Care Home: The Old Vicarage

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What the care home does well The home is run in the best interests of service users. Service users feel that they are treated with dignity and respect. Service users are encouraged to make choices and to remain independent for as long as possible. Service users are confident that complaints will be listened to, taken seriously and acted upon. Housekeeping staff work hard to ensure that the home is clean, pleasant and free from unpleasant odours. What has improved since the last inspection? There is an ongoing programme of redecoration and maintenance. Building work is in progress in the dementia nursing unit to provide two extra bedrooms, a sensory room and a new dining room. The good practice recommendations made at the last inspection have been actioned. Five care assistants have completed the first year of a enhanced role of the carer course. The manager, Carol Bourne has completed the registered managers award. What the care home could do better: Following the pre-admission assessment, service users should be advised in writing that the home is able to meet their care needs. Care planning documentation needs to be in sufficient detail regarding lifestyle choices and preferences of the service user with regard to how care is to be provided and when. Care plans need to be developed further to include how the emotional, social and psychological care needs are identified and met. Service users admitted to the home for personal care ( residential) are entitled to the services of the community nursing team. This needs to be addressed by the manager. The home`s named nurse and key worker role needs to be developed. Consideration should be given to providing all members of staff with name badges. That the training in the MCA and DOLs is extended to all staff. Consider ways of improving the security of the home. Key inspection report Care homes for older people Name: Address: The Old Vicarage Reading Road Moulsford Wallingford Oxfordshire OX10 9JB     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: Marie Carvell     Date: 1 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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 Old Vicarage Reading Road Moulsford Wallingford Oxfordshire OX10 9JB 01491651429 01491652635 manager@theoldvicarage.fote.org.uk www.fote.org.uk Friends of the Elderly care home 50 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home The Old Vicarage is a care home owned and managed by the charity Friends of the Elderly. The home is situated in a residential area of Moulsford and is set in attractive grounds accessible to all the service users. Accommodation is provided over two floors in single rooms with en-suite facilities. There is a separate ten bedded unit for service Care Homes for Older People Page 4 of 29 50 50 0 Over 65 0 0 50 Brief description of the care home users needing dementia nursing care. Service users have use of the communal facilities, including two lounges and two dining rooms. The registered manager and her deputy manage the home, with a team of registered nurses, carers, kitchen and housekeeping staff. A physiotherapist and an activities organiser are also part of the care team. The fees for this home range from 674.00 per week for personal care (residential) to 1038.00 per week for dementia nursing care. Items not covered by the fees include hairdressing, podiatry, newspapers and magazines, toiletries and contributions to some outings and activities. 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: The last key inspection of this service was completed in January 2007. This inspection was an unannounced key inspection. We ( the commission) arrived at the service at 10.30am and we were in the service until 6pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager in November 2009 and any other information that we have received about the service since the last inspection. We looked at how well the service is meeting the standards set by the government and have in this report made judgements about the standards of the service. Time was spent with the manager, service users and staff on duty. We looked at communal areas of the home, examined a sample of records required to be kept in the home, including service user and staff records. We joined service users in the communal dining room for the midday meal and spent Care Homes for Older People Page 6 of 29 time observing how staff interacted with service users. Time was spent briefly with one relative. 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 Care Homes for Older People Page 8 of 29 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 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 10 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. Service users are provided with enough information to help them decide if the home was the right place for them. All prospective service users are fully assessed prior to admission to ensure that their care needs can be met by the care home. Following the pre-admission assessment service users should be advised it writing that the home is able to meet their care needs, whether for personal care, nursing care or dementia care. Evidence: All prospective service users are provided with information about the home, including a copy of the homes service user guide and last inspection report. Service users confirmed that they had received enough information to help them decide if the home was the right place for them, before moving in. A detailed assessment of care need is carried out prior to admission by the manager or deputy manager, this may include input from healthcare professionals, relatives, Care Homes for Older People Page 11 of 29 Evidence: advocates as well as the service user. It is a good practice recommendation that the manager confirms in writing to the service user that having completed the preadmission assessment, the home is able to meet the service users care need to ensure that the individual knows that he/she can expect the home to manage his/her health and welfare needs properly, whether this is for personal care, nursing care or dementia nursing care. Care Homes for Older People Page 12 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. Care plans need to be in sufficient detail regarding lifestyle choices and preferences of the service user with regard to how care is to be provided and when. Care plans need to be developed to include how the emotional, psychological and