Care Home: Verulam House Nursing Home

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What the care home does well The service is very well managed by a stable and long-serving team of managers, nurses and care workers. Their consistency in providing excellent care and support has been very beneficial to the residents who seemed active, happy and content as observed on the day of the inspection. Residents told us that they felt well supported by an effective staff team with a skill mix that benefits residents. Members of staff were gentle and softly spoken in their approach to each resident. The individual was treated with respect and dignity. The service provides a homely, safe and stimulating environment for the residents to live in, and the surrounding grounds are spacious, pleasant and attractive. Social, recreational and therapeutic activities are provided daily and elicited favourable comments from the residents and relatives. Comments received included: "I feel very well cared for." "Very happy with the care." "Care is very good." "There is lots to do here and we have a lot of fun." "I love the outings in the summer." "I can do what I like." "I enjoy myself here. The staff are very friendly and helpful and I can see my family and friends often." "Treats everyone as an individual. You can feel really welcome here." "Staff are all lovely." "The staff look very smart and they are very kind and patient to all of us." "Support from staff and managers. An international team." "The home and staff are excellently trained. I am well looked after in every way." "Good accommodation for residents; good training programme and activities for the elderly." "Good nursing care, activities and meals." "Very friendly, well run home." What has improved since the last inspection? Since the last inspection, the ground floor carpet and much of the bedroom furniture have been replaced. All the beds used are profiling beds which are more comfortable and beneficial for residents requiring nursing care. Additional facilities included an overhead tracking system which has been installed in two of the bedrooms to aid safer moving and handling of residents with severe mobility problem. What the care home could do better: In a recent survey by us when we asked the question: "What could the home do better" some respondents commented: "Could provide more staff in each shift." "Could provide more staff especially weekends." "Covering staff when we are short." In the self- assessment form (AQAA) issued by us, the management had indicated that "staffing levels are calculated according to dependency." However, it would be good if the management took note of the comments and continue to improve the service and maintained the excellent service and care provided. Key inspection report Care homes for older people Name: Address: Verulam House Nursing Home Verulam Road St Albans Hertfordshire AL3 4DH     The quality rating for this care home is:   three star excellent 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: Yoke-Lan Jackson     Date: 3 0 1 2 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 25 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 25 Information about the care home Name of care home: Address: Verulam House Nursing Home Verulam Road St Albans Hertfordshire AL3 4DH 01727853991 01727855059 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Verulam Health Care Limited care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Within the overall capacity, this home may accommodate 5 service users between the ages of 55 and 64. Within the overall capacity, this home may accommodate 50 older people who require nursing or convalescent care. Date of last inspection Brief description of the care home Verulam House provides nursing and personal care to older people and 5 people aged between 55 and 64 years, to a total of 50 residents at any one time. It is situated in the heart of St. Albans and is within walking distance of all the shopping, leisure and transport facilities which are available in the city. The home is a three storey listed building, with two passenger lifts, one serving all the floors and one serving the ground and first floor. The majority of the 50 bedrooms have en suite facilities. The building was formerly the Bishops Palace and has been extended to provide a high standard of accommodation, whilst retaining many original features. There are two main lounges, a recreation and activity room, a large dining Care Homes for Older People Page 4 of 25 Over 65 50 0 Brief description of the care home room and a converted chapel, all providing spacious communal areas on the ground floor. The residents bedrooms are all individual in style and size although most are large. There is parking to the front and side of the building and there are large, well maintained gardens to the rear and patio areas near to the house. The home charges £850 to £1000 per week. Information about the home and the service it offers is contained in the Statement of Purpose and Service Users Guide. A copy of these and the most recent CQC inspection report are available in the home. Care Homes for Older People Page 5 of 25 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: three star excellent 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 service had a key inspection in March 2007 and an annual service review in 2008 and 2009. An annual service service is a review of the service without a site visit. This unannounced key inspection was carried out on 30/01/2010. Both the registered home manager and the deputy manager were present. There were 41 people in residence. The inspection visit included a tour of the premises, lunchtime observation and observation of how the staff interacted with the residents in the dining room and during activity sessions. Staff and residents were spoken with and key documents were examined. The inspection ended with a thorough discussion with the home manager. Survey questionnaires were sent to the residents and relatives and their responses and other information received by us were reviewed. This included the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete annually. The AQAA focuses on how the outcomes are being met for the Care Homes for Older People Page 6 of 25 people using the service and also provides