Care Home: The Lodge

What the care home does well The Lodge provides a safe, clean and comfortable environment, visitors are made welcome and people tell us they are very satisfied with the standard of care. People also benefit from a wide range of suitable and stimulating activities and staff are competent, friendly and helpful. Comments we received included; "They make a real effort, they go out of their way". "You`ll get nothing negative from us, the care`s wonderful". "Its lovely here, we are well looked after, we are all thankful to be here". "I know she`s safe and well cared for and I`ve got no worries what so ever". "They`ve always got time to stop and speak with you". What has improved since the last inspection? Since the last inspection a record of all visits undertaken by the provider under regualtion 26 of the care homes regulations are maintained at the home. Consequently there are no outstanding requirements. What the care home could do better: Following this inspection the home was issued with one requirement to ensure that there storage of controlled drugs was safe and complied with the law. They have since confirmed that they responded immediately and a new `CD` cabinet that meets the required specifications has been installed. Although outcomes for people are generally good improvements can be made to improve peoples experience at mealtimes and opportunities for choice. Care plans could also be in a more suitable format so that people can be more involved in the care planning process. The service has made a commitment to improve signage and visual aids and support the manager on a more advanced programme of dementia training. Key inspection report Care homes for older people Name: Address: The Lodge The Lodge Copdock Ipswich Suffolk IP8 3JD     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: Tina Burns     Date: 1 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: The Lodge The Lodge Copdock Ipswich Suffolk IP8 3JD 01473730245 T/F01473730245 mick@geminicarelodge.orangehome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Gemini Care Limited care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home There has been a residential home caring for older people in the present building for many years. The current owner, Gemini Care Homes Ltd (a company owned wholly by Mr Abbas), was registered in December 1997. The Home is a large country house set in its own mature gardens, situated on the main road running through the village of Copdock. The County Town of Ipswich is a few miles to the north and the home is near to the main A12 road from London. The current owner carried out an extensive refurbishment of the accommodation in 1998, and in late 2005 completed two new ground floor wings providing spacious accommodation to a very high standard. At the same time a further refurbishment, and expansion of the communal areas was carried out, with more separate communal areas being created, and at the same time reducing the number of shared bedrooms. The home now caters for 44 residents, and specialises in caring for older people with dementia. At the time of this inspection fees ranged between £502.93 to £700.00 per week. Care Homes for Older People Page 4 of 29 Over 65 44 0 Brief description of the care home Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection process included a tour of the premises and examination of a wide range of documents and records including three residents care plans and three staff files. We also observed activity at the home and spoke with several residents, visitors and care workers throughout the course of the day. Because people with dementia are not always able to tell us about their experiences we used a formal way to observe people in this inspection to help us understand. We call this a short observational framework for inspection (SOFI). This involved us observing five people who use the service for two hours and recording their experiences at regular intervals. This included their state of well being, how they interacted with staff Care Homes for Older People Page 6 of 29 members, other people and the environment. Information has also been gathered from the homes Annual Quality Assurance Assessment (AQQA) submitted to the commission in September 2009, and survey forms completed by three staff members and one health care professional. Feedback was also gathered from three relatives who spoke with us by phone. The manager Mr Michael Bailey was on duty at the time of our visit and fully contributed to the inspection. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents or their representatives can be assured that they will have sufficient information to make an informed choice about the suitability of the home. Evidence: Information provided in the AQAA and people we spoke with confirmed that prospective residents or their representatives are invited to visit the home to help them decide whether it is the right place for them. They are also given a copy of the homes Service User Guide which includes detailed information about the home, including their terms and conditions and current fees. We looked at the records of three people living at the home and they all included copies of local authority assessments that were undertaken prior to admission. The service had also undertaken initial assessments to determine the individuals needs and preferences. The assessments we looked at covered a wide range of needs, for example; personal care, physical well being, personal hygiene & dressing, breathing, Care Homes for Older People Page 10 of 29 Evidence: mobilisation, eating & drinking, continence, vision, hearing, foot care, history of falls, personal safety & risk, weight & build, hobbies, orientation, social contacts & daily routine. The home does not provide intermediate care. