Care Home: Village Nursing Home

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What the care home does well There is good information available to help people decide if The Village care home is the right place for them to live. Service users needs are also fully assessed before they move into the home. This is important to ensure that the home is able to meet their health and personal care needs. There is good information in the care plans so that staff best know how to meet the service user`s health and social care needs. Relatives and friends can visit anytime they want to and people are able to make choices about how to spend their time. There is an activities co-ordinator and the range of activities available to people is good. These include trips out, as well as a range of indoor activities. Service users are treated with dignity and respect. The food is good with plenty of choices available. There is a good complaints procedure in place so that people know their views will be listened too. There are also good safeguarding procedures in place so that staff know when to refer incidents to the local authority. This is important to ensure that service user are fully protected. The home is clean, homely and well maintained. Nearly all of the staff have completed the NVQ level 2 qualification in care. And staff are provided with lots of other training, for example, training in dementia and the nutritional needs of older people, so that they can meet the diverse needs of the service users. The manager knows what needs to be done to improve the home and it is clear that she is working hard to improve outcomes for the service users. There are good quality assurance systems in place to help make sure care standards are improved in the home. Service users said: "The atmosphere in the home is very friendly, homely and welcoming. The staff are extremely friendly, kind and courteous", "excellent overall care", "great activities", "nice variety of menu", "always clean and smells fresh" and "they take care of me. Happy with everything". Staff said: "Renders the very best possible care", "looks after service users in a professional manner- with high standards", "nice place to work with good support mechanisms", "creates a friendly environment", "good 24 hour care for both nursing and residential clients" and "creates a homely, happy environment. Do their best to accommodate a person`s needs. Offer regular relevant courses". What has improved since the last inspection? When we last visited we made three requirements, for the medication practices to be improved, for the treatment room to be kept locked at all times and to stop wedging open the fire doors. These have all been addressed by the manager. Other positive changes include many improvements to the environment, for example, the provision of new carpets to all corridors and new furniture, specialist training for the activities co-ordinator and a care assistant so that they can offer a wider range of activities to service users and staff training and supervision regarding drug administrative practices. What the care home could do better: There is very little for this service to improve upon. We made some recommendations as to how the medication recording system could be improved and how the environment could be developed for people with dementia. Key inspection report Care homes for older people Name: Address: Village Nursing Home Wellfield Road Murton Seaham Co Durham SR7 9HN     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: Nicola Shaw     Date: 0 3 1 1 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: Village Nursing Home Wellfield Road Murton Seaham Co Durham SR7 9HN 01915171020 P/F NOE-MAIL Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jigsaw Care Ltd care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Village Nursing Home provides nursing and residential care services (41 beds) for people. Jigsaw care Limited is the registered provider of the service. Mr P S Kohli is the responsible individual for the company and Mrs Sharon Simpson is the registered manager responsible for the day-to-day conduct of the home. It is located in a housing estate close to the centre of town and has good links with the local community. It is a single storey building with an enclosed courtyard/garden area, plus car parking space to the side. There are 37 single bedrooms, including a small proportion with en suite facilities, plus 2 double bedrooms. These are all fairly spacious rooms. The fees vary between 404.17 Pounds and 425.29 Pounds per week. The fee covers all accommodation, meals and personal care (plus nursing care for those residents in receipt of continuous nursing care at the home). Hairdressing, toiletries, newspapers, plus services from private opticians, dentists and chiropodists are not included in the Care Homes for Older People Page 4 of 28 Over 65 41 0 0 14 1 4 1 1 2 0 0 8 Brief description of the care home fee. The actual amount people pay will depend upon their individual circumstances. Up to 3 day-care places are available each day for non-residents. 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: The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations-but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the inspection visit: We looked at: Information we have received since the last inspection on 14th November 2008. Care Homes for Older People Page 6 of 28 How the service has dealt with any complaints and concerns since the last visit. Any changes to how the service is run. The providers view of how well they care for people. The results of surveys. We received eight completed surveys from service users and five form staff. The visit: An announced visit was made on 3rd November 2009. During this visit we: Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had knowledge, skills and training to meet the needs of the people they care for. Checked what improvements had been made since the last visit. We told the manager what we found at the end of the visit. Care Homes for Older People Page 7 of 28 What the care home does well: There is good information available to help people decide if The Village care home is the right place for them to live. Service users needs are also fully assessed before they move into the home. This is important to ensure that the home is able to meet their health and personal care needs. There is good information in the care plans so that staff best know how to meet the service users health and social care needs. Relatives and friends can visit anytime they want to and people are able to make choices about how to spend their time. There is an