Care Home: The Pines Nursing Home

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What the care home does well People who live at the home are happy with the food and meals provided. There are appropriate recruitment processes and checks on new staff to ensure that risks to people who live at the service are minimised. The service responds to complaints and maintains appropriate records of these. The service has responded positively to environmental issues raised at previous inspections to make the home more comfortable for the people who live there. What has improved since the last inspection? At the previous inspection there had been nine areas where the service had to improve. The service has taken action on most aspects of these, which represents a positive response to the findings of the previous inspection. In particular, improvements have been made to the environment and medication system. What the care home could do better: Areas where the home could be doing better are highlighted in the report and were discussed with the manager and regional manager during the inspection. We would also like to see better organisation of the staffing resources (when the activities officers are on leave) in being creative and engaging more with people who are less independent, to ensure that they have a more stimulating quality of life. This would be enhanced by better care planning to ensure that all assessed needs, are planned for and actions taken. This is because we found that the care plans focus on the personal care and physical aspects with little, or no reference to all the assessed needs of the person. Key inspection report Care homes for older people Name: Address: The Pines Nursing Home 104 West Hill Putney London SW15 2UQ       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: Louise Phillips Date: 2 5 0 3 2 0 1 0 This report is a review of the 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 stars – excellent • 2 stars – good • 1 star – adequate • 0 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. things that people have said are important to them: 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      They reflect the 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 Care Homes for Older People Page 4 of 28 Information about the care home Name of care home: Address: The Pines Nursing Home 104 West Hill Putney London SW15 2UQ     02088771951  02088770916 www.slnh.co.uk South London Nursing Homes Ltd Susarah Kolbe care home 50 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category      Additional conditions: Number of places (if applicable): Under 65 0 0 50 Over 65 50 50 0 The registered person may provide the following category of service only: Care home with nursing - Code 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 - Code OP Physical disability - Code PD Dementia over 65 years of age - Code DE(E) Date of last inspection: Brief description of the care home: The Pines provides accommodation and nursing care for fifty older people. The service is privately owned and is situated on the A3 in Putney within easy reach of local shops and facilities. The home is an Edwardian building with additional purpose built areas. There is a large garden for residents to use. Information about the home is provided to people who use the service in a written guide. Care Homes for Older People Page 5 of 28 0 6 0 7 2 0 0 9 The current daily fees start from GBP124.00 per day. Care Homes for Older People Page 6 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 activity Complaints and Protection Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: Since the last full key inspection of the service a Random Inspection has been carried out, on the 25th January 2010 due to information received about the service. A Random Inspection is a more focused inspection that looks at specific areas of the service that we want to assess. Some aspects of the Random Inspection have been referred to in this report, as at this current inspection we followed up the findings from that inspection, as well as that from the last Key Inspection that took place in July 2009. Prior to the Random Inspection we also sent surveys to people who live and work at the service. These were referred to in the Random Inspection report and are also referred to in this report. This Key Inspection took place over one day and included a visit to the service by two Care Homes for Older People Page 7 of 28 Regulation Inspectors. When we visited we spoke to the manager, regional manager, thirteen people who work at the home and six people who use the service. We also looked at records, observed what was going on and looked at the environment. Following the inspection the manager sent us a copy of the homes Annual Quality Assurance Assessment, which is a self assessment document that we ask providers of service to complete annually. When we visited the home there were 35 people using the service, with 8 vacancies for single occupancy rooms. At the time two bedrooms were having repairs carried out, and so were not in use.      Care Homes for Older People Page 8 of 28 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 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are appropriately assessed prior to their moving to the home. Evidence: We looked at a sample of pre-admission assessments for the people who live at the home. Although these varied in content and quality, we found that they were generally well detailed and gave a comprehensive record of individual needs, interests and wishes for their care. In one example we saw that the assessor had not only recorded current needs but had also identified potential future changes in the persons needs due to their health condition. We also saw that there was a record of peoples preferences, for example bed times, preferred name and preference for same gender carers. Care Homes for Older People Page 11 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. This is what people staying in this care home experience: Judgement: People using the 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 care planning recording and documentation needs to be improved to give a clear, up-to-date plan of care that sets out the current needs of the person and how these will be met. The dignity needs of people who live at the home needs to be consistently met to ensure that they are treated with respect and have the right care and support at all times. Medication is being managed appropriately