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be treated with respect and have their individual needs met. Evidence: The AQAA tells us that everyone has a comprehensive care plan that is based on individuals needs. It also tell us us that staff have been trained in person centred approach and working practises promote dignity, privacy and choice. We looked at three care plans. They recorded the initial assessment of care needs under several headings such as mobility, continence, moving and handling, and nutrition. The style and format of the plans had not been developed with the needs of people with dementia in mind and the information was not recorded in a style that enabled them to be accessible to the service user. However we could see that they provided staff with information about the assessed needs of the individuals concerned and the interventions required to meet those needs. Care Homes for Older People Page 12 of 29 Evidence: The manager told us that they worked closely with families and relatives to produce detailed life histories and with the exception of four residents these were now in place for everyone. However they had not been completed for the three residents that we tracked two of whom had been resident since February 2009 and one since May 2009. People we spoke with confirmed that they were satisfied with the care and support provided at the home. Comments included; They make a real effort, they go out of their way, Youll get nothing negative from us, the cares wonderful, Weve got every confidence in the fact shes being looked after, Mum always looks well and cared for and Its lovely here, we are well looked after, we are all thankful to be here. Records of contact with residents GPs or other health professionals were maintained together with the outcome of appointments. There was also good evidence that the home kept relatives appropriately informed about residents health care matters. The survey we had returned by one health care professional told us; Peoples social and health care needs are usually properly monitored, reviewed and met by the service. During the inspection, the systems and procedures used for the safe storage and administration of residents medication were examined. We found that overall the systems in place were safe and appropriate. Staff responsible for administering medication had been trained and assessed as competent; the boots monitored dosage system was used and MAR sheets were appropriately signed and completed; Staff observed administering and handling medication did so safely and appropriately and weekly medication audits had been introduced. However, the storage of controlled medication (CD) did not comply with current legislation and consequently a requirement was made for the home to provide and install a suitable CD cabinet. The manager has since confirmed that this requirement has been addressed and a suitable cabinet has been ordered. Observations made during our SOFI assessment and more generally throughout the day were that staff interacted positively with residents. Staff were polite and respectful at all times and residents and relatives we talked with spoke highly of care staff and confirmed that the privacy and dignity of residents was maintained. Care Homes for Older People Page 13 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes active involvement from friends and family and people benefit from an exceptional range of activities and social events. People can also expect to receive meals that are balanced and nutritious but they cannot be sure that they will always be given the assistance they need to help them exercise choice and control over their daily lives. Evidence: Information in the AQAA, observations on the day of our visit and feedback from relatives and residents confirmed that the home works hard to ensure that people have access to stimulating activities. Although there was no structured activities in the morning people mainly congregated in the large main lounge where they listened to music and talked with each other, visitors and staff. Many of the residents clearly enjoyed listening to the music that was playing softly in the room and everyone was encouraged to take part in a minutes silence for remembrance day which was followed by listening to a short remembrance day service. Some people with extra care needs were supported in a quieter room that was more suited to their needs and others used their own private rooms or the small communal lounge in the coach house. We observed that there was a general atmosphere of calm and quiet throughout the morning, people needing assistance or support were attended to promptly and Care Homes for Older People Page 14 of 29 Evidence: appropriately and visitors were made welcome and given the opportunity to meet with their friend or relative in private or in any of the communal areas. There is a good programme of planned activities that includes a range of games, quizzes, and reminiscence sessions and the programmed activity for the afternoon of our visit was a slide show in the large main lounge. The layout of the room was changed so that everyone could comfortably access the room and see the screen clearly. The organiser ran the event extremely well, generating interest from most people and encouraging everyone to talk about the animals displayed on the individual