activities co-ordinator and the range of activities available to people is good. These include trips out, as well as a range of indoor activities. Service users are treated with dignity and respect. The food is good with plenty of choices available. There is a good complaints procedure in place so that people know their views will be listened too. There are also good safeguarding procedures in place so that staff know when to refer incidents to the local authority. This is important to ensure that service user are fully protected. The home is clean, homely and well maintained. Nearly all of the staff have completed the NVQ level 2 qualification in care. And staff are provided with lots of other training, for example, training in dementia and the nutritional needs of older people, so that they can meet the diverse needs of the service users. The manager knows what needs to be done to improve the home and it is clear that she is working hard to improve outcomes for the service users. There are good quality assurance systems in place to help make sure care standards are improved in the home. Service users said: The atmosphere in the home is very friendly, homely and welcoming. The staff are extremely friendly, kind and courteous, excellent overall care, great activities, nice variety of menu, always clean and smells fresh and they take care of me. Happy with everything. Staff said: Renders the very best possible care, looks after service users in a professional manner- with high standards, nice place to work with good support mechanisms, creates a friendly environment, good 24 hour care for both nursing and residential clients and creates a homely, happy environment. Do their best to accommodate a Care Homes for Older People Page 8 of 28 persons needs. Offer regular relevant courses. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using 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. Good information is available to help prospective service users make an informed choice about where to live. The admissions process ensures that people are adequately assessed prior to care being offered. This means that service users are offered the right type of care at the home. Evidence: There is a range of information available for people to read about the service including the Statement of Purpose and Service User Guide, which are kept up to date. We looked at the Statement of Purpose. This is available in large print, so it is easy for people to read, and contains up-to-date information about how to make a complaint. Everyone who completed a survey said that they had received enough information to help them decide if the home was right for them. Care Homes for Older People Page 11 of 28 Evidence: The manager told us in the AQQA that the service user contracts have all been revised. Seven out of eight service users who responded to surveys confirmed that they had been given a copy of the contract. We looked at a sample of contracts. These had been signed by the service user. They contained details of the room to be occupied and information about the home, including the confidentiality policy and complaints procedure. For prospective service users, funded by the local authority or health authority, the manager obtains a copy of the needs assessment and care plan from the care manager. this is so that she can decide whether The Village care home is able to meet their needs. A pre-admission assessment is also completed by a qualified nurse. This is used to identify the service users individual needs, likes, dislikes and personal preferences. It is also used to identify if the prospective service user has any specialist health care needs so that the right equipment, for example, pressure relieving mattresses, are provided. Where possible trial visits are arranged for prospective service users so that they and their families can try out the home, for example, by having a meal. There is also an admission checklist. A nurse and care assistant are allocated to new service users to ensure the admission process is a good experience for them. 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. There is good information in the care plans about the health and personal care needs of the service users. This ensures that everyone receives care and support in a way that they prefer. Staff care practices preserve the dignity and privacy of the people who live here. And medication administration procedures generally protect the service users. Evidence: Individualised care plans are in place which include equality and diversity issues. The care plan used is a nursing model called activities of daily living and covers a number of areas such as communication, maintaining a safe environment, eating and drinking, mobility, activities, expressing sexuality, sleeping and dying. it is what is known as a holistic model because it does not just focus on problems but considers the person as a whole and all of their health as well as social care needs. The care plans we looked at were up-to date and provided good information about the Care Homes for Older People Page 13 of 28 Evidence: service users health and personal care needs. They provided clear guidance to staff on how to support the service users. For example, in one there was good information about the persons preferred personal care routine and details of the assistance they required. It had been written in such a way as to ensure the service user is able to maintain as independent as possible, for example, there was an emphasis in one for staff to encourage the service user to choose their own clothing. There are also care plans in place for those people, who as a result of their dementia, may become agitated. Guidance is provided in these for staff as to what they should do to support the person at such times. For example the use of distraction techniques, which is good practice in dementia care. There are regular care plan review meetings and service users, where able, have signed their care plans. Risk assessments are in place in relation to nutrition, mobility, pressure sores and oral hygiene. These are used to help identify the support each person needs in these areas. Daily records are maintained. Those we looked at had all been signed and the information used to evaluate the care given each month. No one in this home has a pressure sore. Service users have access to all NHS facilities. There are regular visits from GPs and other health professionals, including opticians and chiropody services. Seven out of the eight service users who completed a survey said that the home always made sure they got the medical care they needed and that