Care Home: The White House, Falmouth

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What the care home does well The registered provider provides a stable, comfortable, and homely environment for residents. The people were clearly relaxed, content and able to talk comfortably with the staff and the inspector. The registered provider demonstrated a good understanding of the care needs of the residents, and there is an evident commitment to individualised care provision. There is an established and committed staff team, some of whom have worked at the home for many years. The registered provider is actively involved on a daily basis. Staff were observed to interact with the residents in a professional and caring manner. The staff were also observed to be busy throughout the inspection attending to the needs of the residents. People are only admitted following a thorough assessment to ensure the home can meet their needs. Prospective residents and their family are invited to visit the home prior to any decisions being made to live there. People`s healthcare needs are met and specialist healthcare professionals visit the home when required. All of the people spoken with during this inspection said they are satisfied with the care and services provided to them, including arrangements to maintain their privacy. They said their individual preferences are respected and they can choose what they do each day. All of the surveys returned were positive in respect of the care and services. The people said they are able to choose to either have their meals served to them in their own rooms, or to dine in the main dining room, which adjoins the lounge. Social activities and events take place and entertainers visit the home. The care staff are responsible for activities and people said they enjoy what is on offer. Those that do not wish to join in said their wishes are respected and staff spend time with them on a one to one basis. Residents said the food is good and they get enough to eat. Fresh fruit and vegetables are included and drinks and snacks are available at all times. There have been no complaints but there is a system in place that ensures that complaints would be dealt with promptly and records kept. There is a suitable policy for the prevention of abuse and staff have received training in the protection of vulnerable adults and the procedure to be followed. Sixty percent of the staff have NVQ qualifications and others are working towards them so people can have confidence that they are competent to work with them. There is a quality assurance system in place that allows people to air their views and various audits take place. Relevant service checks take place as required and are up to date. Accidents are reported and there are few. Staff receive relevant statutory training. The provider is very experienced in the care field with over 40 years experience in management and the delivery of care services. She keeps herself updated and attends courses relevant to her role. Staff and residents thought highly of her, they said she works alongside the staff, runs the home well, and is approachable. What has improved since the last inspection? The registered providers continue to offer a stable, relaxed and comfortable home for the residents, who, without exception, were praiseworthy of the home, the registered provider and the staff. There is an ongoing programme to improve the homes environment and a small number of rooms have been refurbished and decorated for residents. The registered provider has plans to refurbish the bathroom facilities and has started work to incorporate en-suite facilities to two bedrooms. She told us she has plans for the garden, further redecoration and refurbishment of rooms, and improvements to bathing facilities as well. Legionella testing has been done and the registered provider will continue with annual tests. The water tanks have been replaced. What the care home could do better: Care plans would benefit from more detail. The provider agreed an improvement plan at a previous inspection to provide thermostatic control valves to all hot water outlets. Until these were in place she agreed to undertake risk assessments for all residents and their access to hot water outlets. This has not been done. The registered provider told the inspector that thermostatic valves would be fitted by the end of January 2010. In view of this the inspector will be recommending an additional random inspection in the first quarter of 2010 to monitor compliance with regulations. The homes environment should continue to be improved so that people using the service and staff have a more pleasant and safe place to live and work in. Controlled drugs must be stored in a cupboard that complies with legislation. This requirement was made at the previous inspection. The registered provider must consistently adhere to and record a robust recruitment procedure. This is to keep residents safe and protect them from abuse. The registered provider should use a system for monitoring and assessing staff training needs (e.g. training matrix). The registered provider should publish a summary of the home`s quality assurance results, including any action taken as a result of the findings. Key inspection report Care homes for older people Name: Address: The White House, Falmouth 128 Dracaena Avenue Falmouth Cornwall TR11 2ER     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: Alan Pitts     Date: 0 5 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 27 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 27 Information about the care home Name of care home: Address: The White House, Falmouth 128 Dracaena Avenue Falmouth Cornwall TR11 2ER 01326318318 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Helen Judith Christopher care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The White House is situated in Falmouth on the main route into the town. The home provides