us with statistical data. Care Homes for Older People Page 7 of 25 What the care home does well: The service is very well managed by a stable and long-serving team of managers, nurses and care workers. Their consistency in providing excellent care and support has been very beneficial to the residents who seemed active, happy and content as observed on the day of the inspection. Residents told us that they felt well supported by an effective staff team with a skill mix that benefits residents. Members of staff were gentle and softly spoken in their approach to each resident. The individual was treated with respect and dignity. The service provides a homely, safe and stimulating environment for the residents to live in, and the surrounding grounds are spacious, pleasant and attractive. Social, recreational and therapeutic activities are provided daily and elicited favourable comments from the residents and relatives. Comments received included: I feel very well cared for. Very happy with the care. Care is very good. There is lots to do here and we have a lot of fun. I love the outings in the summer. I can do what I like. I enjoy myself here. The staff are very friendly and helpful and I can see my family and friends often. Treats everyone as an individual. You can feel really welcome here. Staff are all lovely. The staff look very smart and they are very kind and patient to all of us. Support from staff and managers. An international team. The home and staff are excellently trained. I am well looked after in every way. Good accommodation for residents; good training programme and activities for the elderly. Good nursing care, activities and meals. Very friendly, well run home. Care Homes for Older People Page 8 of 25 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 25 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 25 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. People who use this service can be confident that they will be supported since the home will only admit a prospective client whose care needs can be met. They can be assured that a thorough pre-admission assessment will be carried out to ensure that the home can meet all their care needs and there is a trial period before a permanent contract is agreed. Evidence: The pre-admission documents for two new admissions were examined and they were found to be detailed and informative. The manager had carried out a thorough assessment of each prospective clients personal, healthcare and social care needs. This ensures that the individuals needs can be met on admission. The manager said that the home will only admit prospective clients whose care needs can be appropriately met. We saw that the two new admissions seemed settled in their new home. Care Homes for Older People Page 11 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be treated with respect and they will receive personal and healthcare support in the way they prefer and require and they will be protected by the homes medication policy and procedures. Evidence: Each resident has a written care plan which is detailed and informative. The home manager said that staff are trained to use a new written care plan format. The new care plan is generated by the comprehensive pre-admission assessment information. The written care plan also provides a holistic picture of the individual and gives clear directives to staff. Work is in progress to improve all written care plans to reflect the person-centred care provided. This ensures that those who are looking after the residents have the required information to deliver the personal, social and healthcare needs of the people living in the home. The key worker carries out a regular review of each residents care needs. The manager said that the frequency of review increases depending on the residents progress. There is also a review of each residents care needs that involves the Care Homes for Older People Page 12 of 25 Evidence: resident, their next of kin and the relevant healthcare professionals. Appropriate records are kept. Residents have access to their own doctor and to specialist medical, nursing and other therapeutic services when required. One of the residents who suffers from Parkinsons disease was recently admitted to hospital to review the medication prescribed for the disease. The same resident has since returned to the home and seemed settled with appropriate medication prescribed to stabilise their condition. The deputy manager confirmed that none of the residents have pressure sores but there is a resident with a superficial leg ulcer which is improving. There is a wound progress chart in place. The service is registered with Liverpool Care Pathway and has adopted the organisations guidelines in palliative care. On the day of the site visit there were no residents requiring palliative care. On the day of the inspection, it was noted that members of staff were assisting individual residents who needed assistance. We saw that staff seemed gentle and polite, and an appreciation of respect and dignity was clearly demonstrated. A trained nurse administers medication. All controlled drugs are stored in a controlled drug cupboard which is firmly fixed to the wall in the clinical storage room. Proper records are kept. All other medicines that are in use on each floor are stored in a drug trolley, which is attached securely to the wall in the corridor when not in use. The Medication Administration Record (MAR) charts examined were correctly signed following administration of medicines. The management confirmed that all the nurses and senior care workers have regular refresher courses on the safe administration of medication. The training is provided by the supplying pharmacist. An appropriate audit is carried out by the deputy matron to ensure good practice is well maintained in regards to the safe handling and administration of medicines. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be given the opportunity to make everyday choices and their wishes and preferences will be respected. They will be encouraged to maintain links with their friends and families and they will be encouraged to have a healthy diet. Evidence: Residents interviewed during the site visit were complimentary about the service and care given. During lunchtime, we saw members of staff were readily present to assist individuals to the dining room for lunch. It was noted that lunchtime was unhurried and individuals were assisted appropriately. The menu is reviewed weekly and the large print daily menu is displayed on each dining table for the individual to select their daily choice of dishes. Residents interviewed were complimentary about the meals provided. A resident commented, I like the food. My favourite is the cooks home made pavlova. The chef has been in post for several years and knows the residents likes and dislikes and discusses the menu with the residents regularly. The chef takes into account those residents with dietary needs. Care Homes for Older People Page 14 of 25 Evidence: Residents are given opportunities to plan their daily social routine. The activity programme offers a variety of social activities appropriate to the individual needs of the residents which are documented in their social care plan. Daily group activities and one-to-one sessions are organised according to individual needs and preferences. The planned activity programme is on display on the notice board and includes card games, musical bingo, quiz, poetry corner basketball and entertainment. In addition, there are late evening activities organised by staff two evenings a week known as night owls in response to requests from residents. The home has three activity co-ordinators who work opposite shifts to ensure that residents have the maximum benefit in enjoying themselves with planned group activities, entertainment and one-to-one attention. One of the activity coordinators was present on the day of the site visit and we saw them conducting a reminiscence session with some residents. According to the AQAA, The home manager confirmed that there have been increased outings and facilities provided for residents. These included the installation of a computer with internet access and a choice of private manicure and physiotherapy sessions. The home manager encourages residents family to bring in their family pets. There is a fish tank and a canary kept in the lounge. One of the residents interviewed said that arrangements have been made for a friend to bring in their pet cat. Since the inspection, the manager has encouraged the resident to see more of their pet cat rather then once a week only. Care Homes for Older People Page 15 of 25 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. People who use the service can be assured that the service has a robust Complaints Policy and Procedure and can be assured that they will be listened to and any concerns raised will be investigated and appropriate action taken. Evidence: There are regular Residents and Relatives Meetings and minutes are taken. Immediate action is taken to resolve any issues, which are documented. There have been no complaints raised about the service or the care provided since the last inspection. The home manager confirmed that any complaints or concerns raised will be thoroughly investigated in accordance with the homes robust policy and procedure. All members of staff have received training on the Protection of Vulnerable Adults and on the Hertfordshire Joint Safeguarding Procedure. They are aware of the WhistleBlowing Policy. Since the last inspection, there has been no safeguarding referrals made. Staff have training on the the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards to ensure that staff have an awareness of the assessment of capacity and that decision-making for a resident is being undertaken in a way that complies with the law. This also ensure that people living in the home are not deprived of their liberty without an authorisation. The home manager confirmed that there have been no cases subjected to the Deprivation of Liberty authorisation. Care Homes for Older People Page 16 of 25 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. People who use the service can be assured that the environment they live in is well maintained, comfortable and safe and that they will have access to all communal facilities. Evidence: Verulum House has a homely and warm atmosphere. The premises are well maintained, hygienically clean and tidy. There is an ongoing maintenance programme. The residents interviewed told us that they are happy with their bedrooms, which have personal items and potted plants on display. The home manager confirmed that much of the bedroom furniture has been replaced and the ground floor has had new carpets fitted recently. Since the last inspection only profiling beds have been used as these are more comfortable and beneficial for the residents requiring nursing care. Additional facilities include an overhead tracking system which has been installed in two of the bedrooms to aid safer moving and handling of residents with severe immobility problems. There is a VDU screen available for those residents who are visually impaired and there is a loop system in the television lounge for those who have hearing impairment. The home manager confirmed that all equipment such as hoists and wheelchairs has been regularly serviced and is maintained in good working order. Care Homes for Older People Page 17 of 25 Evidence: The surrounding grounds and the back garden are neat and attractive with bushes, plants and seating areas. The patio and garden are accessible to all residents including wheelchair users. Care Homes for Older People Page 18 of 25 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. People who use the service can be assured that the home has an effective staff team who will support them and can be confident that they are safeguarded by the homes robust recruitment policy and procedures and the improved training programme for staff. Evidence: The home has an effective team of nurses, care workers and domestic staff. However, in a recent survey by us, the answer to the query What could the home do better some of the comments received included: Could provide more staff in each shift. Could provide more staff especially weekends. Covering staff when we are short. However, the home manager indicated (in the AQAA) that the skill mix and numbers are based on the care needs of residents which are reviewed regularly. The home manager (matron) and deputy manager (deputy matron) are trained nurses themselves and they said that