Care Home: Winsford Grange Care Home

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What the care home does well Before any new resident comes to the home, one of the senior nurses goes out to meet them and to assess their needs. The care notes for three people who had been admitted to Winsford Grange quite recently contained good pre-admission assessment documents and assessments from other professionals. In all cases the staff had very good information about the person`s needs before they came to Winsford Grange. In all parts of the home the care plans had been written to a very good standard based on information from assessments and observations. The care plans have a photograph of the resident and most have a life story written with information provided by them or their family. All assessments had been reviewed monthly and an evaluation of the care plans was recorded monthly. The evaluations showed clearly that the nurse had taken time to look at how the person had been during the last month and considered whether any change was needed to their care. On the two units for frail older people there were a significant number of poorly people who needed to be looked after in bed. We saw that equipment was provided to meet their needs and keep them comfortable including adjustable beds and various types of pressure relieving mattresses. There is moving and handling equipment on each unit. The deputy manager has a particular interest and expertise in end of life care and she is doing a degree in palliative care. The home employs an activities organiser four days a week. He has worked at the home for several years and is very well liked. The care staff also show a good awareness of the social needs of residents. There is a weekly activities programme and a photographic record is kept to show what they have done. The people we spoke with said that they very much enjoy the activities. Each of the units has a main lounge and two other smaller comfortable sitting areas. This means that people have a choice of where they spend their time. Each unit has its own staff team and this encourages an atmosphere of belonging. Some members of staff have contributed greatly to providing lovely garden areas for people to enjoy. There is a kitchenette on each of the units where drinks and snacks can be made at any time of day or night. There is a complaints procedure for the home that is available for residents and their visitors. Two complaints have been recorded over the last year and the records kept showed that these had been fully investigated and responded to in writing. All parts of the home were clean and well-maintained and provide a pleasant and comfortable environment for people to live in. There are enough qualified and experienced staff to meet people`s needs. Staff vacancies have been filled, so the use of agency staff has now decreased significantly. Recruitment records for three new members of staff were excellent and showed that new staff had been chosen carefully to make sure they would be safe and suitable to work with vulnerable people. There were records of a very thorough induction for new staff that takes twelve weeks to complete.There are 43 care staff employed and 31 of these have achieved an NVQ in care. One of the registered nurses is the `learning coordinator` for the home and is allocated 13 hours a week for training. What has improved since the last inspection? Where bedrails were being used, the rails were fully covered with protective padded covers and were fitted safely. This is checked weekly by the maintenance person. The recording of receipt and administration of medicines has improved and there was minimal use of `as required` medicines. Where medicines are prescribed to be given `as required`, care plans are being written to give staff guidance about the administration of these medicines. Heated trolleys have been provided and this has improved meals service. More choice of meals is available including a choice for people who need their meals to be pureed. All staff providing direct care have had updates of training about safeguarding vulnerable people from abuse and the training is being extended to include the ancillary staff. Two new sluicing machines have been purchased and were waiting installation when we visited. This will help to prevent the spread of infection. Regular meetings for residents and their relatives meetings have been recommenced and were held in March and April, with relatives of eight people attending. A comments box has also been provided for visitors. There are also regular staff meetings and members of staff can contribute items to the agenda. We saw evidence of regular checking of care plans and medicines by senior staff. All staff have attended fire drills to ensure that they know how to respond appropriately if a fire should occur. What the care home could do better: Some of the daily communication notes in the care plans were detailed, but others were brief and contained comments like `hygiene needs met`, which doesn`t really give any information. We considered that the staff could make their entries in the daily notes more person-centred by writing more about the person rather than the tasks they (the staff) have done. We considered that the home was moving forward well under the guidance of the new manager and no requirements or recommendations have been made as a result of this inspection. Key inspection report Care homes for older people Name: Address: Winsford Grange Care Home Station Road Bypass Winsford Cheshire CW7 3NG     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: Wendy Smith     Date: 1 5 0 5 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: Winsford Grange Care Home Station Road Bypass Winsford Cheshire CW7 3NG 01606861771 01606861705 winsfordgrange@c-i-c.co.uk www.c-i-c.co.uk Community Integrated Care care home 60 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: This home is registered for a maximum of 60 service users to include: * Up to 30 service users in the category of OP (old age not falling within any other category * Up to 30 service users in the category of DE(E) (dementia over the age of 65) * Up to 3 service users age 60 years upwards in the categories of PD or DE * 2 named service users under the age of 65 in the category of PD Date of last inspection Brief description of the care home Winsford Grange is a purpose built care home providing nursing care for frail older people and people with dementia. There are four separate residential units; Dickens and Austen units are for elderly frail residents, and Bronte and Chaucer units are for people with dementia. The home is single storey with good access for wheelchairs. There are 60 single bedrooms. The home has private enclosed gardens. It has good car parking facilities, is on a local Care Homes for Older People Page 4 of 28 Over 65 30 30 0 3 0 2 Brief description of the care home bus route, and is close to rail services. Information about fees can be obtained from the home manager. 