social care needs of service users are identified and met. Who provides the nursing care needs of service users admitted to the home for personal care only needs to be addressed. Medication administration, storage and stock control procedures are maintained to a high standard. Service users feel that they are treated with dignity and respect. Evidence: Care plans are drawn up from information recorded on the pre-admission assessment documentation, agreed and signed by the service user. Information regarding health Care Homes for Older People Page 13 of 29 Evidence: and personal care is well documented. However, a sample of care plans examined with the manager and deputy manager did not evidence how the emotional, psychological or social care needs are identified and met. Care plans are not in sufficient detail regarding lifestyle choices or the preferences of the service user with regard to when care is to be provided or how. Following the inspection we received an action plan from the manager advising us that she was developing a more person centred approach to the homes care planning process. Social and spiritual care plans will be developed further with input from the activities organiser. Nine surveys were completed by service users, seven stated that they always received the care and support they needed and two surveys stated they usually received the care and support they needed. Comments made on surveys included They let you do your own thing. Staff visit two or three times a day to care and for company, They care for people exceptionally well. All the staff are very caring and helpful, It welcomes you and makes you feel that this is your home. It makes me feel that you matter to them and feel that your happiness is important, I often feel very lucky to be here and will always be grateful for the splendid care they gave my late husband, The constant demand to take service users with dementia has caused the balance to be overweighted and simply frail ( physically) elders are in the minority. This can be distressing, at times for those who are fortunate enough to still have all their faculties, I am at times critical of the medical advice. The health care of service users are met by a local GP practice. The care needs of service users receiving nursing or dementia care are met by the registered nurses (RN) employed at the home. At the time of this inspection we were advised that the expectation was that the nursing needs of service users admitted to the home for personal care only was also provided by the RNs on duty, although this had been queried, on occasions by the nursing staff employed. The manager is advised to read the guidance log on the commissions professionals web site. This explains in detail the role of a RN in a care home that provides personal as well as nursing care and concludes that service users receiving personal care only are entitled to services from the community nursing team.Healthcare professionals visit the home as necessary including the falls specialists, community psychiatric nurses and specialist nurses. The home employs a physiotherapist for three hours per week. Some of the lead care assistants are undertaking specialist training to give them the necessary skills to carry out some nursing tasks. The manager is advised to read the commissions guidance on delegation of clinical intervention to care staff in adult and childrens services providing personal care. Following the inspection we received an action plan from the manager advising us that this was to be raised with the GP practice. Four surveys completed by service users to the question Does the home make sure you get the medical care you need. Four service users stated that they always received the Care Homes for Older People Page 14 of 29 Evidence: medical care they needed and five service users stated that they usually received the medical care they needed. Service users are encouraged to take responsibility for their own medication following appropriate risk assessments. The majority of service users prefer their medication to be administered by the staff team. Since the last inspection we have been notified of one medication error, this was investigated and appropriate action taken. From discussion with the deputy manager and examination of medication administration records, storage and stock control, it is evidenced that medication procedures are maintained to a high standard. Staff were observed to interact with service users in a calm, respectful and kind manner. Service users expressed their satisfaction of the care provided. Comments made on service user surveys to the question Are the staff available when you need them. eight services users stated always and one service user stated usually. Service users confirmed that they are always addressed by their preferred term of address and felt that that their privacy and dignity is always maintained. As in many other care homes, there is a wide range of racial, ethnic and faith backgrounds represented within the staff team compared with the current service users. From discussion with the manager and staff on duty, we consider that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. Care Homes for Older People Page 15 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. Service users are encouraged to make choices and remain independent for as long as possible. A range of activities and community involvement is made available to meet the social needs of service users. The homes named nurse and key work system needs to be developed. Service users are provided with a varied, wholesome and nutrious diet. Evidence: There is a varied activities programme in place. However, this is not evidenced from information recorded in service user care plans or daily records.This was discussed with the manager and activities organiser. There is an enthusiastic activity organiser employed from 9am until 3pm Monday to Friday and one evening for the popular DVD club. There is a activities room that is used for some activities and service users benefit from a group of volunteers who support the home and who assist with coffee mornings, sherry parties, weekly shopping trolley, poetry reading and providing transport to outings. All volunteers complete a robust recruitment process including Care Homes for Older People Page 16 of 29 Evidence: police checks. Five surveys stated that the home always arranged activities that the service user could take part in if they wished, three stated usually and one service