personal care for up to seventeen elderly people. Accommodation is provided on two floors and there are stair-lifts to access the first floor. Residents have their own bedrooms that are fitted with hand washbasins. There are sufficient toilets and assisted bathing facilities are provided. Meals are prepared in the kitchen on the ground floor and served in the lounge diner. Residents can choose to eat in their individual bedrooms if preferred. The home has small parking area to the front and slopping gardens to the rear with patios accessible to residents. Some areas are suitable for wheelchairs. The front access to the home is on a slope and limited parking space is available. There is a flexible visiting policy and residents can see their visitors in private. Information about the home is available in the form of a residents guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from 320 to 500 pounds per week. Additional charges are made in respect of private healthcare provision, hairdressing and personal Care Homes for Older People Page 4 of 27 Over 65 17 0 1 2 0 3 2 0 0 9 Brief description of the care home items such as newspapers, confectionary and toiletries. Mrs Christopher became the owner of the home in December 2005. She is responsible for the day-to-day running of the home and employs a team of care assistants and domestic staff. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place on the 5th January 2010. The inspector met and spoke with residents, staff, and the registered provider. The documentation, policies and procedures, and the environment were inspected. CQC surveys have been returned in respect of 9 residents, 5 staff and 1 professional, these have also informed this inspection. The White House is a family-run home, which provides a comfortable and appropriate home for up to 17 residents. On the day of the inspection there were sixteen residents living at the home. The relaxed family atmosphere, and the evident contentment of the residents impressed the Inspector. Nothing should detract from how highly the residents speak about their home, the staff, and the care that they receive. The registered provider must give attention to the requirements and recommendations made in this and previous reports. Care Homes for Older People Page 6 of 27 What the care home does well: The registered provider provides a stable, comfortable, and homely environment for residents. The people were clearly relaxed, content and able to talk comfortably with the staff and the inspector. The registered provider demonstrated a good understanding of the care needs of the residents, and there is an evident commitment to individualised care provision. There is an established and committed staff team, some of whom have worked at the home for many years. The registered provider is actively involved on a daily basis. Staff were observed to interact with the residents in a professional and caring manner. The staff were also observed to be busy throughout the inspection attending to the needs of the residents. People are only admitted following a thorough assessment to ensure the home can meet their needs. Prospective residents and their family are invited to visit the home prior to any decisions being made to live there. Peoples healthcare needs are met and specialist healthcare professionals visit the home when required. All of the people spoken with during this inspection said they are satisfied with the care and services provided to them, including arrangements to maintain their privacy. They said their individual preferences are respected and they can choose what they do each day. All of the surveys returned were positive in respect of the care and services. The people said they are able to choose to either have their meals served to them in their own rooms, or to dine in the main dining room, which adjoins the lounge. Social activities and events take place and entertainers visit the home. The care staff are responsible for activities and people said they enjoy what is on offer. Those that do not wish to join in said their wishes are respected and staff spend time with them on a one to one basis. Residents said the food is good and they get enough to eat. Fresh fruit and vegetables are included and drinks and snacks are available at all times. There have been no complaints but there is a system in place that ensures that complaints would be dealt with promptly and records kept. There is a suitable policy for the prevention of abuse and staff have received training in the protection of vulnerable adults and the procedure to be followed. Sixty percent of the staff have NVQ qualifications and others are working towards them so people can have confidence that they are competent to work with them. There is a quality assurance system in place that allows people to air their views and various audits take place. Relevant service checks take place as required and are up to date. Accidents are reported and there are few. Staff receive relevant statutory training. The provider is very experienced in the care field with over 40 years experience in management and the delivery of care services. She keeps herself updated and attends Care Homes for Older People Page 7 of 27 courses relevant to her role. Staff and residents thought highly of her, they said she works alongside the staff, runs the home well, and is approachable. 