Care Home: Trecarrel Care Home

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What the care home does well The home provides a clean, comfortable, homely environment for people who use the service and it is free from offensive odours. The decor and furnishings are very good and the accommodation is well maintained. The garden is secure with paved pathways, colourful flowerbeds and plenty of seating. Staff told us that residents go outside weather permitting. There is a statement of purpose that details the facilities and services available at the home and enables people to be informed prior to deciding to live in the home. Residents and relatives said that health and personal care needs are met and staff treat people with respect making the quality of their lives as good as possible. Care practice was observed to be undertaken in a calm and quiet manner during this inspection and people`s privacy and dignity was respected. The atmosphere in the home was relaxed and staff interacted very well with the residents and their colleagues. Visitors said they are always made welcome. The system for dealing with medicines is appropriate and staff administering medicines have received relevant training. People told us they could choose how to spend their time and the daily routines such as bedtime and getting up are flexible. A very good range of activities are on offer and organised to suit the residents accommodated People said the food is good and the with fresh fruit, vegetables and homemade cakes included. Procedures for dealing with complaints and adult protection issues are satisfactory and staff receive relevant training. NVQ training is encouraged and 83% of care staff are qualified to at least level 2 in care. Others are undertaking the training or have progressed to levels 3 and 4. Recruitment procedures are robust with appropriate documents held in the home. There are enough staff on duty and people using the service spoke highly of all the staff. They said the staff are kind, caring and patient. Surveys received prior to this inspection were very positive about the staff. The home is well managed and everyone we spoke to said the manager is very approachable and runs the home in a competent but relaxed way. She has implemented systems for the continual improvement of the service. The registered manager`s approach to handling resident`s monies is satisfactory, so people who live in the home can be assured their financial interests are safeguarded. Money is stored safely and securely with appropriate records maintained. Health and safety issues are managed appropriately with all service checks and maintenance kept up to date. What has improved since the last inspection? This is the first inspection of this home under its new registration so this section is not applicable. What the care home could do better: It is a requirement that people are assessed before being admitted to the home to ensure that the home has the facilities and staffing available to meet their individual needs. We found that, although people had an assessment undertaken by the manager or a senior member of the care team, they were not detailed to show people`s individual needs. Care planning needs to be reviewed and the corporate system implemented. Daily records should not include the use of abbreviations. The amount of medicines received should be recorded on the medicine administration record charts and signed by the person recording it. Anything handwritten on the medicine administration record charts should be witnessed and signed by the person writing the order and by a witness. This will help to ensure that the correct order has been recorded. Care planning should include medicines in particular for diabetics and for those prescribed medicines on an as required basis. Some policies do not state the actual processes undertaken in the home and require updating, for example the policies for medicines and the management of resident`s monies. The adult protection and complaints policies need some updating to include contact details of external agencies such as the Department of Adult Social Care and the Care Quality Commission. Bathing facilities must be reviewed to ensure that the National Minimum Standards are met. There should be fly screens on the windows in the kitchen. Photographs of all staff must be held on file. If staff commence work with POVA check prior to the full CRB being received there should be evidence that they are supervised at all times. Key inspection report Care homes for older people Name: Address: Trecarrel Care Home Trecarrel Castledore Road Tywardreath Cornwall PL242TR     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: Diana Penrose     Date: 2 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Trecarrel Care Home Trecarrel Castledore Road Tywardreath Cornwall PL242TR 01726813588 01726816381 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cornwallis Care Services Limited Name of registered manager (if applicable) Mrs Michelle Wray Type of registration: Number of places registered: care home 44 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 44. The registered person may provide the following category of service only: Care home only - Code PC to service users whose primary needs on admission to the home are within the following category: Dementia (Code DE) Date of last inspection Brief description of the care home Trecarrel is a detached property situated in the village of Tywardreath. It is set back from the road and has adequate parking. A two storey extension that meets the National Minimum Standards has been built at the front of the property. All bedrooms in this section have en suite facilities. There is an attractive enclosed garden to the Care Homes for Older People Page 4 of 28 0 0 0 Over 65 44 0 0 Brief description of the care home side and the rear of the building with a patio that is accessible to residents. The home offers residential care for up to forty-four people