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 two stars. This means that the people who use this service experience good quality outcomes. We (the Care Quality Commission) visited Winsford Grange unannounced on 15 May 2009 as part of this inspection. One inspector carried out the visit. During the visit we spoke with residents and staff. We walked round the building to see all the communal areas and were able to visit some of the bedrooms. We checked some of the records kept at the home and spent time talking with the home manager. We also looked at any information that we had received about Winsford Grange since our last key inspection there in April 2008. Before the inspection the manager was asked to complete a questionnaire to give us up to date information about the service. Comments cards were sent out for members of staff to give us their views of the service. Care Homes for Older People Page 6 of 28 We made a short visit to Winsford Grange on 27 October 2008 to check whether progress was being made to meet with the requirements of the key inspection. We found that care plans for people living in Dickens unit had been completed to a better standard. An audit of bedrails had been carried out and staff had received instruction about the safe fitting of bedrails. Recording of medicines on Dickens and Chaucer units was much improved. There was evidence to show that a significant amount of staff training had been taking place over the course of the year and regular fire drills had been held. A suggestions box had been introduced and relatives meetings held bimonthly. There had also been meetings for residents and for staff. We also saw evidence that more effective auditing of medicines and care plans had been taking place. Care Homes for Older People Page 7 of 28 What the care home does well: Before any new resident comes to the home, one of the senior nurses goes out to meet them and to assess their needs. The care notes for three people who had been admitted to Winsford Grange quite recently contained good pre-admission assessment documents and assessments from other professionals. In all cases the staff had very good information about the persons needs before they came to Winsford Grange. In all parts of the home the care plans had been written to a very good standard based on information from assessments and observations. The care plans have a photograph of the resident and most have a life story written with information provided by them or their family. All assessments had been reviewed monthly and an evaluation of the care plans was recorded monthly. The evaluations showed clearly that the nurse had taken time to look at how the person had been during the last month and considered whether any change was needed to their care. On the two units for frail older people there were a significant number of poorly people who needed to be looked after in bed. We saw that equipment was provided to meet their needs and keep them comfortable including adjustable beds and various types of pressure relieving mattresses. There is moving and handling equipment on each unit. The deputy manager has a particular interest and expertise in end of life care and she is doing a degree in palliative care. The home employs an activities organiser four days a week. He has worked at the home for several years and is very well liked. The care staff also show a good awareness of the social needs of residents. There is a weekly activities programme and a photographic record is kept to show what they have done. The people we spoke with said that they very much enjoy the activities. Each of the units has a main lounge and two other smaller comfortable sitting areas. This means that people have a choice of where they spend their time. Each unit has its own staff team and this encourages an atmosphere of belonging. Some members of staff have contributed greatly to providing lovely garden areas for people to enjoy. There is a kitchenette on each of the units where drinks and snacks can be made at any time of day or night. There is a complaints procedure for the home that is available for residents and their visitors. Two complaints have been recorded over the last year and the records kept showed that these had been fully investigated and responded to in writing. All parts of the home were clean and well-maintained and provide a pleasant and comfortable environment for people to live in. There are enough qualified and experienced staff to meet peoples needs. Staff vacancies have been filled, so the use of agency staff has now decreased significantly. Recruitment records for three new members of staff were excellent and showed that new staff had been chosen carefully to make sure they would be safe and suitable to work with vulnerable people. There were records of a very thorough induction for new staff that takes twelve weeks to complete. Care Homes for Older People Page 8 of 28 There are 43 care staff employed and 31 of these have achieved an NVQ in care. One of the registered nurses is the learning coordinator for the home and is allocated 13 hours a week for training. 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. Care Homes for Older People Page 9 of 28 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 10 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 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People going to live at Winsford Grange can be sure that the staff have good information about the care they need. Evidence: The home provides four separate living areas, each with fifteen bedrooms. Dickens and Austen units are for physically frail older people and people with a terminal illness. They have links to the local hospice and the Macmillan nurse service. Bronte and Chaucer units provide care for people who have dementia. There are two respite care places that are funded by the Primary Care Trust. Most new residents are admitted from hospital; some are transferred from other care homes due to a change in their needs. Before any new resident comes to the home, one of the senior nurses goes out to meet them and to assess their needs. During the inspection we looked at the care notes for three people who had been Care Homes for Older People Page 12 of 28 Evidence: admitted to Winsford Grange quite recently. Each of these had a good pre-admission assessment document completed and there were also copies of assessments that had been carried out by a social worker and information from the hospital they came from. In all cases the staff had very good information about the persons needs before they came to Winsford Grange. A temporary care plan had been put in place so that the staff had information about their needs while a more full assessment was carried out. Care Homes for Older