they are hands-on in order to get to know the staff and residents well. On the day of the site visit, the staffing level seemed adequate with assistance from both managers. The service operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of residents. New recruits have Criminal Record Bureau checks and Protection of Vulnerable adults (POVA) checks. Staff supervision is carried out six times a year and proper records are kept. All the staff have clearly defined Care Homes for Older People Page 19 of 25 Evidence: roles and responsibilities. Nurses play a key role in the admission process and in person-centred care planning and documentation. This enhances their administrative skills and professional skills as trained nurses and maintains their nursing practice in line with the requirements of the registration body, the Nursing and Midwifery Council. Four nurses have completed the course on compression bandaging given by a Leg Ulcer Specialist Nurse. This extended responsibility reduces the need to rely on the NHS District Nurse to perform this task. Other training included Venepuncture, which is the process of drawing blood from a vein for medical testing. One of the nurses is on the A1 Award NVQ Assessors course. In addition, the service has a training manager, an experienced and qualified nurse, on site three times a week. The training manager oversees the staff training and development programme. The home follows the Skills for Care common induction training programme for new recruits. On the day of the inspection one new recruit, a care worker, was given a one-to-one session to ensure that their mandatory training and skills are appropriate to meet the care needs of the residents. Later the training manager showed us the computerised training records which were kept up to date. Care workers and domestic staff are encouraged to attain NVQ qualifications. The majority of the care workers have NVQ2 and NVQ3 qualifications and some are currently working towards NVQ2 and NVQ 3 qualifications. One of the laundry workers has completed NVQ in housekeeping and the Assistant Chef has completed NVQ in professional cookery. Staff training includes the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, Infection control, Continence Care, Wound Management, Nutrition and Care of the Dying. The training manager confirmed that all three activity co-ordinators will be undergoing dementia training. The nurses interviewed said that they all have had a refresher course on the administration of medication, wound management and other relevant nursing topics. Staff are trained to follow the Liverpool Care Pathways programme in the delivery of end of life care and support for relatives. The residents we spoke with during the site visit were all complimentary about all the staff. One commented They are all lovely. I think I am in the best place. Another said, I am very pleased with the care. Staff are very kind. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the standards of administration and management of the service are well maintained and that their health and safety are promoted and protected. Evidence: The standards of administration and management of the service continue to be well maintained. The directors are readily available to staff and residents most days and they are actively involved in the management of the home. One of the directors was on site during the inspection. In a recent survey by us a resident commented One of the directors visited me to say Happy New Year, he was so lovely. A member of staff commented, The owners are friendly and are in most days. There have been no changes to the management structure of the home since June 2005. The home manager (matron) and the deputy matron are both experienced and qualified nurses. In a recent survey by us, a member of staff commented, I am very happy working in Verulum - they (management) support me and they gave me Care Homes for Older People Page 21 of 25 Evidence: flexible hours to study and work. I would like to say thank you for everything they have done for me. Another said, Matron is a good person to work for, helpful and she makes it an enjoyable home to work in. A resident said, The matron is lovely with a good sense of humour and often helps look after us. The management carry out regular audit of accidents, falls, wounds and other relevant areas. The provider carries out an annual quality assurance and monitoring survey. This includes written questionnaire feedback from residents, relatives and others. All records for the protection of the residents are kept secure and handled in accordance with the Data Protection Act 1998. The servicing records have been well maintained. The home has systems in place to safeguard the residents finances and personal allowances. The residents money is held in a bank account administered by one of the directors. Each resident has their own customer account within the main account and separate statements can be raised on request. A cashbook is kept monthly and all monies received from the residents and expenses paid on their behalf, are recorded daily. Where possible all cash paid out on the residents behalf is signed for by the resident themselves or their relatives if more appropriate. The accounting records are readily available for inspection. The service provides student placement for trainee nurses from the University of Hertfordshire. The University carries out regular educational audits which have been ongoing since January 2008. The management promote equality and diversity. All members of staff are trained to ensure they follow the homes policy and procedure on equality and diversity issues and they are aware of the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards. The home manager confirmed that there have been no cases subjected to the Deprivation of Liberty authorisation. The Annual Quality Assurance and Assessment (AQAA) forms issued by the Commission were received on time for this inspection. The information provided was detailed and was included in this report. Care Homes for Older People Page 22 of 25 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 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 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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