Care Home: Tudor House

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What the care home does well The home understands the importance of having enough information when choosing a care home. Pre admission documentation was in place, and was being completed appropriately to ensure that individuals` needs could be met in the home. Care plans had been completed in sufficient detail to ensure continuity of care. They included personal preferences and had been written in consultation with the residents where practicable. Residents can access and enjoy the opportunities available in the local community such as library services, local pubs and leisure services. Staff are sensitive to the needs of those residents who find it difficult to eat. They are aware of the importance of feeding at the pace of the resident making them feel comfortable and unhurried. The service has a complaints procedure that is clearly written and easy to understand. It is available on request in a number of different formats, including large print or pictorial, to help anyone living in the home to complain or make suggestions for improvements. There is a safeguarding policy available to staff. Staff working at the home know when incidents need to be reported externally, and who to report them to. The home provides a physical environment that meets the needs of the people who live there. The home is generally clean and comfortable, and there is an programmme in place to improve the decoration, fixtures and fittings, bringing them up to an improved standard. The manager has the required qualifications and experience to run the home, and is working continuously to improve the service. She has good people skills and understands the importance of person centred care and effective outcomes for the residents. The Annual Quality Assurance Assessment was completed in detail and returned to us as requested. This was informative and told us about any changes they had made and areas where improvement was still needed. Accidents and incidents in this home are reported appropriately and in a timely fashion, and risk assessments are completed and reviewed so that risks to residents are minimised. What has improved since the last inspection? Medication Administration Records sheets had been completed accurately and stocks reconciled with records. The old worn carpets that we commented on at the last inspection have now been replaced, and the kitchen ceiling which was in need of attention has also been satisfactorily completed. A new `nurse call` system has been fitted in the home since the last inspection, and the fire alarm system has been upgraded. What the care home could do better: Not all recently appointed staff had attended formal training on safeguarding. The reception area of the home displays information about the home, however is rather dark and dull and would benefit from some attention to bighten it up and make it more homely. Some of the bathrooms / shower facilities are old and worn. The manager told us that the homes` decorating programme is ongoing, and that work is due to start on the bathroom facilities imminently. This will include replacing suites and retiling. The service recognises the importance of training , and tries to deliver a programme that meets any statutory requirements and the National Minimum Standards. The manager is aware that there are gaps in the training and plans to deal with this. Key inspection report Care homes for older people Name: Address: Tudor House 76 West Street Dunstable Bedfordshire LU6 1NX     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 Trainor     Date: 0 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Tudor House 76 West Street Dunstable Bedfordshire LU6 1NX 01582663700 01582673287 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Janes Care Homes Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 18 The registered person may provide the following categories of service only: Care Home only - Code PC 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 Dementia - Code DE Date of last inspection Brief description of the care home Tudor House is situated on a busy road near the centre of Dunstable within a short walk of the town s many amenities. The home provides personal care for up to eighteen people over the age of 65 years who may also have dementia and / or physical disabilities. The registration for physical disabilities was not required as the home could meet the needs of those with physical frailties and mobility problems associated with old age under the category for older persons. The accommodation is distributed over two floors that are accessed by staircases and a shaft lift. There are fourteen single bedrooms and two double rooms. The dining and lounge facilities are Care Homes for Older People Page 4 of 29 18 0 Over 65 0 18 Brief description of the care home located on the ground floor together with the kitchen, conservatory, laundry, bathrooms, WCs and some bedrooms. The second floor accommodates the managers office, sleeping in room and training room for staff. To the rear of the property is a garden with seating areas. The fees for this home vary from £457.06 to £550.00 per week, depending on the funding source and assessed needs of the person. Additional charges are made for hairdressing, barber services and newspapers. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Care Quality Commission (CQC) policy and methodologies which require review of the key standards for the provision of a care home for older people that takes account of service users views and information received about the service since the last inspection. The home manager had submitted a fully completed Annual Quality Assurance Assessment (AQAA) as requested prior to the inspection, which gave us detailed information about improvements they had made since our last visit, and areas where further improvements were planned for the forthcoming year. Only two surveys were completed and returned to us prior to this inspection, one from a service user and one from a member of staff. Evidence used and judgments made within the main body of the report include information from this visit. Care Homes for Older People Page 6 of 29 This was the first Key Inspection for this service this year and it was carried out on the 6th of April 2010 by Regulatory Inspector Mrs Louise Trainor, between the hours of 09:00 and 13:30 hours. During this inspection we picked two residents to case track in detail, and looked more briefly at the documentation relating to another. We spent time observing care practices and informally chatting with staff and residents. We examined two staff files, which included all documentation relating to their recruitment, and other records relating to staff training and supervision. A full tour of the premises was carried out, and documentation relating to health and safety checking procedures, medication administration, complaints, accident and incident reporting and residents finances were also inspected. The home manager was present to assist throughout this inspection, and feedback was given periodically throughout, and at the end of the inspection. We would like to thank everyone involved for their assistance and support. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Medication Administration Records sheets had been completed accurately and stocks Care Homes for Older People Page 8 of 29 reconciled with records. The old worn carpets that we commented on at the last inspection have now been replaced, and the kitchen ceiling which was in need of attention has also been satisfactorily completed. A new nurse call system has been fitted in the home since the last inspection, and the fire alarm system has been upgraded. 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home has detailed information documents and a robust assessment process that ensures that potential residents know that their needs will be fully met in this home. Evidence: There is a Service User Guide and a Statement of Purpose in place for this home. These documents are held electronically and reviewed at regular intervals. The Statement of Purpose is on display in the reception area so that it is easily accessible to residents and their relatives at all times, and residents are generally issued individually with a Service User Guide. The documents that we saw contained the necessary information and correctly reflected the details of the management structure of the home. We viewed two pre admission assessments that had been carried out for recent admissions. The documents identified the dated that the assessment had been carried Care Homes for Older People Page 11 of 29 Evidence: out and who by. Generally this is done by the manager or the deputy manager . The documents that we looked at contained sufficient details relating to individuals needs and the level of care and support required to meet these needs. The information had then been used to assist in generating initial care plans following admission. Contracts of terms and conditions were in place for the residents whose files we examined. These contained required information relating to the fees, facities available, and activities which incurr an extra cost. A copy of each persons contract was held in the managers office, they were appropiately signed and dated. This home does not provide intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are written in detail, ensuring that care for people who live in this home is delivered with continuity. Evidence: At the time of this inspection there were only nine residents living at Tudor House. We looked at the personal files of two of these residents in detail. Files were tidy and well organised, and documentation was being archived within the home on a regular basis to avoid files overflowing. Since the last inspection, the home had adopted a new care plan format. Care plans were generally well written and contained sufficient information to ensure that care could be delivered with continuity. For example one persons care plan identified that although they only required supervision for dressing and undressing, they needed more assistance to choose appropriate clothing. It also identified that due to certain mental health issues this Care Homes for Older People Page 13 of 29 Evidence: individual benefited a structured daily routine, in this case the plan was to wake up at 08:30 hours, assist with shaving and supervise dressing before breakfast. However we noted that some care plans were missing review dates and signatures, but having spoken to the manager about this, we believe it to have been an oversight during the introduction of the new documentation, and the fact that some of the senior care staff had left the service. The manager assured us this would be rectified immediately. In both of the files that we looked at there was a variety of care plans, ranging from social activities, mobility and communication to dietary needs / intake, weight monitoring and medical conditions which required actions such as Blood Pressure monitoring. Where medical procedures such as this are required, the district nurse visits, records are clearly completed and accessible to care staff at all times. We were however a little concerned that where one residents care plan identified the need for twice weekly weighing, the records did not indicate that this was always being done. Their weight had been recorded on 09/02/10, 02/03/10, 18/03/10 and 05/04/10, this was not twice weekly. Identified weights were rather erratic and were not being converted from Kgs to lbs accurately. For example one weight read 67 Kgs = 10st 2 lbs. This is not correct. We discussed this matter with the manager who agreed, she would ensure staff are all competent at using the scales and conversion charts. Personal likes and dislikes, wishes and preferences were also clearly identified in the care plans, as was the level of assistance required by the individual to enable them to meet their full potential in their daily living. Both of the files that we looked at contained various risk assessments, which identified the level of support each person required to minimise risks to them and the staff assisting them. These risk assessments were reflected in the individual care plans. All documents were being reviewed on a regular basis to reflect any changes in the individuals needs. Conversations with residents, and observations of staff interactions with residents indicated that people are happy with the care provided in this home. One gentleman told us I have nothing but praise for the staff here. Residents were relaxed, happy and well presented, and observations of care, identified people being treated with respect, and addressed in a way that was their preference. Care Homes for Older People Page 14 of 29 Evidence: We saw two residents being given breakfast in the middle of the morning, and the manager explained that both of these residents are late risers, and for one of them in particular, who was in the home for a respite visit, his preference to have his breakfast at midday, a hot meal at around 17:00 hours, and a light meal late evening before retiring for bed, fitted in with his normal daily routine. We examined the Medication Administration Record (MAR) sheets for all of the residents presently living in the home. They had been completed appropriately with signatures and omission codes where appropriate, and the reverse of MAR sheets was being completed to identify any reasons for omissions, or as required administrations. Generally stocks reconciled accurately with records, however occasionally this was difficult due to any carried forward stock not being clearly identified. There were no Controlled Drugs in use in the home at the time of this inspection, however appropriate storage and recording facilities were available if required. