Care Home: Waverley Lodge

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What the care home does well The home is well managed by a competent committed manager and he carries out regular checks to make sure the good standard is kept up. He is known to the residents and is knowledgeable about both their care needs and as individuals. Good pre-admission assessments are carried out and these contribute to the detailed care plans. These are developed using all of the information collected about the resident. The people living in the home and their representatives are encouraged to be involved in the care planning. The residents and visitors were very complimentary about the Manager and the staff, they said they were "really good and were always around when they needed help". Staff have good relationships with the people living in the home in a way that maintains their privacy and promotes their dignity. The home has a pleasant and active atmosphere, and the residents are supported to live fulfilled lives by giving them the opportunities to choose activities they want to take part in. These include home based activities and going out to visit places of interest or just to go shopping. The food being served is good quality and is served in a pleasant and comfortable atmosphere where people get choice about what the eat and drink. Those residents who need help are supported in a way that protects there dignity and makes sure that they have a good nutritional intake. Information about how to make a complaint or raise concerns are readily available throughout the home. The residents and their representatives said that they are given information about expressing their concerns. However none of those spoken to had needed to make a formal complaint. The expert by experience said that she had spoken to relatives who were delighted with the care their relatives were receiving and couldn`t speak highly enough of Waverley Lodge. She also said "Yes, it was a lovely bright day outside but I don`t think the brightness in the home was due to this, it would have been the same on a rainy day because it comes from the care for the staff." What has improved since the last inspection? Four requirements were made at the last full inspection these have all been met. The home has carried out the planned redecoration and refurbishment programme, and provided suitable chairs to meet the needs of the individual residents in the home. The way that the dining room is set out has been improved to make it a pleasant place for people to enjoy their meals. This will encourage an adequate nutritional intake. Improvements include having matching crockery, specialist cutlery, condiments, sauces and utensils to meet the needs of residents in the home. Care plans have been improved to show the care being given and shows how the staff plan, the care to make it specific to the individual person. These are reviewed and kept up to date. There was a requirement to make sure that any interest accrued in residents personal accounts could be allocated to the individual. This is now being managed by ensuring that residents who have significant amounts in this account are offered separate accounts so that they can get interest from it. What the care home could do better: No requirements were made at this inspection. One recommendation was identified. This was to review the way that the record of fluids taken by residents who are at risk of dehydration are managed. The manager agreed to review this to make it more accurate and give a better picture of the situation. Key inspection report Care homes for older people Name: Address: Waverley Lodge Bewick Crescent Lemington Newcastle Upon Tyne NE15 8AY     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: Suzanne McKean     Date: 1 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 26 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 26 Information about the care home Name of care home: Address: Waverley Lodge Bewick Crescent Lemington Newcastle Upon Tyne NE15 8AY 01912647292 01912647295 Waverley.Lodge@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bewick Waverley Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 19 service users on the ground floor will be category DE(E). 26 service users on the first floor can receive either nursing or personal care. Date of last inspection Brief description of the care home Waverly Lodge is a purpose built care home that shares its site and is physically attached to another home belonging to the same company. The home is set in large landscaped gardens, in a residential area, close to all local amenities. The home provides social and personal care for older people who have dementia on the ground floor and general nursing care for older people on the first floor. The ground floor dining room has access to the main kitchen and the upstairs dining room has a small kitchenette attached. There are two lounge areas on each floor for residents to use. All of the bedrooms are for single occupancy and 28 of them have en-suite facilities. There Care Homes for Older People Page 4 of 26 0 0 Over 65 19 26 Brief description of the care home are accessible toilets close to all lounges and dining rooms and each floor has adequate bathing facilities. The home charges fees of between £414 and £499 per week depending upon the needs and requirements of the individual residents. As the home provides nursing care the free nursing care element of the funding is provided in addition to the costs charged to the resident. The home provides information about the service through the service user guide. A copy of the last inspection report from The Commission for Social Care Inspection is available in the entrance to the home. Care Homes for Older People Page 5 of 26 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: 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. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. Before the visit, we looked at, information we have received since the last key inspection visit on 6th December 2007. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. Care Homes for Older People Page 6 of 26 The Visit, an unannounced visit was made on 10th December 2009 by the link inspector. A expert by experience also visited the home with the inspector. An expertby-experience is a person who, has a shared experience with the residents of either using services or being the carer of someone who has. They therefore visit the service with an inspector to help them get a picture of what it is like to live in or use the service. The total time taken on both visits was seven hours. During the visit we, talked with people who use the service, relatives, staff, the manager and visitors. 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 the knowledge, skills and training to meet the needs of the people they care for. Looked around the building the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the manager what we found. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? Four requirements were made at the last full inspection these have all been met. The home has carried out the planned redecoration and refurbishment programme, and provided suitable chairs to meet the needs of the individual residents in the home. The way that the dining room is set out has been improved to make it a pleasant place for people to enjoy their meals. This will encourage an adequate nutritional intake. Improvements include having matching crockery, specialist cutlery, condiments, sauces and utensils to meet the needs of residents in the home. Care plans have been improved to show the care being given and shows how the staff plan, the care to make it specific to the individual person. These are reviewed and kept Care Homes for Older People Page 8 of 26 up to date. There was a requirement to make sure that any interest accrued in residents personal accounts could be allocated to the individual. This is now being managed by ensuring that residents who have significant amounts in this account are offered separate accounts so that they can get interest from it. 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 26 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 26 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 admission processes ensure residents needs are clearly identified and can be met before a placement is offered. Evidence: All residents have detailed pre-admission assessments, which are carried out by the manager or senior staff. This is a Four Seasons document called a Care & Health Assessment Programme (CHAP). It is very extensive assessment tool. The people who were case tracked had a well completed CHAP in their care plan. A new resident confirmed that she had met with a member of the staff prior to her admission and that her family were involved in choosing the home. She had not been able to visit herself but her relative had been to the home and had looked around. She had then been able to describe the home to her and tell her about the bedroom she would have if she choose to move in. Care Homes for Older People Page 11 of 26 Evidence: In one instance the home had to arrange for specialist equipment to be available before admission was agreed and this was done in a reasonable time period. Where the assessment has also been carried out through a social services contract and care management arrangements the home receives the assessment and a copy of the care plan. These records form the basis of the documentation process from which the care plans are developed. During the visit a lady and a family visited the home to look around. The Manager took time to show them around the home and to look at potential bedrooms. He spent time with them talking about the service that is offered. Care Homes for Older People Page 12 of 26 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. Good systems are in place to make sure that health and social care needs are planned and delivered in a respectful and person centred way. Evidence: All residents have a care plan which begins before the resident is admitted in the preinspection information and is added to throughout the stay. The care plans show that the personal and health care needs of the residents are being met. The care records including the record of the care delivered on a daily basis are completed to a good standard. Risk assessments are completed for, prevention of falls, wound care and moving and assisting. Care planning is in place for areas such as continence promotion. There is an assessment to look at residents food and fluid intake. The daily fluid balance and nutritional intake records were being completed for those residents at risk and they were up to date. The manager agreed to look at t he way that the fluid balance charts are being reviewed as currently they are not being totaled to show the amount of fluids being taken in one day. Care Homes for Older People Page 13 of 26 Evidence: Residents access NHS services and facilities as necessary. The care plans showed that specialist advisors are used for individual residents. The home liaises with the General Practitioners who provide care and support as necessary. The care was being given by staff that were pleasant and courteous and number of residents were obviously enjoying their company. An example of residents comments about the staff was they really look after us here and there is always someone around to give me a hand when I need it. Residents were dressed for the activities they were undertaking and looked smart and tidy. During the visits the staff were being friendly toward the residents and engaging them in conversation during the activities they were involved in. The treatment room has been decorated since the last inspection visit and it was clean and tidy on the day. The systems for managing medicines in the home are in line with safe working practice guidelines and the company have good policies and procedures. The staff record the medicines being ordered, the prescriptions are then checked on receipt from the General Practitioners and are then sent to the Chemist for dispensing. The medicines are then again checked against the records when received into the home so that any errors can be picked up. The management of the controlled medication is particularly good. No residents are currently managing their own medication. The home have taken on the end of life care pathway protocols and have used it in the care of residents with the support of the primary health care team, including the MacMillan nurses. The end of life pathways are used when a resident is at the end of their life. