the inspection process and demonstrate that the home is meeting its aims and adjectives. 2 3 19 33 4 33 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. 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