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Care Home: Winnie Care (Ashbourne Lodge) Limited

  • The Green Ashbourne Lodge Care Home Billingham Stockton on Tees TS23 1EW
  • Tel: 01642553665
  • Fax: 01642558662
  • Planned feature Advertise here!

  • Latitude: 54.59400177002
    Longitude: -1.2929999828339
  • Manager: Mrs Julie Hickey
  • Price p/w: ~
  • UK
  • Total Capacity: 55
  • Type: Care home only
  • Provider: Winnie Care (Ashbourne Lodge) Ltd
  • Ownership: Private
  • Care Home ID: 18104
Residents Needs:
Old age, not falling within any other category, Dementia

Latest Inspection

This is the latest available inspection report for this service, carried out on 23rd November 2009. CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Winnie Care (Ashbourne Lodge) Limited.

What the care home does well This care home is very popular, with high occupancy rates. People who use the service and relatives said they were very pleased with the quality of care, the premises, the staff and the food. They also expressed confidence in the management of the home and felt able to approach them with any concern or complaint. Typical comments received from people who use the service and relatives included: "You can`t fault the staff here; they`re very approachable and nothing is too much trouble." "The staff are all kind." "The manager Julie is lovely. The staff are all happy here." "Mam has been in 3 years now, it`s a lovely place, Ashbourne Lodge. The warmth we get from the people in there is lovely. The staff are hard working, but still have time to make us welcome." The home is well maintained and each bedroom is a single room of good size, with en suite toilet and wash hand basin. There are plenty of communal rooms on each of the three units that make up this home, such as lounges and dining areas, plus wide corridors with helpful handrails. What has improved since the last inspection? An activities coordinator has been appointed (30 hours per week). Staff training in managing complaints, equality and diversity, plus safeguarding adults from abuse has been provided, and on-going refresher training in mandatory subjects for staff (such as moving and handling) is being organised. One shower room has been re-fitted and several bedrooms have been redecorated, with new carpets having been fitted in a number of areas. What the care home could do better: Some people who use the service and some staff feel that the home`s activities programme could be looked at again and developed further. Some people would like more entertainment and some would like more outings. The best way forward is for the home to ask people who use the service and their representatives for their thoughts and opinions to see how this aspect of the service can be strengthened. Some aspects of the home`s quality assurance programme should be improved, especially with regard to being clear about schedules of audits and visits, plus the reporting of outcomes and actions to be taken. Staff supervision sessions would benefit from increased frequency and delegation to senior staff. Further administrative support is desirable. Some additional care hours are recommended, to cover peaks of demand on the dementia care unit at busy times during the day. Key inspection report Care homes for older people Name: Address: Winnie Care (Ashbourne Lodge) Limited Ashbourne Lodge Care Home The Green Billingham Stockton on Tees TS23 1EW     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: Stephen Ellis     Date: 2 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 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: Winnie Care (Ashbourne Lodge) Limited Ashbourne Lodge Care Home The Green Billingham Stockton on Tees TS23 1EW 01642553665 01642558662 ashbournelodge@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Winnie Care (Ashbourne Lodge) Ltd care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Ashbourne Lodge is a care home which can provide personal care and accommodation for up to 55 older people, 32 of whom have a dementia type illness. Nursing care is not provided, however, the support of District Nursing services can be obtained if this is needed. The home is owned by Winnie Care (Ashbourne Lodge) Ltd which is a private organisation. There are 2 floors of accommodation where people live and includes the main kitchen, laundry area and staff rooms. The home has been specifically designed to provide accommodation for older people and has been open for about ten years. There is a level entrance into the home, and good access once inside because of wide corridors. There is a passenger lift which goes to the first floor, where there are two parts of the building one which provides accommodation for older people who have dementia, the other for older people who are frail or ill. The home provides single Care Homes for Older People Page 4 of 26 Over 65 17 38 0 0 1 1 1 2 2 0 0 8 Brief description of the care home bedrooms, each with their own toilet facilities and there are several lounges and dining areas on each floor. There is a parking area at the back of the home and there is a reception area at the entrance of the home. The home is located in the Billingham Green Area, close to shops, pubs, and community facilities. The weekly fees range from £420 to £443, but the actual amount paid by people who use the service depends on their individual circumstances. 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: This key unannounced inspection took place on 23rd November 2009, over 7 hours. The inspection process was assisted by discussions with twelve people who use the service, four relatives and six members of staff, including the registered manager and the area manager for the company providing the home. Prior to the inspection, a number of written surveys had been received from people who use the service, relatives and staff. Also, the manager had completed a comprehensive self assessment of the homes performance. During the inspection, the records of 7 people who use the service and 4 members of staff were examined. Other documents were seen, including medicine records, maintenance records, staff training programmes and quality assurance reports. The inspector had lunch with a group of residents in the ground floor dining room. A tour of the building was carried out, with various rooms and facilities being sampled. Paul Hulbert, the responsible individual for the company that provides the home, was present for part of the inspection and was able to supply helpful information. Linda Robinson, area manager for the Care Quality Commission, Care Homes for Older People Page 6 of 26 took part in the inspection, primarily