People Page 13 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. People living at the home receive a good standard of health and personal care and this is recorded well in their care plans. Evidence: We looked at a sample of care plans on each of the four units. The care plans are very long and complex but we found that they had been written to a very good standard based on information from assessments and observations. The care plans have a photograph of the resident and most have a life story written with information provided by them or their family. All assessments are reviewed monthly and an evaluation of the care plans is recorded monthly. The evaluations showed clearly that the nurse had taken time to look at how the person had been during the last month and considered whether any change was needed to their care. All of the care plans were of a good standard, however there was one particularly good care plan on Dickens unit that had been very well written without jargon and clearly showed an understanding of the persons needs and empathy for his needs. Also on Bronte unit there was a particularly good care plan that had been written Care Homes for Older People Page 14 of 28 Evidence: showing much insight into the persons condition. Some of the daily communication notes were detailed, but others were brief and contained comments like hygiene needs met, which doesnt really give any information. We considered that the staff could make their entries in the daily notes more person-centred by writing more about the person rather than the tasks they (the staff) have done. On the two units for frail older people there were a significant number of poorly people who needed to be looked after in bed. We saw that equipment was provided to meet their needs and keep them comfortable including adjustable beds and various types of pressure relieving mattresses. There is moving and handling equipment on each unit. Most of the people cared for in bed had bedrails in place. The rails were fully covered with protective padded covers and were fitted safely. This is checked weekly by the maintenance person. The deputy manager has a particular interest and expertise in end of life care and she is doing a degree in palliative care. She has been taking part in a research project about symptom control in palliative care through a local hospice and Lancaster University. The care plans recorded regular visits from dietician, speech and language therapist, chiropodist, optician and others. A GP from one of the local practices visits the home weekly. In one persons care plan we read information about his hearing aid and oral care, and another person had details of an advocacy service. We looked at the management of medicines on each of the units. We found that storage and recording of medicines was good in all parts of the home. Medicines are signed in when they arrive at the home and checks of stock balances were being kept. There is a photograph of the resident on their medication administration record to help any new staff with identification. Weekly medicines audits are being carried out and are followed up for compliance. The manager told us that she is having a meeting with a pharmacy supplier to discuss changing to a monitored dosage system of administration, which is easier to keep a check of. At our last key inspection we were concerned about medicines prescribed to be given as required, with no clear guidance for the staff as to what as required meant for the individual resident. We found that there were now very few as required medicines and they were almost entirely for pain relief, with the exception of two items on Chaucer unit. The manager has asked the nurses to provide a care plan for any as Care Homes for Older People Page 15 of 28 Evidence: required medicines to give clear instructions about when the drug should be given. We saw some of these care plans in place and they were very effective. During the inspection the staff were observed to have very positive relationships with residents and to address them politely and respectfully. People living in the dementia care units were smartly dressed and had been given the assistance they needed to keep up a good standard of personal appearance, which protects their dignity. The only negative observation was of two carers having a personal conversation across the dining table while assisting people with their lunch. Care Homes for Older People Page 16 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. The staff are aware of peoples social and emotional needs and make every effort to ensure that these needs are met. Evidence: The home employs an activities organiser four days a week. He has worked at the home for several years and is very well liked. The care staff also show a good awareness of the social needs of residents. There is a weekly activities programme and a photographic record is kept to show what they have done. A visit by a local theatrical group was planned for the week after our inspection. The home has its own minibus and people had enjoyed a garden centre visit this week. The people we spoke with said that they very much enjoy the activities. A Church of England minister visits the home weekly, and a Eucharistic minister from a local Roman Catholic church also visits weekly bringing communion to those people who wish to take it. Each of the units has a main lounge and two other smaller comfortable sitting areas. This means that people have a choice of where they spend their time. Each unit has its own staff team and this encourages an atmosphere of belonging. Some members of staff have contributed greatly to providing lovely garden areas for people to enjoy. There is a kitchenette on each of the units where drinks and snacks can be made at Care Homes for Older People Page 17 of 28 Evidence: any time of day or night. There is a large dining room that is light and bright and well-furnished. Residents from all parts of the home can use the dining room or can stay on their own unit for meals. We noticed again that some people had been taken to the dining room in wheeled armchairs which did not always provide a suitable sitting position for people eating. The lunch was nicely presented and looked appetising. People needing assistance were being helped one to one with a carer sitting by them. There is a choice of two main meals with other choices available. Hot trolleys have been provided and this has improved the arrangements for meals service. More varied menus have been introduced including a choice for people who need to have their meals pureed. There was a record of a daily menu choice for each person. 