Care Home: The Manor Nursing Home [Bishop`s Hull]

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What the care home does well People who live at the home told us `you couldn`t better it, the staff are superb`, `I couldn`t wish for anymore. The staff are very kind, the food is very good and I`m very happy living here`, `they look after me well` and `I can`t fault it`. The home encourages the people who live there to be involved in the running of the home through taking part in staff interviews and meetings. The home is well maintained, nicely decorated and clean. There is an ongoing maintenance and refurbishment programme. The gardens are pleasant and provide seating areas for people who live at the home. Bedrooms were nicely personalised to reflect people`s individual interests and tastes. The management team are continually identifying areas for improvement and it is evident that people who live at the home have benefited as a result. What has improved since the last inspection? The home has introduced a `Thursday Club`. People who live at the home have the opportunity to put forward their ideas for trips, menus and activities. There is also discussion around what is good and areas the home needs to work on. One person living at the home said `I like going to meetings, it`s good to all get together`. The home has purchased a Wii Fit and people can take part in weekly sporting challenges. The home has been awarded the Barchester `5 star dining experience`. Snacks such as yoghurts and fruit smoothies have been introduced for people with swallowing difficulties and special diets. Seating assessments for each person who lives at the home have been carried out by the physiotherapist. This is to ensure that people have appropriate seating to meet their needs. The home is introducing a life skills kitchen/dining area on the first floor. The worktops and units are fitted at a height that people who use a wheelchair will be able to access. The home has carried out work in the garden to create a pleasant environment. There are a number of seating areas, bird feeders, and attractive plants. Ramps have been put in place so that people who use a wheelchair can access the gardens. An organic vegetable garden is being introduced, the fresh produce will be used within the home. What the care home could do better: When information in a person`s care plan changes, the previous entry should be crossed through so that there is clear information for staff to follow and to ensure the persons wishes are met. The home should ensure that they date prescribed medicinal creams on opening and discard appropriately. This it to ensure that the cream is used when at it`s best. The home should ensure that two staff sign hand written Medication Administration Record Sheets to ensure the entry is checked for accuracy. This is to ensure that people receive the correct medicine. When employing new staff, a reference from the last employer should always be sought. A written explanation of why the reference could not be obtained should be provided if appropriate. Key inspection report Care homes for older people Name: Address: The Manor Nursing Home [Bishop`s Hull] Haydon Close Bishops Hull Taunton Somerset TA1 5HF     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: Alison Philpott     Date: 0 7 0 8 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 28 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 28 Information about the care home Name of care home: Address: The Manor Nursing Home [Bishop`s Hull] Haydon Close Bishops Hull Taunton Somerset TA1 5HF 01823336633 01823346072 manor@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Alexandra Crew Type of registration: Number of places registered: care home 86 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 86, which includes a maximum of 20 service users with a physical disability. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) and Physical disability (Code PD) Date of last inspection Brief description of the care home The Manor Nursing Home was purpose built and is set in attractive landscaped gardens with ample car parking space. Accommodation is mainly provided in single bedrooms all of which have en-suite facilities. Care Homes for Older People Page 4 of 28 Over 65 86 0 0 20 Brief description of the care home Corridors are wide and equipped with handrails. There are a variety of communal areas, which are comfortably furnished; one lounge is set aside for the use of younger residents. Residents are free to spend time where they wish and with whom they wish; visitors are welcome at the home without appointment. The home employs unit managers, registered nurses, carers, activities staff, and catering and housekeeping staff to care for residents. The home is owned by Barchester Healthcare Homes Ltd. The Registered Manager is Alexandra Crew. The homes current fees are £800 to £1250 per week for the older people living at the home. Fees for the younger people are determined upon the assessed needs of an individual . Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 unannounced key inspection was conducted over two days (total of 24 hours) by regulation inspectors Alison Philpott and Jane Poole. On the day of the inspection, 80 people were living at the home. Alexandra Crew, Registered Manager was available throughout the inspection. We were given unrestricted access to all parts of the home and all records requested for this inspection, were made available to us. We were able to meet with people using the service, and staff. We carried out an annual service review on 15th August 2008. People told us that they were happy with the care they received at the home. Some concerns were raised that staff were not always available when needed. This was followed up at this inspection. Care Homes for Older People Page 6 of 28 We carried out a random inspection on 5th November 2008. We looked at staff recruitment records and found that a number of employees had started working in the home without the required checks. The home carried out an audit of recruitment records to identify an shortfalls in recruitment practice so that action could be taken. The home completed its Annual Quality Assurance Assessment (AQAA) and this was received by the Commission within agreed timescales. The AQAA is a self assessment which focuses on how well outcomes are being met for people using the service. It also provides us with some numerical information. The term we, used throughout this report, refers to we the Commission. We would like to thank all involved for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: When information in a persons care plan changes, the previous entry should be crossed through so that there is clear information for staff to follow and to ensure the persons wishes are met. The home should ensure that they date prescribed medicinal creams on opening and discard appropriately. This it to ensure that the cream is used when at its best. Care Homes for Older People Page 8 of 28 The home should ensure that two staff sign hand written Medication Administration Record Sheets to ensure the entry is checked for accuracy. This is to ensure that people receive the correct medicine. When employing new staff, a reference from the last employer should always be sought. A written explanation of why the reference could not be obtained should be provided if appropriate. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive sufficient information so that they can make an informed decision about the home. The home carries out detailed assessments to ensure that it can meet the individual needs of people before they move in to the home. Evidence: The home has a Statement of Purpose, Service Users Guide and brochures which contain information about the home. People who live at the home told us they received enough information to help them decide that the home was the right place for them before they moved in. We looked at the information that the home had obtained about a new person living at the home. The home had carried out a pre admission assessment to identify the persons needs. Information had also been obtained from the placing authority. Care Homes for Older People Page 11 of 28 Evidence: The home encourages people to visit the home and look around to help them decide if its the right place for them. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans look at all areas of the individuals life. People receive personal and healthcare support using a person centred approach. Medication and records relating to medicines are generally well managed and protect people who live at the home. Staff treat people who live at the home with respect. Evidence: We looked at five care plans. These were person centred and contained a good level of detail about what the person could do independently and support needed. The home has also introduced a personal profile for each person. The profile is called This is I and includes information on the individuals likes, dislikes, preferred routines and other useful information. One person commented that they have their own routines which staff respect. One care plan stated that a person did not wish to be resuscitated. Later in the same Care Homes for Older People Page 13 of 28 Evidence: care plan, it stated that they did wish to be resuscitated. The previous entry should have been crossed through so that there is clear information for staff to follow and to ensure the persons wishes are met. The home told us on their AQAA individual reviews are held 6 monthly - families and advocates are invited and plans set out. We looked at reviews in peoples care plans that confirmed that people are involved in their care planning. Each person who lives at the home has an allocated key worker to support them. Some people had a card in their bedroom with the name and a photo of their key worker. Two people who live at the home commented I dont see my key worker very often and I dont know who my key worker is. We observed a poster that told us there are plans to try and develop the key worker role. We looked at risk assessments relating to falls, bed rails, and choking. The physiotherapist visits the home two days a week. Seating assessments have been carried out for each person who lives at the home. We saw evidence that people have access to a wide range of health professionals including GP, district nurse, consultants, clinical psychologist, dietician, speech & language therapist, and chiropodist. The home keeps a record of visits which gives information about the reason for the visit and action that needs to be taken. We looked at medication and records in two of the homes treatment rooms. The home uses a monitored dosage system. All medicines had been signed in by two staff. One persons medication administration record sheet (MAR) had been hand written. One member of staff had signed the sheet. The home should ensure that two staff sign hand written MAR Sheets to ensure the entry is checked for accuracy. The home keeps some controlled drugs. These were stored securely and we checked the balance of five controlled drugs. These were found to be correct. We found a number of creams kept in peoples bedrooms on the ground floor that had not been dated on opening. The home should date medicinal creams on opening and discard after 28 days. This is to ensure they are used when at their best. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of people when planning daily living and arranging activities. Meals at the home are well balanced and nutritious. People are generally very happy with the food and the choices available to them. Evidence: The home employs three activities workers. The home told us on the AQAA we plan and deliver a diverse range of daily sessions in both group and individual formats and we focus on the specifics of a group and what their interest and needs are ie takeaway and DVD nights for the younger residents. There is a weekly activities programme. The week of the inspection there was an entertainer, scarecrow making for the Taunton flower show, games and a film afternoon. People who live at the home told us they also enjoy taking part in chair exercises, and singing. The activities workers support people who choose to go to church. The home has its own minibus, a visit to Taunton flower show was planned for the weekend. Care Homes for Older People Page 15 of 28 Evidence: The home told us on the AQAA we have a Thursday Club which meets weekly for sherry prior to lunch - the past week is discussed. We looked at the minutes of the Thursday Club. People said that they liked the quiz and crosswords; bell ringing; arts and crafts and pamper sessions. People have the opportunity to put forward their ideas for trips, menus and activities. There is also discussion around what is good and areas the home needs to work on. One person living at the home said I like going to meetings, its good to all get together. The home has an internet lounge for people to access a computer. The home has purchased a Wii Fit and people can take part in weekly sporting challenges. The home produces a newsletter. We looked at the July 2009 newsletter. This contained information about projects, new staff, a quiz and forthcoming events. People told us that their visitors are made to feel welcome by the staff at the home. The home has been awarded the Barchester 5 star dining experience. The home told us our food is sourced locally and cooked fresh daily. There is an extensive breakfast menu with choice of cereals, fresh fruit, traditional english breakfast, warmed baked rolls. The home introduced a weekly breakfast club in June 2009. People can have a different dish each week. Recent dishes included scrambled egg and smoked salmon, poached egg, bacon and grilled tomatoes, and bacon butties. We joined the people who live at the home for lunch. A menu was available at the entrance to the dining room. Smaller menus were available on the tables. The tables were nicely laid. Hosts and hostesses take peoples orders once they are seated. We observed staff offering people a choice of drinks. People were offered a choice of starter, main course and dessert. Vegetables and potatoes were served separately in silver dishes. The main meal was chicken with a white wine and tarragon sauce or omelette. The choice of desserts included jelly, trifle, mousse, fresh fruit, and cake. People who live at the home said the food is very good, we can have a glass of wine at lunchtime, thats rather nice. Where staff were providing assistance to people, this was done in a respectful and Care Homes for Older People Page 16 of 28 Evidence: unhurried manner. Staff chatted to people whilst assisting them. One person told us I prefer to eat in my bedroom, staff come in and chat because I spend time in my room. Special menus are made available for themed events. We looked at menus and photographs for Ladies day at Ascot, menus for St Georges Day and Wimbledon. We spoke to the chef. Snacks are available between meals which include fresh fruit, homemade cakes and biscuits. The home has introduced snacks for people with swallowing difficulties and special diets. These include yoghurts and fruit smoothies. If people would like a snack between supper time and breakfast, sandwiches and cereals are made available. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an open culture that allows people to express their views and concerns. The homes has policies relating to abuse and whistleblowing which protect people from the risk of harm. Evidence: The home has a complaints procedure in place. People who live at the home knew what to do if they had any concerns. One person said I could talk to any of the nurses if I wasnt happy. The home has received four complaints in the past twelve months. We saw evidence that the complaints had been fully investigated and action taken where necessary. The home has a whistleblowing policy and staff spoken with knew what to do if they suspected or witnessed abuse. The whistleblowing policy does not contain the contact details for the Care Quality Commission. The home undertakes criminal record bureau checks for new staff before they commence work within the home to protect people from the risk of abuse. As a result of an incident which took place at the home, the manager arranged training for staff in challenging behaviour. This is to make sure that staff know what to do if a person should present a challenge to the service. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained, decorated to a high standard and provides a comfortable environment for the people who live there. Peoples bedrooms are personalised to reflect their individual tastes and interests. Evidence: We viewed the premises. The accommodation is provided over two floors. There are two passenger lifts and stairs available for access to all areas of the home. The home has two communal lounges and dining rooms. There is a physiotherapy room. A designated smoking area is available for people who live at the home and wish to smoke. The home told us on the AQAA the 3 units have been separated due to dedicated speciality - to ensure that residents are situated in an area appropriate to their age and needs. The home provides care and support to people in the following three areas; Hestercombe unit for people who are elderly frail; Vivary unit for people with complex care needs; Victoria unit for people with a physical disability. The AQAA said throughout our home we have little areas and pockets of social gathering - this gives either privacy or encourages interaction. We viewed comfortable seating areas throughout the home. Small table lamps added extra light Care Homes for Older People Page 19 of 28 Evidence: and atmosphere. We sampled twelve bedrooms. Bedrooms are nicely personalised and reflect peoples individual tastes and interests. Some bedroom doors are not lockable but a lock can be fitted if a person chooses to have one. The home has a rolling programme for replacement of carpets. We observed a number of bedrooms that had been redecorated and recarpeted. A number of bedrooms have new flat screen televisions. People had access to a call bell in their bedroom so that they could contact staff for assistance if necessary. The home has purchased some electric profiling beds and pressure relieving mattresses. The home told us on the AQAA we are commencing the adaptation of the first floor dining area to a life skills kitchen/dining area for the residents. This will facilitate increased independence for those able. On the day of the inspection the life skills kitchen/dining area was nearing completion. The worktops and units are fitted at a height that people who use a wheelchair will be able to access. The main dining area has been decorated. This area leads out onto a patio area that has been improved. The home has carried out work in the garden to create a pleasant environment. There are a number of seating areas, bird feeders, and attractive plants. Ramps have been put in place so that people who use a wheelchair can access the gardens. An organic vegetable garden is being introduced,the fresh produce will be used within the home. The home has recently created a chicken run, the chickens arrived the day before the inspection. People who live at the home were looking forward to seeing the chickens and were suggesting possible names for them. The environment was clean and fresh throughout. The home employs housekeeping staff. Carpet cleaning machines are kept at the home, the home told us that bedroom carpets are cleaned on a weekly basis. The laundry has been upgraded and redesigned so that staff bring the washing into one side of the laundry and process clean washing out the other side. This promotes good infection control and hygiene practice. We observed that liquid soap and paper hand towels were available throughout the home. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are normally sufficient staff on duty to meet the needs of people who live at the home. People who live at the home benefit from having caring, skilled and trained staff. The homes recruitment procedures generally protect people from risk of harm. Evidence: Barchester were rated in the Sunday Times top 20 big companies to work for in 2009. People who live at the home comments included the staff are superb, the staff are very kind, they look after me well, and the staff are nice, I can talk to them. People told us that there are generally enough staff on duty. One person commented if I ring the call bell, staff come quickly, theres always someone about. One person living on the first floor commented that on one recent occasion when they rang their bell they had to wait fifteen minutes for a response. On the day of the inspection the staffing levels were as follows; Morning - 3 registered nurses and 14 care staff; Afternoon - 3 registered nurses and 12 care staff; Night - 3 registered nurses and 5 care staff. Care Homes for Older People Page 21 of 28 Evidence: The home has introduced unit managers, unit care co-ordinators and the post of night sister to improve care and communication. In addition, the home employs the following staff; housekeeping; maintenance; gardening; laundry; catering; host; administration; physiotherapy; music therapist; exercise therapist. There are three activity workers, two work full time and one works part time. Weekend cover is provided. The home has two student nurse placements each year. Eight of the staff who work at the home are being supported to complete apprenticeships in catering, administration, hospitality and care. The home has developed its own bank of staff to