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are encouraged and assisted to make choices about all aspects of their daily life. Evidence: There was an activity programme on display in the entrance of this home. It identified a range of activities, which included, music and dancing, movie sessions, nail care, newspaper and reminiscing groups, religious services, baking and quizzes. In addition to this there were numerous posters displayed advertising external entertainers and events such as a visiting clothes sale. At the time of this inspection the home was decorated with poems and pictures to reflect the Easter festival and Mothering Sunday. One resident was closely guarding a large toy Easter bunny that she had won in a competition over the Easter weekend. The cook in this home also works as an activity co ordinator for two hours in the afternoons. As well as doing group and individual work, her role includes the co ordinating of residents meetings, and trips out to the town centre and local facilities, such as the market. Care Homes for Older People Page 16 of 29 Evidence: The manager told us that some of the residents had recently been for a taster session at the local bowling alley, and they were hoping this would become a regular activity. There was a four week rolling menu plan in place, offering a variety of healthy nutritious meals. A choice of two main meals was available daily, with lighter options in the evening. Drinks, snacks and fresh fruit are readily available throughout the day. On the day of this inspection the cook was on a day off, and so she had left instructions for the carer who was on cooking duty, to prepare omelettes, with potatoes and tinned tomatoes or cold meat salad, followed by a dessert of trifle. We observed the lunch time service and residents were enjoying their meals, and although verbal communication was very limited for many of the residents present in the dining room at the time, the clean plates indicated their appreciation of the meal. One resident that was able to communicate well verbally told us. The food is good, I just cant put weight on. There was a care plan reflecting this problem in his file. Assistance was being given by staff in an unhurried and dignified manner. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are safeguarded from abuse, and there is a complaints procedure that is clearly written and easy to understand so that people who live in this home can be sure their complaints will be listened to and acted upon. Evidence: This home has a complaints policy, which is on display and easily accessible to residents and visitors to the home. This document details expected timescales for responses, and guidance for any complainant that remains dissatisfied with investigatory outcomes. We looked at the complaints file. Since the last inspection six complaints had been logged, some of these were informal concerns from residents and were not formal complaints, however they had all been treated with the same level of importance and were addressed, investigated and recorded appropriately. None were related to care practices in the home. Letters of response were sent out within the policies specified time frame and a copy filed for inspection purposes. There is a copy of the safeguarding policy accessible to all staff, and although safeguarding is addressed with staff as part of a detailed induction programme when they are appointed into post, and their knowledge and competencies are assessed and signed off by the manager or the deputy manager, not all recently appointed staff had attended formal training. Care Homes for Older People Page 18 of 29 Evidence: However those that we spoke to were able to demonstrate their knowledge and understanding of abuse, and their role in the reporting process. During this inspection we were told by care staff and the manager that there was a formal safeguarding training session booked for the following week. We reinforced the need for all staff to attend this training. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and comfortable environment for the people who live here, however some facilities are still in the process of refurbishment. Evidence: The home was generally clean and free from offensive odours. The reception area of the home displays information about the home, however this area is rather dark and dull and would benefit from some attention to brighten it up and make it more homely. The communal areas were generally comfortable, clean and tidy, with pictures, poems and photographs in place on the walls. The bedrooms that we visited were decorated and furnished with personal photographs and ornaments that reflected the individuals life history. A survey that we recieved prior to this visit read. Owners could spend some money on bringing the fixtures and fittings to a higher standard. We were able to see that this is beig addressed, for example: The old worn carpets that we commented on at the last inspection have now been replaced, and the kitchen ceiling which was in need Care Homes for Older People Page 20 of 29 Evidence: of attention has also been satisfactorily completed. Some of the bathrooms / shower facilities are old and worn. The manager told us that the homes decorating programme is ongoing, and that work is due to start on the bathroom facilities imminently. This will include replacing suites and retiling. A new nurse call system has been fitted in the home since the last inspection, and the fire alarm system has been upgraded. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can be assured that they are protected by the homes recruitment procedures, however there are some gaps in the training program which are presently being addressed. Evidence: Since the last inspection in this home, there has been an entire change of staff with the exception of the cook and one carer. However the new team is now establishing itself well and the staff that we met were generally enthusiastic, confident and competent in their roles. During the inspection we looked at the files of two staff that had been appointed within the last few months. All the relevant recruitment documentation was present in these files including: fully completed application forms, Criminal Record Bureau (CRB) and POVA first checks, various forms of identification including, passports, birth certificates and photographs, references from appropriate sources, health questionnaires, interview records and contracts/ terms and conditions of employment. We looked at the induction and training programmes, which are in place for staff. The induction programme involves working through all the principles of care with a specific focus on certain core standards. Staff must complete knowledge based assessment questionnaires on each core standard, which are checked by the manager Care Homes for Older People Page 22 of 29 Evidence: or deputy manager, who sign each individuals competency sheets as they demonstrate they have achieved the required level of knowledge and skills. The training programme includes scheduled sessions in a variety of subjects including both mandatory and some more specialist, such as Challenging Behavior, Dementia, and Dying, Death and Bereavement. We also looked at the training matrix, which identifies when staff have attended courses, and when they are scheduled to next attend. This did indicate that there are presently some gaps, although due to the vast number of staff changes over recent months, this was to be expected. The manager was aware of these gaps, which were relating to mandatory subjects, such as Safeguarding and Moving and Handling, which had been addressed through the induction programme, and formal certificated training sessions have been booked to take place over the next few weeks. There is presently five staff on the team that are either working towards, or have achieved NVQ level 2 or above. The Area Manager also advised us that she is planning to introduce e learning into the home in the near future, which will make it easier for staff to update and refresh their knowledge as necessary. During this inspection, we had the opportunity to speak with some of the staff on duty, and also observed some of the care interactions during the morning. Staff were confident and competent in their roles and were respectful in their approach to residents. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager demonstrates clear leadership within the home and people who live here are cared for in a person centred way by staff who are supervised and supported in their care practices. Evidence: A new manager has come into post since the last inspection in this home. She has many years experience in the care profession, and has completed her Registered Managers Award and NVQ level 3 and 4. She is in the process of submitting an application for Registered Manager to CQC. She is supported in the home by a deputy manager who has also achieved her NVQ level 3 and is presently working towards level 4. Additionally she is an NVQ Assessor and Internal Verifier. They have worked hard through a difficult period with many staff changes within the team, particularly where senior care staff have left the service, leaving care plan reviews and assessments to be completed. Generally these records were up to date, however as mentioned elsewhere in this report, there are still some areas where further improvement is needed. Care Homes for Older People Page 24 of 29 Evidence: The Annual Quality Assurance Assessment was completed in detail and returned to us as requested. This was informative and told us about any changes they had made and areas where improvement was still needed. We looked at the health and safety file, which indicated that fire call points, water temperatures and food temperatures are being checked on a regular basis. Risk assessments had been completed in relation to fire hazards and the general environment. At the last inspection we reported several concerns relating to maintenance work that was not being addressed in a timely way, in particular regarding loose radiator covers, which could have presented risks to the residents. These issues had all been addressed. The home have also had a new nurse call system installed, and the fire call system had been upgraded since our last visit. We looked at the supervision records. These indicated that since the new manager had come into this home all staff have received at least one supervision session. This must continue to ensure that standards are met. This home only holds personal money for three of the residents who live here. We looked at the account records for two of them. Record of each transaction was clearly documented and each balance corresponded with the funds correctly. Accidents and incidents in this home are reported appropriately and in a timely fashion, and risk assessments are completed and reviewed so that risks to residents are minimised. Monthly residents meetings are held in this home, and the minutes that we looked at indicated that residents are encouraged to voice their opinions about all aspects of life in this home, as well as subjects such as outings and menus. In addition to annual questionnaires which are sent out to residents, their families and external health and social care professionals, this information is contributory to the quality assurance process in the home. Prior to this inspection, we sent surveys out to staff and residents, however only one from each group was returned to CQC. Both had been completed mainly with tick Care Homes for Older People Page 25 of 29 Evidence: boxes, indicating an overall satisfaction of the service. The only comment on the service user survey read. Although ownership and management have changed, the standard has been maintained Staff meetings are also held on a regular basis to ensure that communication with staff remains effective and staff are fully aware of any changes that maybe required in the home. A monthly newsletter is also produced and issued to residents and their families, giving an update on any events in the home, such as new staff appointments, new systems or ideas which maybe introduced and feedback from outings and the activity programme. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 18 Staff working in this home must be trained with the appropriate skills to perform their duties. People who live in this home must be cared for by staff that are competent in their role. 28/05/2010 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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