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. People who live at the home are protected by the CIC procedures for dealing with complaints and reporting any abusive incidents. Evidence: There is a complaints procedure for the home that is available for residents and their visitors. Two complaints have been recorded over the last year and the records kept showed that these had been fully investigated and responded to in writing. One of these people also contacted the Commission with their complaint. There are company policies and procedures for safeguarding people from abuse, including a whistleblowing policy. Two incidents that occurred over the last year were reported to social services following the agreed procedures. The electronic training programme for staff includes training about safeguarding people from abuse. This is being expanded to include the ancillary staff as well as direct care staff. 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. People living at the home enjoy a safe, comfortable, clean and well-maintained environment. Evidence: The home is set in its own grounds just outside Winsford town centre. It is a modern single storey building. The grounds are maintained by a contractor and were tidy. Each unit has a secure garden outside the main lounge where residents can walk about and sit out. These gardens are maintained by the homes staff and are very pleasant and well tended. All of the windows were replaced in 2008. The home employs a maintenance person and he is responsible for the routine maintenance of the home and redecoration of bedrooms as required. A number of bedrooms have been decorated over recent months and the flooring replaced as needed. The bedrooms we were visited on each of the units were comfortably furnished and personalised to suit the person occupying the room. Each unit has a choice of areas for people to sit in and a choice of armchairs to ensure that people who are physically frail can be supported to spend time out of bed comfortably and safely. There is a shower room and an assisted bathroom on each unit. Care Homes for Older People Page 20 of 28 Evidence: There was a member of the housekeeping staff working on each of the units and all parts of the home were spotlessly clean, tidy and free from unpleasant smells. The laundry was altered and improved in 2008. There is a sluice on each unit and they were very clean and tidy. Two new sluicing machines have been delivered and are waiting to be installed. The manager told us that she is looking at better signage for the dementia care units to make it easier for people to identify toilets etc. 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. The staff working at the home are carefully selected and receive regular training to ensure that they know how to work safely. Evidence: On each unit there is a nurse and three care staff in a morning and a nurse and two care staff in an afternoon and evening. At night, two nurses and six care staff cover the whole home. There are two registered mental health nurses working on the dementia care units. There were a number of staff vacancies which have now been filled, so the use of agency staff has now decreased significantly. The rotas identify the senior person on duty over the 24 hour period. There is a good mix of male and female staff. We looked at the recruitment records for three new members of staff. We found that they had all completed a full application form giving details of their previous employment. Interview notes had been kept. All had two good references from previous employers and satisfactory Criminal Records Bureau disclosures had been returned. These were excellent records to show that new staff had been chosen carefully to make sure they would be safe and suitable to work with vulnerable people. There are 43 care staff employed and 31 of these have achieved an NVQ in care. One of the registered nurses is the learning coordinator for the home and is allocated 13 Care Homes for Older People Page 22 of 28 Evidence: hours a week for training. The company provides an electronic training programme that covers all of the important health and safety subjects. Detailed records are kept to show when all staff have worked through the training programme and updated it each year. This has now been extended to include ancillary staff. A company training audit in February 2009 recorded a very good score for Winsford Grange. All staff have done fire training and drills during 2008/9. There were records of a very thorough induction for new staff that takes twelve weeks to complete and includes two days of practical work at head office. Other training is recorded in an individual file for each person and these showed a good amount of external training including falls prevention and pressure area care. Staff from the home attend training events provided by the primary care trust and the local hospice. 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. The home is well managed to ensure that people are kept safe and good standards of care are maintained. Evidence: The home now has a new manager. She has been working at the home in a temporary capacity since January 2009 but was appointed as manager on 11 May 2009. She is a registered nurse with a management qualification and has previous experience of managing a care home that achieved an excellent rating from the Commission for Social Care Inspection. The manager is supported by a deputy manager, a learning coordinator and an administrator, who has worked at the home since it opened 19 years ago. Regular meetings for residents and their relatives have recommenced and were held in March and April, with relatives of eight people attending. A comments box has also been provided for visitors. The manager attends a monthly managers meeting with CIC and this is fed back to a monthly heads of department at Winsford Grange, Care Homes for Older People Page 24 of 28 Evidence: followed by a staff meeting for each of the units. Staff are also able to contribute to the agenda. Meetings had not been held regularly over recent months and the new manager identified that communication within the home needed to improve. Senior nurses check the medicines and care plans regularly and we saw copies of their audits. The manager from another home in the group carries out a monthly monitoring visit. Residents are able to put small amounts of personal spending money in safekeeping and the administrator keeps a full record for each person. The self assessment completed by the manager gave dates when all plant and equipment had been tested and serviced to ensure safety. We saw records of monthly fire drills and the names of the staff attending. The fire risk assessment for the building was updated in February 2009 by the new manager. The maintenance person carries out and records weekly fire alarm checks. There is an identified outside area for staff who smoke. 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 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. 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). 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