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are well supported to continue to keep control over decision making about lifestyle choices, keeping community contacts and engaging in meaningful activities. Evidence: The home employs a activities co-ordinator these are called a Personal Activity Leader PAL in the company. She has worked in the home for about eighteen months and is settled into her role. She is enthusiastic and organises various events both within and outside of the home. Individual records are kept are up to date and detailed. The examples of events organised are dominoes, ball games, skittles, bingo, sing a longs, chair exercises, trips out as well as visiting entertainers. The day prior to the visit two residents had been out to the Metro Center, two had gone the week before and the plan was for two to go at a time until each person who wanted to had done their Christmas shopping. The expert by experience reported that The activities lady talked me through all they had done which included trips out for lunch, shopping or just a ride along the coast. Some residents did not want to join in but then that was their own choice. She has several visits planned for the next few weeks including Carol Services and Christmas Care Homes for Older People Page 15 of 26 Evidence: Dinner out for those who want to go. She also said The residents are happy and content and this is mainly because they are cared for by carers who care about them. Residents said they could get up and go to bed when they wanted to. Many spent time in the lounges, some stayed in their own rooms and said this was their choice. The residents are encouraged to take control of their daily routines in simple but important ways including the time they get up, and what and when they eat or how they spend their time. There are large landscaped gardens surrounding the home. This has fencing around the patio area and a secure gate with a key pad lock on one side and a single turn handle on the outside. This results in the residents being able to access the gardens unaccompanied, as it is a secure and safe area. The area has raised planters and shrubs with lawned areas and paving. It is a very pleasant area now for people to use and enjoy. The residents said that they are encouraged to take control of their daily routines in simple but important ways including the time they get up, and what and when they eat or how they spend their time. The home has a four week choice menu, which showed variety and was balanced. The residents were being supported to make choices as to what they wanted. There were menus on the tables. There was choice offered of the type of drink they could have and staff were responsive to requests made by the residents as to what they wanted or did not want. The dining rooms are set out to make them a suitable place to give a positive experience. The dining rooms were effectively prepared and there were condiments and sauces on the tables to allow residents to add them themselves. The expert by experience eat a meal with the residents in the dining room she said The meal was well cooked or sandwiches if you prefer. If you didnt like the choices the cook found something you did like. It is a company policy to offer fluids to the residents on a regular basis, and drinks were given to the residents mid morning and in the afternoon. This was recorded on individual fluid balance records. Care Homes for Older People Page 16 of 26 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. Good complaints and protection of vulnerable adults policies, which are followed give the residents the opportunity to have their concerns dealt with and their safety maintained. Evidence: The home has policies and procedures for residents and staff to use should they have any concern or complaint about the care or other services. The documentation is in place for any complaints to be recorded and there are standardised letters to make sure that each stage is communicated with any complainant. They can also be audited and used in the homes quality assurance process. There have been no formal complaints made to the home since the manager has come into post so it is not possible to determine if he would have investigated them and taken appropriate action in response. However the residents are confident that any minor concerns are listened to and There are no ongoing complainants at this time. Policies and procedures are in place to protect residents. Staff have continued to receive training and said they would know what to do should there be any allegation of abuse. The records of the training provide were clear and the manager is currently undertaking an audit of the training to be sure that all of the staff are up to date. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained and suitably designed to meet the needs of residents, which ensures that the residents live in safe and pleasant surroundings. Evidence: Waverley Lodge is a two storey building of traditional brick and tiled roof cons ruction. It was purpose built for the client group so has wide corridors and is designed to allow people living in the home to use the entire home with ease and in safety. The decoration is in keeping with the style of the home and the furnishings are suitable for the residents living in the home. The company has an ongoing redecoration plan and ongoing improvements have been made in the last year. The home is set in large well kept landscaped gardens and there is now easy access to a safe garden area for residents who have dementia and those in wheelchairs would find it difficult to access the vast grassed areas. The home is clean and odour free. The residents bedrooms were personalised reflecting individual choices and preferences and residents asked about their bedrooms said they were happy with the way they were kept clean by the staff. The bedrooms are part of the redecoration programme and residents are asked for their preferences when any changes are planned. Care Homes for Older People Page 18 of 26 Evidence: The expert by experience spend her time with the residents and said It is well decorated and very clean. Most of the bedrooms are en-suite with plenty of room for residents own things around. All very clean and tidy carers and a hoist