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. Care Homes for Older People Page 8 of 27 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 27 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 27 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. The most recent admission to the home was properly assessed prior to finalising the move. Intermediate care is not offered. The people who are thinking about a move to The White House are provided with good information to help inform them about their choice of home, though consideration should be given to alternative formats. Evidence: The registered provider confirmed that copies of the Statement of Purpose and Service User Guide (documents that tell a person about the home) are given to prospective and current residents. This also includes the Complaints Procedure. As part of this inspection we looked at the assessments that were carried out prior to a person moving to the home. The care documentation of the person most recently admitted to the home showed that a proper pre-admission assessment had take place. Comments received from residents at the time of the inspection, and provided by the quality assurance surveys sent out prior to the inspection were positive, and Care Homes for Older People Page 11 of 27 Evidence: confirmed that people feel they receive the information they need. Residents are involved in determining their care plans. Intermediate care is not offered. Care Homes for Older People Page 12 of 27 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. Each resident has a plan of care. The care documentation shows the involvement of other health care professionals, and residents confirmed that they receive a good standard of care and felt well looked after by staff. Medicines are generally handled appropriately, and the home has a relevant procedure. The residents could not speak highly enough of the care, attention, and respect shown by the staff. Evidence: Residents care plans and documentation were inspected. Care plans are reviewed monthly with the staff and the resident. The records show that changes are made when needed, but one care plan discussed had not been reviewed properly since the residents admission. Relevant risk assessments were seen in the care files and they are reviewed monthly or more often if needed. The residents health, spiritual, social and personal care needs are set out in an individual plan of care and these are being reviewed with resident and/or representative involvement, where possible. More detail would be of benefit (e.g. avoid the use of generic phrases such as all assistance needed, rather describe the capabilities of the individual and the actual care intervention needed). The aims and objectives of the home reinforce the importance Care Homes for Older People Page 13 of 27 Evidence: of treating residents with respect and dignity. Daily entries in the care documentation show the involvement of other healthcare agencies as appropriate to the needs of the resident. Daily entries made by staff evidence the general health care given. Residents are registered with a GP, and professional advice is sought as needed. The residents confirmed that they have the opportunity for exercise and activity. All the residents have access to support services such as opticians. There is suitable storage for medicines requiring refrigeration. Controlled drugs must be stored in a cupboard that complies with legislation, this was identified as a requirement at the last inspection and discussed again with the registered provider who agreed to address this. There were no controlled drugs in use at the time of the inspection. A medicine policy is in operation. Medicine Administration Records were seen to be in order. The supplying pharmacist reviews peoples medication regularly and provides training for staff. Residents and their representatives or relatives are treated with respect and their right to privacy is upheld. Staff were observed to treat people with respect and dignity at all times throughout the inspection. The residents preferred name is documented as well as peoples likes and dislikes. People spoken with confirmed that they are treated respectfully; their privacy and rights to make decisions are supported, and they spoke very highly of the staff and the autonomy that they are afforded. Residents confirmed that they are able to meet relatives and friends within the communal areas, or in their own rooms. The size of the home means that it runs as a large extended family, with the established and experienced staff having an in-depth understanding of the residents and their needs. Clients have access to a telephone for private use. Care Homes for Older People Page 14 of 27 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. Residents said that the staff could not do enough for them, and that they were free to see visitors as they wished. They also confirmed that they have enough to do to keep themselves occupied. The residents said that they enjoyed the food that was provided, and confirmed that they were offered a choice. Evidence: The residents informed the inspector that they were able to make choices about how to spend their time, and they felt that their recreational interests were being met on an individual basis. Care staff provide activities for people using the service as part of their daily work. People said they enjoy the activities on offer and others said their wishes are respected as they do not like to join in. People said they were able to choose where to eat e.g. dining room, lounge or in their room. Spiritual and social needs are included in the care plans. The residents were happy with the flexibility within the home and felt that it met their needs and wishes. The registered provider said that most people do not want organised activities but they enjoy aromatherapy, manicures, skittles, making cards and one to one chats. There are records of the activities undertaken by each person in their care file, though with one exception where specific effort is being made to record the residents participation, the entries made by staff could provide more detail about the quality of the residentsday and Care Homes for Older People Page 15 of 27 Evidence: reflect the individual preferences of that person. Residents are able to meet relatives and friends within the communal areas, or in their own rooms. Visitors are welcomed to the home, depending on the residents wishes, which are respected at all times. Rooms are personalised with