they always received the care and support they needed. Medication is stored in a locked, secure room. The staff monitor the temperature of the medication room and the medication fridge to make sure that medicines are stored correctly. The nurse orders the medication from the prescriptions to ensure that service users are provided with the correct medication. The manager carries out regular audits of the medication to make sure that it has been given to service users as prescribed. The pharmacist who supplies the medication also does spot audits to make sure medication is stored correctly. Care Homes for Older People Page 14 of 28 Evidence: There are no controlled drugs. The majority of medication is held in a Monitored Dosage System, however, there is a also a supply of of as and when, loose medication. It was not possible to do an audit of this medication as records are not kept of the total amount of tablets in stock. Some service users have been prescribed creams. However, it was not clear from the medication records where or when the creams were to be administered. During our visit time was spent with the service users. Staff were caring in their approach towards the service users and ensured that their privacy was upheld. Personal and intimate care tasks were carried out in the privacy of the service users own bedrooms. Staff referred to the service users by their preferred name and it was clear there was a good rapport between the staff and service users. Service users said they (the staff) treat you with respect. 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. Service users enjoy a variety of activities, and are able to maintain family and other contacts if they want to. This ensures service users have opportunities to lead a fulfilling lifestyle and do not become socially isolated. Service users are able to exercise control and choice over their lives, as far as is possible, which enables them to remain independent. Service users receive a varied menu, which promotes their general health and well being. Evidence: There is an activities co-ordinator who works flexibly over 4 days each week. She and a member of care staff have recently attended a training course about activities for older people. This has helped them to increase the range of activities available to service users. The activities programme is displayed in the home and includes games which encourage gentle exercises, trips out to local events such as the Theater and entertainers who come into the home. There is a social care plan for each service Care Homes for Older People Page 16 of 28 Evidence: user, which is evaluated every month. Plans for the future include the provision of activities, for example sensory stimulation, for those service users who have complex physical needs. Seven out of eight service users who responded to surveys said that the home always arranged activities that they could take part in. Service users were offered a choice of where to have their lunchtime meal and are able to spend time where they wish. Service users choice of daily routine is recorded in their care plans. The manager has involved an advocate for one person with dementia to make sure that any decisions made are in their best interests. Throughout our visit friends and relatives were seen to freely come and go. We spent time with people whilst lunch was served. Tables were nicely presented with napkins and table cloths. Those service users who needed support were offered this by staff in a discrete sensitive manner. There is a choice of main meal and pudding. Staff have completed training about the nutritional needs of older people. Those staff we spoke to said that they had found this very beneficial. As a result of this training the manager has introduced, by using red serviettes, a discrete creative way of making sure staff know those service users nutritionally at risk. This helps to make sure their food intake is closely monitored. The kitchen staff are also currently completing in-depth training about the nutritional needs of older people. The manager told us that they are moving away from using fortified drinks as a food supplement for service users. Instead, they are increasing service users calorie intake by offering full fat milk, home baked cakes every day and jam and cream as an alternative to biscuits. Four people commented in surveys that they always liked the meals in the home and two said usually. One person said, when asked about what the home does well nice variety of menu. Another said I like the meals, cant complain about them. I have a banana every day . When asked what the home could do better one member of staff said in the survey provide better meals, residents often complain about the food and another said that the presentation of meals could be better. One service user we spoke to said that the food isnt first class and two people commented in surveys that they sometimes liked the meals. The manager told us that she is aware that some service users do not like the choice of menu available and regularly consults with them about Care Homes for Older People Page 17 of 28 Evidence: this. Care Homes for Older People Page 18 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 good complaints procedure so people know that their views will be listened to and acted upon. And staff training helps to ensure that the service users are protected from abuse. Evidence: The home has a complaints procedure. This is on display throughout the home and is also explained to service users when they are first admitted to the home. There have been no complaints in the last year. The manager told us that the home has an open door policy so that anyone can approach her or the nurse in charge to discuss any issues or concerns. One service user we spoke to said I would make an appointment to see Sharon, (the manager), if I had any worries. Another said Ive nothing to complain about. Everyone who completed a survey said that there was someone they could speak to informally if they were not happy. Seven out of eight service users said in surveys that they knew how to make a formal complaint. There have been no safeguarding referrals made in the last year. All staff have been provided with training in whistleblowing and safeguarding adults. Care Homes for Older People Page 19 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. Service users benefit from a clean, homely and well maintained place to live. Evidence: The home is all on ground level with wide spacious corridors so that people who use a wheelchair can get around easily. There is a safe secluded garden with a water feature. Service users