as an observer (from a quality assurance perspective) but also assisted in examining records and interviewing people. The last key inspection of this service took place on 11th December 2008. Care Homes for Older People Page 7 of 26 What the care home does well: 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 8 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 9 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. People who may use this service and their representatives have the information needed to decide whether this home will meet their needs. People are only admitted after a full assessment of their needs has been carried out. Evidence: A cross-section of 7 plans of care were examined and these showed that the home carried out full assessments of needs before people were admitted. These were based on the activities of daily living. Often, in addition, there were care needs assessments supplied by a social worker or care manager. Comments received from six people who use the service and six relatives indicated good levels of satisfaction with the knowledge and understanding shown by care staff concerning peoples personal and health care needs. They also said that they had enough information supplied by the home to help them make an informed choice about its suitability and were also welcome to have a trial visit. Intermediate care is not provided. Care Homes for Older People Page 10 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. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: A representative sample of seven plans of care were examined. These were useful in providing clear plans of care, highlighting key issues, such as skin integrity, nutritional screening/monitoring, falls analysis, medicines profiles, pen pictures, bath charts, professional visits records and risk assessments. Seven people who use the service and six relatives expressed good levels of satisfaction with the standards of health and personal care provided. Typical comments included: You cant fault the staff here; theyre very approachable and nothing is too much trouble. The staff are all kind. The manager Julie is lovely. The staff are all happy here. Staff are lovely, they ask what you want. Mam has been in 3 years now, its a lovely place, Ashbourne Lodge. The warmth we get from the people in there is lovely. The staff are hard working, but still have time to make us welcome. One service user said he was very impressed recently when the dentist came to see him and filled his tooth at the home. A check of a sample of medicines records in the medicines room revealed good practice, with Care Homes for Older People Page 11 of 26 Evidence: good arrangements for storage, administration and disposal. Several examples of good practice were noted, such as supplementary sheets for Paracetamol being maintained next to the medication administration record (MAR) sheets, to monitor pattern of usage. Also, where MAR sheets had been handwritten for the medicines profile, 2 staff signatures had been recorded along with the quantities of medicines received and the dates they were received/started. Staff responsible for administering medicines have completed Safe Handling of Medicines training, usually at accredited level (accredited with the Further Education Colleges). Only one minor issue was apparent, and that concerned the keeping of a record of fridge temperatures using the new, indwelling thermometer, which was not up to date. Staff reported good professional relationships with health and social care staff, such as Community Nurses who visit regularly. Regular audits of medicines records and plans of care are carried out by the manager and senior staff. Nonetheless, the care plans of people who use the service would benefit from closer quality checks to ensure that all evaluations and updates are fully documented and signed by the service user or their representative where appropriate. Care Homes for Older People Page 12 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. People who use the service are able to make choices about their lifestyle, and supported to develop their life skills. Social, educational, cultural and recreational activities largely meet peoples expectations. Evidence: An activities coordinator is employed 5 days per week between 10:00 am and 4:00 pm. There is an activities room available. However several residents and staff said that they would like to see more activities and entertainment taking place, including outings to places of local interest. Every other month or so the home has a motivation person come into the home to provide a range of stimulating activities. Typical comments received from people who use the service or their representatives included: Its a bit quiet here after tea and I find the evenings dull. Theres the television and not much else. I came here about 2 months ago and I thought there would be more entertainment. I enjoyed the outing to South Shields in the summer. I would like a few more if possible. We have a singer coming in to entertain the residents, monthly. Dominoes, cards and bingo...plenty of magazines, books and other games to play. Also we (relatives) are invited to come in and enjoy the entertainment. We have just had a buffet, singer and raffle for Halloween night. When its someones birthday, its celebrated. Several people commented positively about staff assisting them to Care Homes for Older People Page 13 of 26 Evidence: make short outings, such as to the Remembrance Sunday service or the local betting shop to put a bet on. Several people also said that at times there was too much noise from music or television being played loudly, and some had even resorted to earplugs. However, people who use the service were complimentary in their comments about staff trying to help them, respecting their individuality and personal preferences. Daily life at the home is based on respect for the individual and their right to choose how to live their lives as much as possible, such as when to get up and go to bed, what to wear and what to do. Several staff said that more activities would be desirable, as would more accessible outdoor amenity space. However, residents and staff confirmed that peoples birthdays are always celebrated with a cake and birthday tea, with special birthdays involving a party as well (unless the person concerned didnt want one). Everyone spoken with on the day said that the food was either good or very good, with good choice and ample portions. The inspector had lunch with some residents and thoroughly enjoyed his meal. A four week menu is used and showed an appetising and nutritious selection of meals, including cooked breakfast. Special diets are catered for, including vegetarian options. The kitchen has been awarded the maximum 5 stars for food hygiene by the local environmental health authority. Care Homes for Older People Page 14 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. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, and are protected from abuse. Evidence: Six people who use the service and four relatives said they were confident about expressing concerns or making a complaint about any aspect of the service. They described the staff and manager as being approachable and caring. They were confident that any complaint would be taken seriously and acted on fairly. Staff have ready access to the homes complaints procedure, as do the people who use the service and their representatives. It is available in the service users guide and on notice boards. The manager had highlighted the complaints procedure as the policy of the month in the work station outside her office. Six staff who replied to surveys said they knew what to do if someone had concerns about the home. Training records and staff also confirmed that they had had training in safeguarding people from abuse and neglect and were confident about approaching the manager and/or safeguarding authorities about any concerns they might have. Care Homes for Older People Page 15 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 physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: A tour of the building revealed the home to be clean and well maintained. Good use was made of notices, posters and photographs of interest to people who use the service. Wall mounted memory boxes holding items of personal significanse, such as photographs, were also observed outside some peoples bedrooms. Bedrooms tended to be well equipped and personalised. All showers, bathrooms and toilets were supplied with liquid soap and paper towels in wall mounted containers to help promote hand hygiene. A cleaning programme ensures that each room is cleaned at least once each day. This includes communal areas such as lounges and bathrooms. A member of the domestic staff confirmed that she had sufficient cleaning equipment and time to do the work. A sample of the maintenance records showed that the home is well maintained, with checks and servicing being carried out at appropriate intervals. This was also confirmed by the homes maintenance officer. Fire training and fire drills are routinely carried out, along with regular checks of fire warning and fire safety equipment. People who use the service and their representatives said that they were pleased with the facilities, including comfortable bedrooms with en suite toilet and wash hand basin, plus wide corridors and lounge and dining areas on each of the three Care Homes for Older People Page 16 of 26 Evidence: units. Dining areas were noted to be well equipped with suitable, attractive furniture. The home has refitted the shower room on Cedar Unit over the past year and has redecorated a number of bedrooms and replaced a number of carpets. The home plans to improve the bathroom on Ash Unit, creating a more relaxed and friendly atmosphere, over the next 12 months. There is a well equipped laundry room and key staff have completed training in infection control and control of substances hazardous to health. Care Homes for Older People Page 17 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. Staff in the home are trained, skilled and generally in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Evidence: People who use the service and their representatives were very positive and complimentary in their comments about the staff. Typical comments included: Staff are lovely, they ask what you want. and I always receive the care and support I need. A very good rapport was observed between people who use the service and staff. Staff also commented positively about the quality of the relationships. They felt they had had appropriate induction and training and that the checks carried out by the home before their employment were full and satisfactory. An examination of four staff files confirmed this to be the case, with the exception of one member of staff where there was no record of an enhanced Criminal Record Bureau check (CRB) having been completed. The manager apologised and said she was at a loss to explain how this could have been overlooked, especially as the member of staff was long serving. The provider undertook to ensure that an enhanced CRB check will be expedited for this person, with appropriate supervision of their work whilst the result is awaited. Over 54 of permanent care staff have achieved National Vocational Qualifications (NVQ) in Care at level 2 or above. All staff have undergone induction and foundation training, with refresher courses being arranged on a rolling programme by the homes area Care Homes for Older People Page 18 of 26 Evidence: manager. Staff members confirmed that they felt confident that they had the necessary skills, knowledge and understanding to carry out their duties well. For example, many staff had had training in dementia care, and all key staff responsible for administering medicines have completed training in Safe Handling of Medicines, normally to an accredited level or equivalent. Staffing levels were generally appropriate. Typically there are 3 care staff on the ground floor unit and two on each of the first floor units, during the day (8 am to 10 pm) plus one on each unit at night, plus a fourth member floating between units, wherever most needed. In addition there is an activities coordinator five days per week between 10 am and 4 pm. Catering and domestic hours are reported to be sufficient for the needs of the home. There is input from a maintenance officer most days each week. The manager is full time and her hours are not included in the care hours provided. She is assisted by an administrator who works three days per week. Whilst these staffing levels appear to be generally sufficient, it is recommended that a third carer should be deployed on the first floor dementia care unit to cover peaks of demand during the day. This unit was reported to be very busy at times due to the complex needs of the 16 people living there. Staff find it difficult at times to complete the updates in plans of care when they have to prioritise meeting peoples needs for care and support. Also, in a home of this size and complexity (there were 53 people in residence on the day of inspection, which is fairly typical for this popular home) an additional two days of administrative support for the management of the home would be desirable. These two measures would help the service maintain