plenty of evidence of personal possessions being brought in. Two rooms are currently being refurbished with the cooperation and involvement of the residents. The work necessary for one is being carried out around the residents preferred daily activities. The likes and dislikes of each resident are noted and an alternative provided if the resident is known not to like something. Residents are advised of the menu planned for the day. Residents were aware what was for lunch that day. Choice is provided at all meals. Food records are kept and special diets are catered for, as required. Fresh fruit and vegetables are readily available. Baking takes place on a regular basis. The residents were complimentary about the food. The dining room provides an attractive, comfortable setting that is laid up for residents who choose to eat there. The kitchen was seen to be clean and orderly. Care Homes for Older People Page 16 of 27 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. Neither the home nor the Care Quality Commission have received any complaints since the last inspection. The registered provider and staff were seen to interact well with residents, who confirmed that they would feel able to raise any concerns. Residents welfare is protected. Evidence: There is a complaints procedure in operation, and residents confirmed that they would feel able to express any concerns. There is a method for recording complaints, the action taken and the outcome. The residents said that they knew who to talk to if they had a concern, and would feel able to do so. There is a Protection of Vulnerable Adults policy and a whistle blowing policy. Residents are additionally safeguarded by the family approach of the home and the small, established staff team. Safeguarding training is provided for all staff, as is regular staff supervision. People are not consistently protected by the homes recruitment procedures. Care Homes for Older People Page 17 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents said that they were comfortable and very happy with their accommodation. Residents rooms were personalised and comfortably furnished. There is no lift or other aid to assist access between floors. The environment is clean, and homely. Evidence: The home is warm, comfortable and homely. It is well ventilated and there is domestic style lighting. The registered provider has made further improvements including the ongoing refurbishment of bedrooms. The registered provider has discussed the ongoing refurbishment of rooms with the relevant residents, and anticipates the completion of two rooms within a fortnight of the inspection (including the provision of new furniture and redecorating). The provider talked of the plans she has for the improvement of the two bathrooms and the shower room. These are to include the installation of a Parker bath, and the registered provider said she expects this to be completed by the end of March 2010. Grab rails and raised toilet seats are provided in toilets and there are stair lifts to access upstairs. People have their own bedrooms (the double room is not shared at the moment). Some of the downstairs bedrooms have doors leading to the garden and the windows in these rooms have restrictors fitted and alarms on the doors. The provider agreed an improvement plan at a previous inspection to provide Care Homes for Older People Page 18 of 27 Evidence: thermostatic control valves to all hot water outlets. Until these were in place she agreed to undertake risk assessments for all residents and their access to hot water outlets. This has not been done. The registered provider told the inspector that thermostatic valves would be fitted by the end of January 2010. In view of this the inspector will be recommending an additional random inspection in the first quarter of 2010 to monitor compliance with regulations. The home was seen to be clean and there were no undue odours. The laundry facilities are two domestic washing machines and one drier. The provider said she is hoping to refurbish the laundry and replace these with industrial machines. The home deals with all laundry and all staff undertake this. People said that on the whole the system works well, issues have been raised at residents meetings and have been addressed by the provider. Suitable hand washing facilities are provided. Alcohol gel is not in use, and this was discussed with the registered provider. Protective clothing is supplied. The home does show signs of wear and tear in a number of places (e.g. damaged walls, wallpaper missing), and this was discussed with the registered provider with a view to the best way to keep on top of the ongoing small jobs that need attention. Care Homes for Older People Page 19 of 27 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. The training records have improved to better demonstrate that staff are provided with the skills and knowledge to perform their roles, and residents were very complimentary about the care provided. We were advised a National Training Organisation compliant induction programme is in use, though a current record was not available. The home uses a robust employment procedure to protect residents, but care should be taken to ensure this is consistently adhered to. Evidence: This is a small establishment with a small team of mostly long-serving staff. Staffing levels are recorded. Staff often share roles within a shift, such as cooking and caring or cleaning and caring. Residents were, without exception, complimentary about the staff and the care they provide, saying nothing is too much trouble. There are generally two care staff on duty at all times, with three in the mornings to cover cooking the main meal. At night there is one awake and one sleeping. Staffing levels were appropriate to the care needs of the residents at the time of the inspection. Staff were observed to be caring and respectful during their interactions with each other and