user stated sometimes the home arranged activities that they could take part in if they wished. Service user meetings are held every three months and there is a suggestions box in the entrance hall. Many of the service users have friends and family members who are able to visit on a regular basis. One service user confirmed that her young relatives enjoyed visiting the home and were always made welcome. Service users are encouraged as far as possible, to maintain contact, with the local community. Religious ministers visit the home regularly and the homes chapel is used for a service every Friday. The chapel is also made available for funeral services, one relative expressed his appreciation of this resource being made available. The home has a named nurse and key worker system. The nineteen service users receiving nursing care and the nine service users receiving dementia nursing care have a named nurse and key worker allocated to them. The sixteen service users receiving personal care have a key worker. In discussion with service users it was unclear how the two roles work in the home. Service users stated that the role of key worker had not been explained to them and stated that although the name of their allocated key worker was displayed in their bedroom, they were unable to identify the individual as their care is provided by several different care staff. None of the staff in the home wear a name badge, so it is difficult for service users and visitors to know the names of staff on duty. Service users stated that they felt disadvantaged as they could not remember the names of individuals because the home employs a significant number of staff. One service user said it was difficult to know if ten members of staff had been asked one question or the same question to the same person ten times. This was discussed with the manager, who confirmed that the no badge rule was charity policy. Following this inspection we received an action plan from the manager confirming that the charity would look into this for consideration. Service users confirmed that the routines in the home are flexible such as being able to choose how they spend their day, when to go to bed and when to get up in the morning. One service user commented They let you do your own thing. Staff visit two or three times a day to care and for company. We observed lunch being served in the dementia care unit and joined service users in Care Homes for Older People Page 17 of 29 Evidence: the main dining room for lunch. The menus was displayed and service users confirmed that there is always a choice of main meals. Menus demonstrated that a varied, wholesome and nutritious diet is provided. The meal was hot, tasty and attractively served. Staff were observed assisting service users in a quiet, discreet and dignified manner. The home does not employ any catering staff as this service is provided by an external company, although the food is prepared on site. In discussion with the manager and chef, this arrangement works well. Two surveys completed stated that the service user always enjoyed the meals at the home and seven surveys stated that the service users usually liked the meals at the home. Care Homes for Older People Page 18 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. Service users are confident that any concerns or complaints would be listened to, taken seriously and acted upon. All staff receive training in safeguarding vulnerable adults procedures. Training in MCA and DOLS training need to be extended to all members of staff. Evidence: The homes complaints procedure is displayed in a prominent position in the entrance hall. In the last twelve months the home has received eight complaints either verbally or in writing. The recording of complaints was seen to be clear, detailed and included action taken and outcomes. In discussion with service users and comments made on the nine surveys received from service users, all confirmed that there was someone that they could speak to informally if they were not happy, this was usually friends, family, the nurse on duty or the deputy manager. All service users spoken to and eight of the service users who completed a survey confirmed that they knew how to make a formal complaint and were confident that their concerns or complaints would be listened to, taken seriously and acted upon. One survey stated that the service user did not know how to make a formal complaint. Since the last inspection we have received information regarding one complaint, the complainant was referred to the manager. Care Homes for Older People Page 19 of 29 Evidence: All staff receive training in safeguarding vulnerable adult procedures including whistle blowing via e-learning during their initial induction, this is updated on a regular basis. All RNs have been given copies of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS) policies and have been set a quiz to complete in order to demonstrate that they understand the legislation. It is not clear how this training will be provided to care and ancillary staff. It is a good practice recommendation that MCA and DOLS training is provided to all staff as soon as possible. No safeguarding adult protection referrals or safeguarding adult investigations have taken place in the last twelve months. No referrals have been made for inclusion of staff on the protection of vulnerable adults list (POVA). Care Homes for Older People Page 20 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. Service users expressed their satisfaction of the accommodation, facilities and garden. The housekeeping staff work hard to ensuring that the home is clean, pleasant and free from unpleasant odours. Evidence: The location and layout of the building is suitable for its stated purpose. Service users expressed their satisfaction of the accommodation, facilities and garden. The home is well maintained and there is an ongoing programme of redecoration and maintenance. Building work is in progress in the dementia nursing unit, to provide two extra bedrooms, a sensory room and a new dining room. At the last inspection two good practice recommendations were made, that disposable aprons should be provided for laundry staff to use when dealing with soiled/infected linen to reduce the risk of spreading infection and that soiled/infected linen should be placed into alginate bags that can be put directly into the washing machine without being opened to minimise the risk of spreading infection. This type of bag dissolves