cover staff leave. This means that agency staff are not currently needed. At the random inspection on 5th November 2008, we looked at recruitment records. We found that the homes practice around seeking references could be more rigorous in that when seeking references the home must make sure one is from a previous employer and that they are not both personal references. At this inspection, we looked at three staff recruitment files. One of the files contained two references; one of the references had been given by a relative of the applicant. This was discussed with the manager who told us that the home had been unable to access employment references. We did not see any evidence to show that the home had tried to contact the previous employer. Another staff recruitment file was for a new member of staff who was from overseas. There was evidence of a residence permit on the file and a temporary work permit that expires on 30th August 2009. The home told us they would follow up the progress of the new work permit. The home told us on their AQAA we are introducing the participation of the residents in the interview procedure for potential new staff..meet the candidate and ask generalised questions over a cup of tea. The home has individual training files for each member of staff. We looked at a number of files which contained evidence of training in fire; manual handling; protection of vulnerable adults (POVA); food hygiene; health & safety; customer care; Care Homes for Older People Page 22 of 28 Evidence: challenging behaviour; infection control; medication; first aid; person centred care. There is also a computerised system that flags up when training updates are due. 26 of the 57 care staff have completed NVQ at level 2 or above. The home has arranged for 5 staff to start their NVQ in September 2009. The management team carry out observations of staff practice eg carrying out personal care. We looked at the records of these observations and found they contained a good level of detail. There is a meeting every morning for all staff to ensure that they are kept informed of what is happening in the home. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home benefit from a well managed service and an open and inclusive atmosphere. Effective quality assurance systems are in place. The homes health & safety policies and procedures protect peoples health, safety and welfare. Evidence: Alexandra Crew is the registered manager. Alexandra has been in post since October 2008 and has twelve years experience of managing care homes. Prior to this, she worked as a clinical nurse manager. Alexandra has completed NVQ level 5 in management and is an NVQ assessor. The registered manager is supported by a deputy manager and three unit managers. The home has introduced a unit care co-ordinator role to liaise between registered Care Homes for Older People Page 24 of 28 Evidence: nurses and care assistants. Staff spoken with told us that they feel well supported, find the registered manager approachable and can see improvements within the home. The regional operations director carries out monthly visits to the home to monitor quality. We looked at the most recent report. This was detailed and evidenced that the regional operations director checks records and speaks to to lots of people who live at the home and staff. Two quality assurance questionnaires are sent out each year; one from head office and one from the home. The results are collated and action is taken where necessary. We observed suggestion forms in the reception area. the home said the comments made in the returned forms are reviewed and where subsequent action is taken this is fed back to residents and/or relatives. The home currently stores small amounts of personal monies for some of the people who live there. We were told that this is being phased out and alternative options will be offered to people. The monies were stored individually and securely. We checked the records and balance of monies for two people who live at the home. The balances were found to be correct. We looked at health & safety records and checks relating to portable appliance testing; fire alarm system; legionella; lifting equipment; boilers; gas safety; electrical installation and water temperatures. These were all found to be up-to-date. One person who lives at the home uses oxygen in their bedroom. Appropriate signage was in place. We looked at accident records. The home carries out an audit of accidents to identify patterns and minimise the risk of further incidents and injury to people. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 When information in a persons care plan changes, the previous entry should be crossed through so that there is clear information for staff to follow and to ensure the persons wishes are met. The home should date medicinal creams on opening and discard after 28 days. This is to ensure that they are used when at their best. The home should ensure that two staff sign hand written MAR Sheets to ensure the entry is checked for accuracy. This is to ensure that people receive the correct medicine. When employing new staff, a reference from the last employer should always be sought. A written explanation of why the reference could not be obtained should be provided if appropriate. 2 9 3 9 4 29 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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