the residents. There is an evident rapport with residents and a relaxed atmosphere that is the result of attention to individual needs and preferences. Staff training records have improved since the last inspection and demonstrate a commitment to furthering the staffs skills and knowledge base. Six of ten staff Care Homes for Older People Page 20 of 27 Evidence: members have achieved the NVQ Level 2 qualification or above, and we were advised that another two are undertaking this training. We could not see who had or had not attended training easily as the details are held separately in each file. The registered provider has compiled a training matrix to help her see who needs to attend training and when. The staff meeting minutes show that the provider talks to staff about current issues. Two staff personnel files were inspected and one was seen to be satisfactory, showing evidence of application forms, 2 references, POVA checks and evidence of interviews. One was incomplete, and the registered provider was unable to locate the missing information or confirm an accurate start date for the staff member. This file did not show 2 references, POVA check, CRB, contract, and evidence of interview. The registered provider located the missing information after the inspection and sent it to the inspector. The home is running a National Training Organisation compliant induction programme. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The inspector is of the opinion that the registered provider has the residents best interests at heart, and this is supported by the positive comments received from the people that live there. Evidence: The registered provider has over 40 years experience in management and delivery of care services. The provider works hands on with the staff and knows the people using the service well and how to care for them. She is competent in running the home and has invested in the home to improve the service for the people that live there. She said she keeps up to date on current issues by using the internet and reading relevant magazines, she also attends courses when appropriate. Staff said the provider runs the home well and in the best interest of the people living there. People living there said she is kind and approachable. There is an annual quality assurance survey, and this is distributed to residents, Care Homes for Older People Page 22 of 27 Evidence: relatives, staff and external stakeholders. The last survey was in 2009 and completed forms were seen. The provider has not yet published a summary of the findings, including any action taken as a result of the findings. The forms seen were positive about the home and the services provided. Staff and residents meetings take place and the minutes were seen, they show that issues are discussed and addressed. There are few accidents. The registered provider said she talks with staff individually during supervision to ensure they understand the homes policies and procedures. The provider does not manage personal finances for the people using the service. Residents, family members and relatives deal with finances and fees. The registered provider operates a petty cash float to purchase items for people living there. They or their relative may then be retrospectively invoiced with a copy of the relevant receipt. Statutory training takes place and attendance is recorded. Appropriate documentation was in place to evidence servicing and maintenance. The provider has not purchased the door guards as stated in the last report and the report previous to that. She said she has undertaken a fire risk assessment and has discussed this with a fire officer. Records show a fire officer did visit, but there is no record of what was discussed or the purpose of the visit. The registered provider said that the door guards were on order. Two water tanks have been replaced, and the registered provider said she will continue annual Legionella monitoring. The registered provider has agreed to address outstanding breaches of regulation, and she is aware that if this is not done enforcement action may well be taken. The inspector will be recommending a further random inspection in the first quarter of 2010 to monitor compliance. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made 31/07/2009 to ensure that controlled drugs are stored in a cupboard that complies with current regulations This will comply with the law and ensure controlled drugs are safely stored. 2 38 13 Water outlets accessed by people using the service must be thermostatically controlled or appropriately risk assessed with hot water signage in place. This will make sure that people are safe from the risk of injury from hot water. 31/07/2009 Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made to ensure that controlled drugs are stored in a cupboard that complies with current regulations. This will comply with the law and ensure controlled drugs are safely stored. 01/03/2010 2 25 13 Water outlets accessed by 01/03/2010 people using the service must be thermostatically controlled or appropriately risk-assessed with hot water signage in place. This will make sure that people are safe from the risk of injury from hot water. 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 More detail in care plans would give better direction to staff Page 25 of 27 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations delivering care and help to ensure consistency in care provision. 2 12 The entries made by staff in the daily notes could provide more detail about the quality of the residentsday and reflect the individual preferences of that person and the choices made. The registered provider should publish a summary of the homes quality assurance results, including any action taken as a result of the findings. 3 33 Care Homes for Older People Page 26 of 27 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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