we spoke to said that they liked to use this in the warmer weather. When we visited the home was clean with no unpleasant odours. Everyone who completed a survey said that the home was always clean and fresh. There have been a number of improvements to the home in the last twelve months. These include the provision of new carpets in all corridors and the entrance to the home, the installation of two new washing machines and ventilation in the kitchen, lighting in the corridors and extractors in toilets and some of the furniture replaced and external windows painted. All doors have also been fitted with door guards. This is a special device that holds fire doors open, yet releases the door should there be a fire. Some of the current service users have dementia. The environment has not been adapted to meet the special needs of this client group, for example, signs to help Care Homes for Older People Page 20 of 28 Evidence: people find their way around and bright contrasting coloured grab rails along corridors so that they can be easily seen by people. The manager was receptive to the advice offered. Fifty three staff have completed infection control training. Care Homes for Older People Page 21 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. Staffing levels are sufficient, which ensures staff provide person centred care. Staff training is good and includes specialist training in order to meet the diverse needs of the service users. This ensures staff can effectively meet the care needs of people with dementia. The staff recruitment process fully protects the service users. Evidence: When we visited on duty was the Manager, Deputy Manager, two Registered General Nurses and seven care staff, which is sufficient for the thirty eight people living in the home. Six out of eight service users said in surveys that there were always staff available when they needed them and two said usually. There has been a low turn over in staff which is excellent for continuity of care. All of the service users spoke positively about the staff and there was clearly a good rapport between the service users and staff. Service users said: Care Homes for Older People Page 22 of 28 Evidence: I like the staff and The staff are extremely friendly, kind and courteous. They are very approachable. Relatives said: the staff are wonderful. Staff have attended a number of training courses. In addition to health and safety training this has included training about equality and diversity, meeting the needs of people with dementia and caring for people who are dying. Nearly all of the care staff have completed an NVQ level two qualification in care and three staff have achieved the NVQ Assessors Award. The manager has developed a six month training programme to ensure that staff training is kept up-to-date. All of the staff who completed a survey said that the training provided was relevant and helped them understand the needs of the service users. All new staff complete an induction training programme. The five staff who completed surveys said that this mostly or very well covered everything they needed to know to do the job when they started. Staff files showed that the companys recruitment procedures are followed. This includes obtaining two written references and an Enhanced Criminal Records Bureau (CRB) check to ensure that the prospective staff member is suitable. A number of years ago, the previous manager, when recruiting staff, obtained a Standard CRB check only. The current manager is aware of this and is in the process of obtaining these at the Enhanced level, which is necessary for all staff working with vulnerable adults. Staff confirmed in surveys that the manager had carried out checks, such as the CRB and references, before they started working in the home. Care Homes for Older People Page 23 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. Good management systems ensure the health, safety and welfare of service users. There is a good quality assurance system. This is based on the views of service users, where they are able to communicate their wishes, so that they know their rights and views will be listened to. Evidence: It was evident that the manager works hard to improve the service for service users. She provided us with good information, before we visited, about what has improved in the home in the last year and it is clear she knows what needs to be done to improve things further. The manager has managed this care home for five years. She has completed the Registered Managers Award and is also a Registered Nurse. In order to keep her skills and knowledge up-to-date she has undertaken other training alongside her staff. This has included the needs of people with dementia, equality and diversity and the Care Homes for Older People Page 24 of 28 Evidence: nutritional needs of older people. Service users said about the manager: The manager, Sharon, is a great listener and very easy to talk to, always ensuring she is available. She appears to run a very tight ship. Staff said: The manager is very supportiveand Sharon is a very good support. She knows what she expects and has a nice manner. If there is a problem she will listen. Service user satisfaction questionnaires are used to obtain feedback about the service. The results of these are displayed in the home for service users and relatives to read. The information from these are used to improve the service. There is an internal audit system. This involves a monthly check carried out by the manager of the number of accidents, complaints and untoward incidents. We looked at how the home manages the service users personal allowance. Good records of this are maintained and receipts are obtained for any money deposited or withdrawn. Each time money is withdrawn or deposited staff check that the records are correct. The manager also checks this as part of her internal auditing. The home carries out internal maintenance checks and has contractors to service equipment. There are regular team meetings. And all staff receive annual appraisals and regular supervisions. 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 9 A record of the amount of loose medication held in stock should be maintained. This is so that the medication can be properly audited. Information about where and when prescribed creams are to be administered should be maintained. This is so that service users receive their prescribed medication when they need it. The environment should be adapted to meet the special needs of people with dementia. 2 19 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. 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