slides. Most people appeared to thoroughly enjoy the event but those that didnt want to participate used one of the other communal areas or chose the solitude of their own room. The assistant manager, who was also the activities organiser, showed us photo albums that were a good record of events and activities that had taken place. They also showed us some of the biographies which had been created for residents in conjunction with their families as part of their reminiscence work, and as a guide for staff on interpreting and understanding residents feelings and interests. Information provided in the Autumn newsletter included details of recent events and events planned for the coming month. Planned activities included several different entertainers and singers, a Christmas Spectacular, christmas carols by Hadleigh Orchestra, christmas variety shows, candle light carols, a christmas party and a special festive show. Arrangements were also being made for a visit by some of the performers in the Wolseys pantomime production of Aladdin and some scottish bagpipers over new year. Comments we received from relatives included; Virtually something on everyday of the week, They dont just sit them there and forget them, We get newsletters twice or three times a year and were invited to events and Somethings going on most days. With the exception of people accommodated in the Coach House most of the residents had their lunch in one of the two main dining areas apart from the six high dependency residents who were supported to have their lunch in the quiet room. The main meal was ham and cheese bake with chips, peas and tomatoes followed by chocolate sponge and custard. Our observations were that people appeared to be enjoying their food. When asked about the quality of food one person told us Pretty good really. We all get plenty and a relative said Looks to be alright. Mum never complains and likes her food. Condiments were available by request but not freely Care Homes for Older People Page 15 of 29 Evidence: available on any of the tables, it was also noted that people were not offered a glass of drink with their lunch although coffee and teas were available afterwards. Paper napkins were used and plastic aprons were provided to everyone to protect their clothes. Of the six people in the quiet room five required one to one assistance with their meal however they had the assistance of two staff which meant that three people had to wait until staff were free. We were told that until then their food was kept hot in the kitchen. We observed that the staff assisting were supporting residents at a suitable pace and manner, however the routine in place has the potential to cause staff to rush so that they do not have to leave other residents waiting. We were provided with two menus. One was the main menu and the other was the alternative menu. We were advised that people were not asked to chose from a menu but if they did not like the main option they could have the alternative. The manager told us that they had tried to offer menu options in the past but it hadnt worked, instead they keep a record of everyones likes, dislikes and special requirements and design the menus around them. The menus we looked confirmed that people are offered well balanced, nutritious meals. The menu was displayed on the wall with suitable pictures however it was not easily accessible or in a suitable font size. On the morning of our visit we observed that people were only asked if they wanted a cup of tea from the drinks trolley despite alternatives available. This practice does not encourage people to make simple choices in their daily lives. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be listened to and have their complaints taken seriously. Further more they can expect to be safeguarded from abuse. Evidence: The homes complaints procedure was on display in the entrance to the home and included in the Service User Guide. It was clearly detailed and included relevant contact details and information about the different stages of the complaints process. Information provided in the AQAA confirms that all prospective residents (or their representatives) are given a copy of the service user guide which details the complaints procedure. It also tells us that the complaints procedure is discussed during the admission process so that people are clear about how they can make a complaint. Further more, it tells us that new staff undertaking their induction programme undertake training or instruction in receiving complaints, staff whistle blowing and abuse. People we spoke with during our visit confirmed that residents and their relatives are able to raise concerns via formal and informal processes, such as reviews, surveys and relatives meetings and the manager routinely takes the opportunity to talk to everyone informally. This was observed during our visit. Consequently people confirmed that issues are usually resolved as they crop up and before they become Care Homes for Older People Page 17 of 29 Evidence: complaints. Comments we received from relatives included; I know shes safe and well cared for and Ive got no worries what so ever, We have every confidence in the fact that she is being well looked after and Theyve always got time to stop and speak with you. The home maintained a record of complaints and compliments. Since the last inspection they had received numerous compliments from relatives about the care provided and one formal complaint. The complaint had been investigated and addressed appropriately under the homes complaints procedure. Staff we spoke with had undertaken Safeguarding Adults Training and they confirmed that they felt confident they knew how to recognise signs and symptoms of abuse and report any concerns. The manager confirmed that the homes adult protection policies reflect the local authoritys multi agency safeguarding procedures. Since the previous inspection we have received two complaints. The first was investigated and addressed appropriately by the home. The second included some serious allegations of poor practice which we referred to the local authority safeguarding team. These allegations were taken seriously and investigated but were not upheld. The Local Authority tell us that during the investigation the manager was fully co-operative and provided all information required. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to live in a safe, clean and comfortable environment. Evidence: The home is registered to provide accommodation for up to 44 older people with a diagnosis of dementia. The home stands in extensive grounds and accommodation is sited on two floors both of which are accessible via a passenger lift. With the exception of two double rooms all bedrooms are single rooms. At the time of our visit six of the single rooms were located in the coach house which is detached from the main building. The managed advised that the double rooms will cease to exist following the planned building works in 2010. Further more we were advised that the coach house will no longer be used as residents accommodation, all accommodation will be provided in the main building which will have been extended. We looked round the premises and our findings reflected that of our last visit. There was a range of communal accommodation available, including a large lounge, another smaller lounge for residents with higher dependency levels, a small lounge and conservatory area in the coach house, and two small dining rooms. Nineteen of the bedrooms were provided in wings that had been built in 2005 and these were modern and spacious and furnished to a good standard. Bedrooms we saw Care Homes for Older People Page 19 of 29 Evidence: within the older part of the building were also comfortably furnished and maintained to a good standard of decorative order and repair. Residents and their families had also been encouraged to make their bedrooms as homely as possible with the addition of personal belongings, ornaments, mementos and photographs. Our observations were that as a specialist dementia care service there was insufficient suitable signage and visual orientation aids throughout the home. However information provided in the AQAA and discussions with the senior managers indicates that this in an area that they intend to improve on in the coming months, particularly in light of the proposed building works that aim to improve and modernise the environment. The and two gel, homes laundry room was situated in a separate building between the main house the coach house. It was fitted with a sink and hand wash basin and equipped with suitable commercial washing machines and tumble dryers. Liquid soap and hand disposable gloves and disposable aprons were provided. The home appeared clean and tidy, and there were no unpleasant odours. Comments received from relatives included; Its always clean. The room has never been dirty and theres always clean towels, The minute I walked in I got such a good feeling. It looked nice, it was lovely and clean and Its always clean. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect their needs to be met by a team of trained and competent staff. Further more they can expect to be safeguarded by thorough and robust recruitment procedures. Evidence: The manager advised us that there is usually six care staff on duty between 7:00am and 9:00pm and four from nine pm until 7:00am. The manager is supernumerary and there is also a team of ancillary staff including kitchen and domestic staff. On the day of our visit the SOFI observation we carried out and our general observations throughout the day were that there was a good staff presence and care staff were available at all times to attend to peoples needs. Comments we received from residents and their relatives gave high praise to staff and included: The cares wonderful, the people are wonderful, Weve got every confidence in the fact shes being looked after, Mum always looks well and cared for and Its lovely here, we are well looked after, we are all thankful to be here. We looked at three care workers records and found that all documentation required was in place including evidence of a personal identification check, a Criminal Record Bureau CRB check and POVA first check, a copy of their application form and two written references. People told us that they had also had face to face interviews as Care Homes for Older People Page 21 of 29 Evidence: part of the staff selection process. The AQAA tells us that new staff undertake induction programmes that meet the skills for care induction standards. It also tells us that twenty one out of twenty five care staff have completed or are working towards a relevant NVQ qualification and the remaining four are waiting to enrol. Records we examined and staff we spoke with confirmed that staff training is provided in the following areas; Care planning, dementia, fire safety, moving and handling, food hygiene, safeguarding adults, infection control and health & safety. Staff responsible for administering medication also undertake medication training. All training was provided in-house by the homes manager or HR manager with the assistance of DVDs. Some discussion took place with the manager and senior management team about the suitability of this type of training and they agreed to look at alternatives to enhance their in-house programme, particularly with regard to dementia care. Three out of three staff that completed surveys told us that their induction covered everything they needed to know to do the job. They also confirmed that they are provided with training that is relevant to their work, helps them to understand the needs of people they support, keeps them up to date and provides them with the knowledge and skills they require to do the job. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the residents. The health, safety and welfare of staff and residents is promoted and protected. Evidence: The Registered Manager of the home is Mr Michael Bailey. Mr Bailey has been in post for five years and completed the Registered Managers Award in March 2005. He told us that the training he has undertaken specifically relating to dementia care has included a one day and a three day course run by the Alzheimers society.Some discussion took place with the manager and senior management team about the range of higher level courses for people working in dementia care services and they agreed that the manager should undertake further training in this area to ensure that their knowledge was current and up to date. Mr Bailey was present on both days that we visited. He was fully involved in the inspection process, co-operated fully and gave us all the information we asked for promptly, openly and professionally. We also met and spoke with the companys Care Homes for Older People Page 23 of 29 Evidence: senior managers; the Managing Director, the Human Resources and Compliance Manager and the Operations Manager. The registered manager leads a senior care team that consists of a care manager, assistant care managers and senior carers. Feedback from people we spoke with confirmed that the management structure works well. There is always a senior member of the team on duty and people feel that they are approachable, helpful and supportive. Discussion with the managers and documentation examined confirmed that the home has appropriate Quality Assurance processes in place such as internal audits, residents reviews and surveys. We also saw records of provider visits carried out under regulation 26 of the Care Homes Regulations 2001 and the minutes of staff meetings and relatives meetings giving people the opportunity to contribute their views to matters relating to the home. The homes AQAA was adequately completed and submitted to us within the given timescale. It demonstrated that the manager has a good understanding of National Care Standards and included information about how they are able to evidence what they do well. The manager advised that the home does not handle large sums of residents personal monies or manage anyones personal accounts. We were advised that all current residents manage their finances with support from their relatives or representatives. All bedrooms have lockable facilities for cash and valuables. Three out of three care staff that returned surveys told us that their manager gives them enough support and meets with them regularly to discuss how they are working. This was evidenced in documentation that we examined during our visit and in the comments we received which confirmed that people found the manager approachable and supportive. Staff training covered areas such as health and safety, infection control, moving and handling and fire safety. The staff we spoke with told us that they found the moving and handling training thorough and they confirmed that they were provided with all the equipment they required. Moving and handling tasks observed throughout the inspection were carried out safely and appropriately. The AQAA tells us that manual handling equipment and fire protection equipment is Care Homes for Older People Page 24 of 29 Evidence: regularly serviced. During our visit there was good evidence of routine health and safety checks. A recent food hygiene inspection by the local borough council had awarded the home four out of five stars which meant that the home had a High standard of compliance with food safety legislation. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 A suitable controlled drug 05/02/2010 cabinet must be supplied. (The cabinet must be a metal cupboard of specified gauge, it must have a specified double locking mechanism and it must be fixed to a solid wall or a wall that has a steel plate mounted behind it and fixed with either Rawl or Rag bolts). To ensure that arrangements are sufficiently robust and comply with current legislation regarding controlled medication. 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 7 Care plans should be developed with the needs of the service user group in mind so that they are in a style and format that enables them to have access to their care plans. The home should review how people with high care needs are assisted at meal times so that they can enjoy their Page 27 of 29 2 15 Care Homes for Older People 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 meal at the same time as everyone else in the home. 3 15 The home should look at how they can improve the meal time experience for everyone, for example by making drinks and condiments more freely accessible, by improving opportunities for choice and by providing more suitable clothing protectors. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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