at the service. Evidence: Everyone who lives at the home has a care plan which records their needs and the support the staff should give them. We looked at a sample of these. Some of the information was complicated and this made it difficult to see what the staff needed to do to support the person, whereas care plans should give simple clear instructions to staff. We saw that some of the information which had been gathered during pre-admission assessments had not been transferred to care plans, as there was no care plan for social needs or peoples interests. The manager told us that separate information on this was held by the activities officers. Some of the information in peoples files was unclear. For example, where wounds and injuries had been recorded, the records of these were muddled and often referred to several different wounds or injuries. Some of the information in these records did not state what wound or injury they were referring to. Records should clearly show how the wound is monitored and any changes in this. Care Homes for Older People Page 12 of 28 Some care plans contained old information which had been superseded by newer care and support guidelines. Because this information had not been appropriately archived it was difficult to see what the current care plan was. Records showed that care plans were reviewed monthly but we saw one persons care plan had not been updated, nor had their risk assessments, following a fall and their return from hospital 12 days previously. The care plans and risk assessments need to be accurate and updated to reflect changes in need. We saw that various assessments of peoples wellbeing, including moving and handling assessments, nutritional assessments and risk assessments were made and reviewed regularly. In the survey that we received back from people who live at the home, they said that their privacy and dignity is respected, and that staff listen to and act upon what they say. During the inspection we spent a over two hours sat in the lounge area, observing what was going on for the seven people who were present throughout this time. The people were less independent than a number of the other people who live at the home. During the morning a member of staff brought a jug of cold water and glasses into the lounge during the morning. They offered one of the people in the lounge a drink, but never poured this, despite the person accepting their offer. The staff member then left the jug on a table behind the television. Only one of the people in the lounge was independently mobile and they were not able to pour themselves a drink from the jug due to where this had been left. People were offered one hot drink during the morning. Two people in the lounge were not able to have their drinks independently, though no staff came to offer them support to take their drinks, and they were untouched and left to go cold. None of the staff appeared to check how much people had drunk or if they wished for more, and the cups were just taken away by kitchen staff at the end of the morning. Some of the interactions we saw between staff and people who live at the home were positive. We saw some staff being kind and complimenting people on their appearance. One member of staff told us, I like to take extra time in the morning to help people get up, making sure their hair is nice and they are wearing lipstick if they want to. We saw another member of staff being very kind and patient with someone who was becoming distressed and resisting the care they needed. However, we also saw examples of staff not giving people the support and care they needed. One person who became distressed during the morning started to cry and got very upset. We saw one member of staff ignore them. We asked another member of staff who was walking through the lounge to attend to them as they were becoming increasingly distressed. The member of staff told us, I am not working here today I am in the kitchen today. Therefore we asked the staff member if she would get a carer to attend to the person. The staff member replied, care staff are around and walked away. However, none of the care staff attended to the person and after some time the person became more distressed and they told us that they needed the toilet. We alerted the manager who we saw asking a member of staff to attend to them, however no staff came to support the person. After some time another member of Care Homes for Older People Page 13 of 28 staff entered the lounge and started talking to other people. We asked them to attend to the distressed person and although they tried to be pleasant they told the person not to cry because they were upsetting the member of staff. This reaction is not appropriate. They then offered the person a cup of tea which they did not give them. The person who was distressed was not given any activity or support during the morning and the only interactions they had with staff were in response to our request that staff attended them. We saw that staff reassured people and told them what they were doing and what was happening when they supported them to move using the hoist and when supporting them into wheelchairs. We saw that most staff followed appropriate procedures when supporting people to move and used the equipment safely. However, we saw two members of staff lowering someone into a chair, whilst grabbing hold of their clothing to support them. This is not appropriate and can put the person at risk of injury. We looked at the medication system in use on the new wing of the ground floor only, and checked the medication and associated records for a sample of people who are supported with their medication. We saw that the medication we looked at is being appropriately managed and recorded by staff, and the medication charts record any allergies of the person, or they state none known, as necessary. The nurse on duty showed us records of the weekly audit that takes place. This is a weekly medication stock record that is carried out by the nurses. The monthly visits by the regional manager include an audit of any drug errors and of the medication charts. It is recommended the weekly in-house include the checking of the medication charts, so that any errors identified are dealt with promptly to minimise risks to people who use the service.             