with a dementia. Care staff provide personal care within a relaxed, friendly atmosphere. Assisted bathing and showering facilities are provided and all rooms have call bells. Security alarms are fitted to all external doors. There are two large non-smoking sitting rooms and a separate dining room with a conservatory. There is also a small seating area in the reception. There are opportunities for socialising and visitors are openly encouraged. Information about the home is available in the form of a statement of purpose which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from 405 to 500 pounds per week according to the registered manager, who supplied this information during the inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An Inspector visited Trecarrel Care Home on the 25 August 2009 and spent seven and a half hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that residents needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that residents placements in the home result in good outcomes for them. This home has changed its company name and this is the first inspection under the new registration. The home is owned by the same registered provider. There has been an extension to the building and a new registered manager has been in post since April 2009. On the day of inspection 42 residents were living in the home. The methods used to undertake the inspection were to meet with residents, relatives, staff and the registered manager to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. The Care Homes for Older People Page 6 of 28 registered manager has returned a completed Annual Quality Assurance Assessment, which has informed this inspection. Also surveys have been returned in respect of 5 residents, 6 staff and 1 healthcare professional, these have also informed this inspection. This report summarises the findings of this inspection. Residents who were able to talk to the inspector expressed satisfaction with the care they receive at the home. Relatives said the staff are kind and caring. Areas for improvement have been discussed with the registered manager who has agreed to address the issues. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 28 This is the first inspection of this home under its new registration so this section is not applicable. 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 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. Prospective residents are given information about the home enabling them to make an informed decision. People are only admitted to the home following an assessment of their healthcare needs, there is insufficient information recorded to determine whether or not the home can actually meet their needs. Evidence: We were shown the statement of purpose which includes coloured photographs of the home, the grounds and life in the home. It contains all the information required by legislation. The registered manager told us that she tends to assess all prospective residents herself but sometimes takes a carer with her. A specific form is used to record the needs assessment. The assessment documentation for four people using the service was inspected. The forms seen were lengthy and comprised of tick boxes with spaces alongside for comments. The forms were incomplete and most had no comments Care Homes for Older People Page 11 of 28 Evidence: included. There were various risk assessments included with the assessment form but many had not been completed. This was discussed with the manager who told us that she would review the documentation used and ensure that the forms are fully completed in future. Assessment information from the Department of Adult Social Care (DASC) and discharge information from hospitals were seen in the files. The manager said these are very useful. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and staff feel that healthcare needs are met, the care plan format is to be changed however current plans lack detail to fully inform and direct staff on the care they have to provide. There is an appropriate medicines system in place extra attention in some areas will ensure a safer system. Evidence: The care files for four residents were examined. A pre-printed care plan was in use with the persons name inserted where necessary. Various risk assessments are included but not referred to in the care plans. The plans are not person centred and do not inform or direct staff on the care to be provided. A summary of care is included in the front of the files which gives a clearer picture but is not detailed. The manager told us she inherited the format but does not like it. The operations director said that the template used in another home owned by the company is to be adopted in this home. We have inspected the format used at the other home and it will be much more suitable. We were assured that this will happen promptly and we will be fully informed of the progress. Care Homes for Older People Page 13 of 28 Evidence: Daily records were seen and were informative. Abbreviations were seen in some records and this is not seen as good practice. The manager told us that some residents had been assessed under the Mental Capacity Act but there were no Deprivation of Liberties authorisations. We observed that most of the people using the service were able to move around independently. Staff told us that most people need minimal assistance or prompting with their personal care needs. Staff talked about the care of people using the service and they seemed to know the residents very well. The care practice observed was good and staff interacted well with residents in a very calm manner. Surveys received prior to this inspection from residents (some completed by relatives) say the care and support is always good in the home. One member of staff commented Trecarrel is the only place that I have worked that is a true care home. All the staff ensure that all residents get the help and time they need. We were told the home has good