during the wash cycle. Laundry and housekeeping staff are now provided with disposable aprons. The manager confirmed that the home had considered the use of alginate bags, but decided that other means of reducing the risk of spreading infection were equally effective and less expensive. Care Homes for Older People Page 21 of 29 Evidence: The manager is considering installing CCTV cameras to external areas of the home for security purposes. One survey expressed concerns that the XXX is not locked in the evening until XXX and stated I consider this to be too dangerous for the times in which we live. Anyone can walk in and around the building at any time. This is particularly pertinent considering that none of the staff wear a name badge and the current use of agency staff. It is a good practice recommendation that this is addressed as soon as possible. The housekeeping staff work hard to ensuring that the home is clean, pleasant and free from unpleasant odours. Seven surveys stated that the home is always fresh and clean and two surveys stated that usually the home is fresh and clean. One survey commented that the home could do better by The regular dusting of residents rooms Care Homes for Older People Page 22 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. Staffing levels appear to be adequate to meet the needs of the current service users. Recruitment procedures are robust. Staff are well trained and are able to carry out their duties in a professional manner. Evidence: From discussion with the manager, staff on duty, examination of duty rosters and observation, there appears to be adequate staffing levels to meet the needs of the current forty four service users. At present due to staff vacancies, the home is using agency staff to cover vacant posts, the manager tries to ensure that the same staff are used for consistency. In the last year nine nursing/care staff have resigned. The home currently has vacancies for day and night care and nursing staff. The manager is confident that these posts will be filled. Five surveys stated that there was always staff available and four surveys stated usually there was staff available. Comments made on surveys included Shortages of staff has made life hard for all, carers and residents, but life has gone on, cheerfully on the whole. During the bad weather, staff were working day and night shifts and sleeping where and when possible, They go out of their way to make birthdays and Christmas special. The staff are always cheerful and greet you by name,We have a Care Homes for Older People Page 23 of 29 Evidence: wonderful therapist who is always full of ideas to keep us fit and happy, I think there are peak times when more staff are needed- demands are very high and although many of the agency staff are very good, some are of poor quality and permanent staff are burdened because of poor agency help. Care staff are encouraged to undertake national vocational qualification (NVQ) training. Currently eleven of the thirty two care staff have completed NVQ at level II. Five care assistants are undertaking an enhanced role of the carer course and have completed their first year of the two year course. At the last inspection a good practice recommendation was made that all new employees should keep a record of their induction training to have evidence that the skills for care training standards have been satisfactorily completed. This has been addressed by the manager. From examination of a sample of staff personnel files it was evidenced that the home has robust recruitment procedures in place. Following the inspection we received an action plan from the manager advising us that in future all interviews will be conducted by two members of staff. Each member of staff has a training and development in place. All staff complete mandatory training and undertake specialist training as appropriate. Nursing staff are assisted with their continuous professional development. Members of staff spoken to said that they enjoyed working in the home, felt valued and well supported by the charity. Communication systems in the home are well organised, with staff handovers taking place at the beginning of each shift. Staff meetings are held every three months. Staff were observed to be courteous and professional when carrying out their duties. Care Homes for Older People Page 24 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. Service users benefit from a well managed home. Evidence: The manager Carol Bourne has managed the home since 2003. She is an experienced and qualified manager as well as a registered nurse. The manager has recently completed the registered managers award. Supporting the manager is an experienced, full time deputy manager and a part time administrator. Service users and staff on duty all expressed the view that the home was run in the best interests of the service users. Policies and procedures are in place and are reviewed and updated as necessary. Policies and procedures are in place for dealing with service users monies and valuables kept in safekeeping by the home are in place. The recording of service users monies was discussed with the manager and following this inspection we received an action plan, confirming that the six good practice recommendations made would be implemented. All financial records are audited annually. Care Homes for Older People Page 25 of 29 Evidence: All nursing and care staff receive formal 1-1 supervision at least six times per year, a sample of records examined were seen to be detailed, well maintained and up to date. Some good practice recommendations were made following a discussion with the manager and deputy manager. Following the inspection we received an action plan confirming what action would be taken. Reports written by a provider representative, following a monthly unannounced visit to the home, were available for examination. Quality assurance systems are in place as well as monthly and annual internal audits. These are detailed and well documented. Evidence was seen that the views of service users, relatives and stakeholders are obtained to measure the homes success in meeting the aims, objectives and statement of purpose. A sample of records relating to health, safety, welfare and fire were examined and found to be well maintained and up to date. Care Homes for Older People Page 26 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 27 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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