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. This is what people staying in this care home experience: Judgement: People using the service adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities co-ordinators plan activities for people who live at the home, however the care staff should more pro active in providing these. People who are less independent should be supported to access external activities, and be supported to engaged in more in-house activities. People who live at the home are satisfied with the meals provided. Evidence: A new activities officer has recently started working at the home to support the activity officer to run activities. The activity officer was not present on the day we visited as she was on leave. The activities officer told us that she liked to play board games with people when there was no organised activities planned. She told us that she was beginning to get to know different peoples needs. The activities team have records about individual people and their interests and they keep records of activities and the success of these which they use for planning future events. There is a small activity lounge which contains books, puzzles, audio books and games. This was not used during our visit to the home. In the morning of the day we visited there was a trip to a local church for a tea party, which more independent people who use the service participated in. We talked to some of the people who went on this trip. They told us that they had enjoyed themselves and showed us gifts they had been given. Care Homes for Older People Page 15 of 28 On the afternoon of our visit some musicians visited the home for a short concert and people who live at the home appeared to enjoy this. During the inspection we saw one independently mobile person sat in the garden, with the resident cat. We did not see any less independent people being supported into the garden or taken out of the service. We saw that the assessments of people before they came to the home included information on their interests and hobbies. Some of these were very detailed and included important events, people and life history. However, some assessments were not as detailed. We also saw that information from the assessments had not been recorded in care plans. Therefore the staff who support people with their everyday care needs did not see what peoples interests, hobbies and life experiences were. Whilst the activities officers have their own information, the care staff also need clear care plans relating to individual social needs and interests, particularly for interacting appropriately with people and also engaging people in activities when there are no structured activities taking place at the home. As stated earlier in the report, we spent over two hours of our visit in the main lounge area observing what was happening there. For the majority of the time seven people who live at the home were in the lounge. There was no organised activity for them and whilst the television was on, the majority of people did not seem interested in this. Some people got upset and distressed during our visit, as detailed earlier on the report. None of the staff spent any time in the lounge during the two hours we were there. Some staff did walk through the lounge and spoke to people, but none of them stopped for more than a brief interaction. We felt that if people had had more support and input from staff they may not have been so distressed. The manager should consider ways for staff to support people with their social needs when there is no organised activities. For example, spending time talking to the people about their interests, reading with them, playing games taking them out into the garden or for a walk. The manager told us that she has regular meetings with relatives and people who live at the home and we saw evidence of these. All the feedback we received, from staff and people who live at the home was positive about the food, choice and portion sizes, with people telling us, that they feel the food is cooked well and there is sufficient choice. We spent time talking to the chef and other kitchen staff, whilst looking at the food supplies in the kitchen. We saw a variety of fresh, frozen, tinned and dry foods that are used to prepare the varied weekly menu. The chef is responsible for managing the food budget and ordering the food. They told us that at the time the budget is sufficient for purchasing the foods needed. Care Homes for Older People Page 16 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. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are managed appropriately by the service, and risks to people who use the service is minimised. Evidence: We looked at the complaints log for the service and saw that appropriate records are kept to indicate that complaints are managed appropriately. Staff told us that if anyone had concerns about the service they would refer them to the manager to raise this as a complaint. Staff told us that they receive training in safeguarding issues and there are appropriate policies and procedures in place for dealing with any safeguarding issues.      Care Homes for Older People Page 17 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. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Positive steps are being taken to improve the environment to ensure that it is safe and hygienic for the people who live there. Evidence: Prior to the random inspection of the service that we carried out in January 2010 we had received information about the environment and looked at specific areas in detail. Following the inspection we also made requirements and recommendations for the service to address these areas. During this recent inspection we followed up the requirements we made to see how the service was progressing with these. We found that the service is clean in most areas, apart from the emergency escape stairwell that leads from the first to ground floor. This was seen to be in need of painting and the carpets to be cleaned. There was also a rolled up carpet in this area that needs to be removed, as it could be a potential obstruction in the event of evacuation of the home. The lift and chairlift were both working on the day of inspection. Work has started to install a new bathroom on the ground floor, as well as a storage cupboard. The builders working on this told us that the bathroom should be usable in the week following our visit. We were also told that a shed is due to arrive by the end of the week, which will be used for extra storage. The service anticipates that these steps will solve the storage issues of the home, as