care and administrative records, thereby assisting the planning and review processes. Care Homes for Older People Page 19 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. The management and administration of the home is based on openness and respect, with generally effective quality assurance systems developed by a qualified, competent manager. Evidence: The registered manager is qualified and experienced in managing a care home. She promotes an open and inclusive atmosphere, as confirmed by people who use the service, their representatives and staff. Typical comments included: The manager Julie is lovely. The staff are all happy here. (from a resident) and I like Julie cos she sorts everything out, shes straight. (from a member of staff). Staff said that they felt supported by management and could discuss any issues with the registered manager. However, one to one supervision sessions were infrequently recorded, suggesting that this responsibility would benefit from being shared more widely. Good leadership was evident in the observed atmosphere in the home and from the numerous positive comments received. The registered manager is responsible for the day to day conduct of the home, and is assisted with some aspects of staff training by an area manager Care Homes for Older People Page 20 of 26 Evidence: based on site (Catherine). She invites feedback, comments and suggestions from people who use the service about quality and satisfaction levels, by face to face communication and written surveys. The last residents surveys were dated September 2009. There were also audits completed by the manager of files in one unit dated May 2009, of toilets and bathrooms dated October 2009, and of bedrooms, public areas, kitchen, lounge and outside buildings, also in October 2009. The registered responsible person for the company providing the service, Paul Hulbert, visits the home very frequently to check on various aspects of the quality, including regulation 26 reports. However, the last available regulation 26 report was dated February 2009. These should be completed monthly. In the homes quality assurance manual, it was not clear about which checks would be done when, and there was no apparent check of whether recommendations identified in various audits and regulation 26 visits had been actioned. The service should identify in its quality assurance procedure, which checks are done when and by whom. It should also ensure that the results are made known to the appropriate people, along with details of the action taken or proposed by the home to address the findings. The results of surveys of service users opinions should also be made known to service users in a more formal way, along with details of actions taken or proposed. The home looks after small sums of money on behalf of some service users and keeps clear records and receipts, involving two witness signatures in respect of transactions. A check revealed this system to be working well, although the second signature was not always obtained at the time of the transaction. This is a potential weakness and the home is urged to obtain two signatures at the time of the transaction. Discussions with staff and checks of records showed that safe working practices are promoted through audits, maintenance schedules, staff training and meetings. For example, most staff have had training in fire safety, food hygiene and manual handling and these are kept under active review by management, with on-going refresher training. Care Homes for Older People Page 21 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 22 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 1 29 19 The home must ensure that all staff providing personal care have had a satisfactory enhanced Criminal Record Bureau (CRB) check. An enhanced CRB check is a necessary part of the recruitment process designed to help safeguard the people who use the service from abuse. 11/12/2009 2 33 26 Monthly reports of provider visits to the home are required to be produced and distributed in accordance with the regulation. This is to ensure that there is evidence of monthly provider visits and quality assurance checks being carried out and actioned by the provider. 31/12/2009 Care Homes for Older People Page 23 of 26 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 care plans of people who use the service would benefit from closer quality checks to ensure that all evaluations and updates are fully documented and signed by the service user or their representative where appropriate. Up to date records of fridge temperatures in the medicines room should be maintained, using the new, indwelling thermometer. It is desirable to talk more with people who use the service, individually and in small groups, to find out more about the activities and events they would like to be involved with, both in and outside the home. In a home of this size and complexity (there were 53 people in residence on the day of inspection, which is fairly typical for this popular home) an additional two days of administrative support for the management of the home would be desirable. It is desirable for a third carer to be deployed on the first floor dementia care unit to cover peaks of demand during the day. This unit was reported to be very busy at times due to the complex needs of the 16 people living there. Staff find it difficult at times to complete the updates in plans of care when they have to prioritise meeting peoples needs for care and support. The homes quality assurance manual should clarify what quality assurance checks are carried out, when and by whom. It should also give clear guidance about the analysis and publication of findings of quality assurance surveys of service users, their representatives, staff and any other stakeholders, so that people know both the results and what action will be taken. It is desirable to obtain two signatures for each monetary transaction involving the personal monies of people who use the service, in which the home is involved, in order to safeguard everyone involved. This should occur as far as possible at the time of the transaction. The home should ensure that formal, one to one staff supervision sessions occur at regular intervals throughout the year and are documented, to promote performance appraisal, training needs analysis and good practice. The manager may wish to share this activity with other senior staff, to manage the workload. Page 24 of 26 2 9 3 12 4 27 5 27 6 33 7 35 8 36 Care Homes for Older People 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 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. 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