if this was required. She also time in the communal lounge saying The lounges were very light and airy with music playing but the television was off because the residents were too busy making cards with the activities lady and enjoying a good chat. The laundry was clean, organised and well equipped. The sluices were tidy, clean and odour free and the disinfectors operational. Staff followed infection control policies throughout the day. The light and emergency call cords were all clean and all emergency cords reached skirting level. Bathing facilities are provided in adequate numbers for the number and needs of the residents in the home. There are toilets and bathrooms close to the communal areas and twenty eight bedrooms have an en suite facility. There is no central heating within the communal bathing and en suite areas. The home has provided wall mounted blow heaters to ensure the correct temperatures are maintained. There are records in place to show that the maintenance contracts cover all of the necessary areas. There is a system in place for these to be renewed as necessary and the equipment in the home to be regularly inspected by outside contractors. The internal maintenance records were up to date as there is a handyman employed. Care Homes for Older People Page 19 of 26 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, training, and good systems around recruitment and selection makes sure that the diverse needs of the people living in the home are met. Evidence: The Manager makes sure that there are sufficient numbers of staff scheduled to work in the home. On the day of the visit the following staff were on duty:- The Manager, two registered nurses, four care staff, one laundry assistant, two domestics, the PAL (activity organiser) and the handyman. There was also an administrator on duty. The staffing levels are those which would be expected for the number of residents in the home. Very occasionally sickness can result in periods when there are insufficient numbers for some of the time. Generally the staff cover absences among themselves by picking up extra shifts. This is monitored by the Manager and the Regional Manager to ensure that staff do not work unacceptably long hours. Staff recruitment and selection records were complete including two references and a completed application form. The requirement to have a CRB and POVA check in place is applied to all of the staff in the home. The interviews are recorded formally in the staff record giving the Manager a record of the full process. The manager confirmed that he has made sure that the staff are up to date with moving and handling, first aid, and fire training. This was confirmed by the records. Care Homes for Older People Page 20 of 26 Evidence: There are only a few gaps in the statutory training where due to extenuating circumstances and are addressed through the appropriate process. Staff are offered a number of other training opportunities including pressure area care; continence training and end of life care. The staff are encouraged to undertake National Vocational Qualifications (NVQ 2) once they have had their induction training. Care Homes for Older People Page 21 of 26 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. Waverley Lodge is a safe comfortable and well managed home, which is run in the best interests of the people living there. Evidence: There is now a new manager who has been in post since August 2009. He is a registered nurse and has experience in a broad spectrum of care delivery. He has recent experience working in development of quality systems. There are two administrators employed in the home who split the week between them to make sure that there is cover Monday to Friday. This appears to work well as there is good evidence that they work well in the role and communicate effectively. There is a supervision programme in place which the manager is involved in delivering. It is well organised and the records show that it is almost up to date with any gaps being where there are unforeseen circumstances. These are being addressed by the Manager. Care Homes for Older People Page 22 of 26 Evidence: Relatives continue to be complementary about the staff and felt that they could talk to the Manager and the nurses if they have any problems. One said that they felt that they could speak to the Manager as he was good at communicating and felt that they could approach him if they had any concerns or views. The manager is involved in developing the management and leadership strategy in the home and is developing staff roles to meet the needs of the residents and the service. The personal records kept in the home of residents who are receiving assistance to manage their finances detailed, logical and appropriate. Receipts are in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place. The staff, residents and relatives were confident that their views were listened to and valued by the Manager. The expert by experience said that although he had not been there very long he knew residents names and more important the residents knew him. There is a very detailed internal quality assurance process in place, which is a comprehensive self-assessment document and from this the Remedial Action Plan is developed. The manager is aware of any improvements he needs to make as part of this ongoing improvement process. Accidents are well recorded and there is a reporting mechanism to make sure that they are analysed to look at any trends. The manager is responsible for a weekly risk monitor report which includes accidents and other areas such as anyone loosing weight or who have any wounds. There is a process for ensuring that health and safety issues are looked at and risk assessments are in place for any areas that could present a risk to people living in the home, staff or visitors. The handyman is responsible for regular health and safety checks and the records of this were up to date and complete. Care Homes for Older People Page 23 of 26 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 24 of 26 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 7 The way that the fluid balance charts are being completed should be reviewed to show the total amount of fluids being taken in one day Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!