we observed the salon, games storage area and hallways being used to store equipment not currently in use. The areas of water damage we observed at the random inspection were seen to have been addressed in bedroom 29 and work is ongoing in bedroom 11. We did observe further areas of damp/ water damage inside bedroom 15 and under the window near bedroom 16, which need to be addressed. The staff told us that all the hoists at the home were in working order and we saw thee in use on the day. Care Homes for Older People Page 18 of 28 The manager told us that since our visit in January 2010 she has made improvements to ensure that there is enough gloves, aprons and continence supplies for staff to use when assisting people with personal care. Staff also told us that there are always enough supplies for them to use. We also observed that all the communal toilets and bathrooms had a supply of soap and paper towels. During the inspection we were told that a freezer in the kitchen was not working, which we observed the manager reporting to the maintenance department. The chef also told us that some kitchen equipment was not working, such as the water heater and food mixer, which, during the inspection, we passed onto the manager to address. The hole in the ceiling of the dining area that we saw during the random inspection in January 2010 has been repaired. We also saw that some of the furniture in the lounge was in need of cleaning. For example, some of the sofas and chairs in the main lounge were greasy and marked on head rests and arms. At the last key inspection of the service in July 2009 we required that window restrictors be installed on the ground floor windows, to minimise risks to the people who live at the service. We looked at the windows in the lounge area and saw that these had not had restrictors installed, but had been sealed shut. The service needs to ensure that there is still sufficient ventilation in the rooms where the windows have been sealed closed. At this inspection we saw that there was an old commode and table in the garden that needed to be removed. There was also a bath, but the manager told us this was due to be installed in the new bathroom. Care Homes for Older People Page 19 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. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Thorough recruitment checks of staff minimise risks to the people who use the service, and staff receive relevant training for their role. The staffing levels should be based on the fully assessed holistic needs of people who live at the home, not on the number of people currently residing there. Evidence: Prior to our random inspection in January 2010 we received information alleging that staffing levels were low at the service. During that inspection we found that the staffing levels had not changed since the previous key inspection of the service in July 2009. People who use the service told us that there are usually always staff available when they need them, though approximately half of those who responded to our survey said that this is only sometimes. One person who uses the service said that there is a good level of staff during the day, though they do not feel there enough staff working at night. Another person said that they would like more personal contact from staff. One person also commented that they feel there are not always enough staff around. The surveys that we received from staff indicate that the majority feel there is not enough staff on duty. Staff we spoke to during the inspection told us that they would like more time to spend with the people who live at the home, instead of just helping them with washing ad dressing. Staff also told us that sometimes when staff are absent due to sickness, their shift is not covered, so they are down on the staffing level for the shift. We spoke to the manager about this, where she said that due to less people living at the service than at the last inspection, if she is not given enough notice by staff of their absenteeism, she does not always try to cover the shift. On the day we visited the manager was the second nurse counted on shift, due to the absence of a qualified nurse. We looked at the record of falls for the period January, February and March, up to the Care Homes for Older People Page 20 of 28 date of our inspection. We measured these against the number of staff on duty to see if there was any correlation with having less staff on duty. We found that, throughout this time there were fourteen recorded incidents where people who use the service had had a fall or were found on the floor. On all occasions there was the number of staff on duty as at the previous key inspection, apart from one, where there was one carer less on duty than the normal eight for the morning. At the random inspection in January 2010 we recommended that the staffing levels at the home be kept under review and adjusted where necessary to ensure the assessed needs of the people who use the service are met. In following this up at this inspection we found (as stated earlier in the report) that the assessed needs of people who live at the home are not always put into their care plan. We also found that whilst the staff are involved in attending to the personal care needs of the people who live at the home, their input into the holistic needs of the people is limited. By this we mean that the care staff seem to have limited input into the social, emotional and leisure activities of people who live at the home. This is highlighted under health and personal care and the daily life and social activities sections of this report. Therefore, in following up our recommendation from the January 2010 random inspection about keeping staffing levels under review to ensure the assessed needs of the people who use the service are met, we feel that thisThere is an in-house trainer who works four days a week at the home. She was not present on the day of our inspection, but the manager supplied us with a copy of the training record for staff. This showed that staff receive various training in aspects of their work, including first aid, fire safety, personal care, use of bed rails and equality and diversity. Records also indicate that the staff have, or are undertaking, relevant National Vocational Qualification (NVQ) training for their work, Following findings highlighted earlier in the report, we have made a requirement for the registered person to ensure that staff always use approved