links with the doctors surgeries and the Community Nurses are very supportive. None of the residents have pressure sores and equipment is provided for moving and handling purposes. We were told that all but two continence assessments have been undertaken. We saw forms that showed that nutritional screening is undertaken on admission. The manager told us that the speech and language therapist and the dietician are involved when necessary. She said the speech and language therapist had provided training for staff as had the diabetic liaison nurse. We were shown the medicines policy which was not the companys up to date policy. The manager said she would obtain the relevant copy and review and update it for the home. She also agreed to obtain a copy of the document on the handling of medicines in social care. There are medicines reference books for staff to use and the patient information leaflets are kept to inform staff and residents as necessary. The manager told us that medicines are checked when received in the home, we saw that there was no record of this on the medicine administration record charts. We saw that the administration and disposal records were completed appropriately. Handwritten instructions on the medicine administration record charts were not signed or witnessed and this was discussed with the manager who said she would address it with the care staff. For people prescribed to have medicines administered, when required, we found that there were no care plans in place about the use of this medicine, or any directions on Care Homes for Older People Page 14 of 28 Evidence: how to make an assessment if this medicine is required. There were no specific care plans for diabetic residents and this was discussed with the manager. We were told that care staff sometimes test for blood sugar levels but insulin is administered by the Community Nurses, their records were seen and the injection sites were recorded. The storage of medicines was shown to us and all was satisfactory. We were told that care staff who administer medicines receive appropriate training and we were shown the training records. The induction programme shown to us included basic information regarding medicines. We saw that peoples privacy and dignity were respected during this inspection. Staff knocked on doors prior to opening them and kept people covered with a blanket whilst hoisting. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A variety of activities and entertainment are provided, a nutritious menu is on offer and residents are encouraged to live a life of their preference. Evidence: An activities coordinator is employed and we spoke with her during this inspection. She told us that activities take place every day, when she is not in the home one of the care staff is allocated to provide activities. We saw the activities calendar which included visiting entertainers as well as in house activities. It included reminiscence, board games, a visiting pat dog, songs of praise, sing a longs, quoits, skittles, musical movement, music for health and holy communion. We were told the list is not written in stone it is adjusted to what people want to do. Several staff told us about the cooking that residents are involved in each week. An aromatherapist was visiting during this inspection and a resident enjoyed her feet and legs massaged. We observed a sing a long and some people enjoying the Hokey Cokey. We saw that individual records were maintained for each person with a list of the activity and a level of participation. More detail as to what people get out of the sessions and their emotional responses was discussed with the manager and the coordinator. They said they would change the format to include this and felt it would be useful. The Annual Quality Assurance Assessment (AQAA) completed by the manager states that she Care Homes for Older People Page 16 of 28 Evidence: hopes to improve the weekend activities and trips out. Some people commented that outdoor activities could be improved. We were told that people walk in the grounds regularly and two people do some gardening. Surveys received by CQC prior to this inspection show that people are happy with the activities provided. Comments include A number of activities are arranged within the home which are available to all residents if they wish to take part, I believe a number of residents find these entertaining and The day is tailored to the needs of the clients, we have activities every day and there is always a happy, relaxed atmosphere. The visitors record shows that people come to the home regularly. We were told there are no restrictions on visiting times. People visiting during this inspection said they can call in whenever they like. The manager told us that peoples individual preferences are respected as far as possible and they are supported to maintain their independence. The preferred times for people getting up and going to bed were seen in their files. Daily records show that choices are respected. People were moving about the home as they wished, if able to do so. There were no restrictions between the old and new parts of the building, people were using both lounges not just the one nearest their bedroom. People had their own belongings in their rooms including furniture. We were shown a 4 week menu that included choices. The manager said that people choose their meals on the day and are shown the two options on plates enabling them to make a visual choice. The cook told us that people using the service have very good appetites and fresh produce is used. Cakes are all homemade. She said there is one vegetarian and several diabetics to cater for as well as six on varying degrees of soft food. Nutritional needs assessments were seen in the care files and we saw that peoples weight is monitored. We were told that one person has mainly finger food as she wanders around all of the time. The dining room is spacious, light and airy and it is utilised by most residents. People told us the food provided is very good and surveys were positive about the food. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure that ensures complaints will be listened to and acted upon. Arrangements are in place for the protection of residents safeguarding them from harm or abuse. Evidence: We saw the homes complaints policy, it needs some updating to include the contact details of external agencies. The policy was available to staff in their office. It is also included in the statement of purpose which is available to residents at reception and provided to relatives. There is a file for holding thank you letters and cards. There have been no complaints to the manager or the Care Quality Commission. There is an appropriate adult protection policy and the manager has a copy of the local authority procedures. Some minor updating of the policy was discussed with the manager. The manager was able to verbalise the relevant course of action to be taken should there be an allegation of abuse in the home. Staff told us they have received adult protection training both in house and externally. The manager told us she has some training materials to undertake more in house training. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained, decorated and furnished to a good standard with no unpleasant odours making it a safe and pleasant place to live in. Evidence: We toured the premises and found it to be clean and free from offensive odours. The building is a one storey building with a modern two storey extension at the front. There is a reception area with a desk for the receptionist in the new building. There is some seating for residents in this area. The managers office is also in the new building. There are lounges in both parts of the building that are homely and comfortable. The kitchen is in the older building; it is large and fitted with stainless steel units. One fly screen was missing from a window in the kitchen and the manager was unsure why; she said she would make sure that a screen is re-fitted. The older part of the building has been refurbished and re-decorated, the dining room has been extended with a conservatory which makes it very light. There are two wet room showers and an assisted bath in the new part of the building and an assisted bath in the older building. A further bathing facility is required to comply with the National Minimum Standards. We were shown one bathroom that is not used at the moment and another that had the bath removed some time ago. We were told that one of these rooms will be converted into another wet room shower and the other hopefully into a hairdressing salon; at present hairdressing takes place in a small Care Homes for Older People Page 19 of 28 Evidence: corridor. Some door thresholds are not level and are unsuitable for wheelchair users. We were told that there are no wheelchair users at the moment. The grounds are tidy with enclosed gardens and seating areas for residents. There are pathways for people to walk and colourful flowerbeds. The laundry is spacious with two washers and two driers. There is a door that opens to the outside where there is a washing line. There are two sluices in the home, both in the older part of the building. Procedures to guide staff on the control of infection were seen along with records of staff training in this subject. Staff were observed wearing plastic aprons and gloves and there were soap dispensers and paper towels provided at each hand basin. Alcohol cleansing gel was also seen in use. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are robust and there are sufficient staff employed who receive regular training to improve their knowledge and skills. Evidence: We were told there were no staff vacancies at the home. The manager said there is usually one team leader with five care staff during the day and four care staff overnight. She said that sometimes extra staff are on duty in the evenings to help get people ready for bed. An activities coordinator, catering, laundry and housekeeping staff, a receptionist and a maintenance man are also employed. The manager told us that agency staff are employed when required but this is not very often. Staff told us there are sufficient numbers of staff on duty to meet the needs of the residents. Twelve surveys were received from staff, residents and healthcare professionals. They told us that there are always / usually sufficient staff available; although three people commented that more staff were needed. Staff appeared to enjoy their work and the atmosphere was very relaxed and friendly. All staff interacted well together and with the residents. Staff told us they are happy in their work and that the team works very well together. One member of staff said she enjoys coming to work and it is stress free. One survey comment stated Since the new building has opened all the staff and residents have really pulled together and Care Homes for Older People Page 21 of 28 Evidence: worked as a team, even though it is a big change, it has been a real positive time. We were told that 83 of care staff have achieved an NVQ qualification to at least level 2, in care. Four others are working towards level 2 and five towards level 3. Two have achieved level 4. Four staff files were inspected and they were well organised. None of them contained a photograph of the employee or a job description; the manager said she would address this. One person was noted to have commenced work following a POVA first check but prior to the full CRB check being received. We were assured that she was supervised at all times but there was no written evidence to support this. The manager said she would ensure a system is put in place for this in future. The manager told us that she has introduced the skills for care induction programme and that new employees had their packs to work through. We did not see a completed pack. The staff files only held a checklist of orientation to the home. Certificates of training attendance were seen in the staff training files. We were shown a training matrix that held the names of all staff and the dates they had attended training or were booked onto training. The records show that as well as statutory training staff also attend sessions on dementia, diabetes, palliative care, conflict, Mental Capacity Act and Deprivation of Liberties for example. Staff told us that they receive a great deal of training, some in house and some externally. Surveys were extremely positive about the training provided. One comment was Staff are well trained and everyone gets support and advice to enable them to work well. The AQAA told us that the manager has improved training for staff but intends to widen the training provision. She hopes to include challenging behaviour training and ensure that all care staff achieve an NVQ qualification. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is competent in running the home; systems are in place for health and safety and to monitor and improve the service for residents and staff. There is a suitable system for managing peoples money to ensure that their finances are safeguarded. Evidence: The registered manager told us that she has achieved NVQ qualifications in care at levels 2, 3 and 4. She has also achieved the Registered Managers Award. She said she is very keen on attending training to further her knowledge and skills and attends managers courses locally. She networks with other managers and uses the internet sometimes. Recent training includes equality and diversity, POVA and Deprivation of Liberties. She said she is going to do the moving and handling train the trainers course. She said she enjoys her role and the appointment of a receptionist to assist with administration has been a great help. Staff and visitors said the home is well run and the Operations Director visits Care Homes for Older People Page 23 of 28 Evidence: regularly. They said the manager has settled in well and changes she has implemented have improved the home a great deal. Everyone said the manager has an open door policy and she is always out and about in the home. Some staff said she works on the floor if needed. Staff told us they were supported by the manager and that meetings and formal supervision sessions take place regularly. We were told there are quality assurance systems in place. These include surveys of relatives and residents undertaken quarterly at the moment. They have not been collated as yet. Resident / relatives meetings take place every six months as do staff meetings. The minutes of the last meeting had not been typed up so were not seen. The manager said she holds departmental meetings as required and that informal meetings take place all the time. We were told that a fundraising committee has been set up and that a newsletter is to be produced with input from families. The manager said she checks the medicine administration records and we saw that accidents are audited per individual but there are no other audits at the moment. The registered manager has completed an Annual Quality Assurance Assessment (AQAA) for the Commission. The Operations Director completes a monthly regulation 26 report that reports on the conduct of the home; these reports were seen in the home and they are sent to the Commission. The manager explained the process in place for the management of residents monies. She said that one person controls her own money and that families assist residents with their money. Money was seen individually held for most residents in the safe. We were told this is purely small amounts to cover toiletries and hairdressing and so on. Written records were seen and two signatures were recorded alongside each transaction, regular checking of the sheets was recorded. Receipts were seen and the manager was advised to number these for ease of auditing. There are suitable arrangements in place for access to the safe that enable residents to access their money out of office hours if required. The policy in respect of managing residents monies was seen and requires reviewing and updating to state the process in place in the home. We were told that health and safety and fire risk assessments have been undertaken and the fire officer was satisfied with the systems in place. A file for fire documentation and records was seen which was kept up to date. We saw records that show that equipment and service checks are carried out regularly. Data sheets for the control of hazardous substances (COSHH) were seen and available to staff. The records show that statutory training takes place and most was up to date or booked. The manager was aware of some gaps in training but said she was getting these up to date. Catering staff and most of the care staff have undertaken food hygiene training, Care Homes for Older People Page 24 of 28 Evidence: one cook at intermediate level. The most recent Environmental Health Officers report was seen and was complimentary about the home and the cleanliness of the kitchen. The accident records show that the home has a high level of accidents, mainly residents falling. There were 44 accidents recorded for July 2009 and 25 for August. The manager explained the reasons for the high level of falls which she was aware of. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 All prospective residents should have their care needs thoroughly assessed and recorded prior to admission to the home, to ensure the home is able to meet their individual needs. The care planning system should be reviewed to ensure that staff are informed and directed on the individual care to be provided. Residents who have medicines prescribed on an as required basis should have care plans to direct staff on their use Handwritten instructions on the medicines charts should be witnessed and signed by two members of staff. 2 7 3 9 4 9 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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