moving and handling techniques when supporting people. has not been achieved, and have now made this a requirement. We looked at the recruitment files for six staff who work at the home. These were seen to contain relevant information to demonstrate that thorough checks take place on staff prior to their starting work at the home, including gaining references from the previous employer, Criminal Records Bureau check, interview records and copies of identification. Care Homes for Older People Page 21 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. This is what people staying in this care home experience: Judgement: People using the 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 manager demonstrates a caring approach towards the people who live at the home, and this needs to be used proactively to give the staff a clear sense of what is expected of them when dealing with people who live at the home. The management of the service needs to promote more creativity and different ways of working with the people who live there to promote their quality of life. The quality assurance processes promote seeking the views of the people who use the service. There are regular health and safety checks carried out at the service. Evidence: The manager has been at the service for approximately eighteen months. During our inspections of the service we observed that she has a good, caring rapport towards the people who live at the home and their relatives. Staff we spoke to were respectful of the manager, though some said that they would like to see her spending time out of her office more. The service has a number of quality assurance processes that take place, such as regular team meetings and meetings the manager has with people who live at the home and their representatives. We saw that the organisation conducts an annual quality audit by issuing surveys to people who live at the home, their representatives and staff. These ask for their views on the service and ideas for improvement. The manager creates a report from the surveys including an action plan to address any issues. There was also a recent survey on peoples experiences of the food provided at the home. Care Homes for Older People Page 22 of 28 We saw that the organisation arranges for monthly checks on the service by the regional manager. We saw a record of these checks. They are comprehensive and included talking to people who live at the home and staff, looking at records and the environment and setting an action plan for improvement. The regional manager told us that the organisations clinical governance team ask for information on falls, accidents and incidents that have occurred at the home each week. They use this to monitor any patterns so that they can take action where necessary. There are also regular recorded checks on health and safety, including fire safety and water temperatures. The maintenance worker and management meet quarterly to discuss the environment and health and safety, and make plans for improvements. We saw records of these meetings. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action                                                                                           Care Homes for Older People Page 24 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. 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      7 15 The registered person must make sure records relating to wounds and injuries are clear and show how the wound is to be cared for and monitored, including a separate care plan (if needed) for all wounds. So that staff are following consistent and correct procedures when assisting people who use the service. 30/06/2010 2 7 15 The registered person must make sure care plans are clear, easy to read and understand and include up to date and accurate information about each persons assessed care, health and social needs. So that all assessed needs are planned for and people receive a good quality of care and support in all 30/06/2010 Care Homes for Older People Page 25 of 28 aspects of their lives. 3 8 16 The registered person must make sure people are offered, and if needed supported to have, regular hot and cold drinks. So that people have regular drinks and are kept propely hydrated. 4 8 12 The registered person must make sure people are supported to use the toilet if they request this as soon as it is reasonably practical. 30/04/2010 30/04/2010 5 12 16 So that the needs of the people who use the service are met promptly and they are not put at unnecessary distress. All people who live at the 31/05/2010 home must be provided with opportunities for stimulation, leisure and recreational activities both in and outside the home, with particular consideration to people with cognitive and/ or physical impairments. So that people who live at the home have a good quality of life The registered person must make sure all areas of the home and garden are clean and clutter free. So that the home is pleasant, safe and homely for the people who live there. Staffing levels must be based on meeting the fully assessed holistic needs of the people who use the service, and this must be kept under review and increased as necessary. 6 19 23 31/05/2010 7 27 18 30/04/2010 Care Homes for Older People Page 26 of 28 So that people who live at the home receive consistent support in all areas of their life. 8 30 13 The registered person must make sure staff always use approved moving and handling techniques when supporting people. So that people who live at the home are not put at risk by the staff interventions. 30/04/2010 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 12 People who are less independent should be supported to regularly attend external visits, and be engaged in the inhouse activities. All staff need to be involved in supporting people to meet their social needs and interests, particularly when there is no organised activities. Staffing levels on any shift should remain constant and not reduced, even if the number of people living at the home decrease. The management of the home and staffing during the period of less residents should be used as a time for developing the service and encouraging the staff to be more innovative and creative in their work with the people who live at the home, to enhance their lives and daily activities. 2 12 3 27 4 32 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. 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). 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