Care Home: Wolfeton Manor

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What the care home does well People`s needs are properly assessed before they are offered a place at the home, ensuring that anyone who does move in can be supported and cared for by the service. They can make an informed decision about whether the home is the right place for them in the long-term, because they can get good information on the home and its facilities. People are treated with respect, and their right to privacy is generally upheld. A range of activities is offered, and people enjoy links with the community around the home, including continued relationships with family or acquaintances. They are helped to exercise control of their lives where possible, with choice offered and their decisions respected. Varied and balanced meals are available, in pleasant surroundings, meeting people`s dietary and social preferences. The home is generally well maintained, safe and clean, with ongoing investment in the facilities to provide homely and suitable accommodation. The home is being run in the best interests of those who live there. People using the service are listened to and taken seriously, as well as being safeguarded by the home`s policies and procedures for protecting their welfare. People living the home are cared for by staff who are fit for their role and who as a team provide a safe basic level of care. What has improved since the last inspection? Systems are being established for involving people routinely in the planning of their care. Each person has a care plan that provides detailed guidance for staff so that people`s various and health and welfare needs are met in individualised ways. They are assisted to eat and drink in more sociable ways, so that mealtimes are a pleasant experience for the individual. The quality of the meat served in the home is better, and people living at the home are being involved in how the home should cater for them. They have opportunities to go out on trips and engage in social activities outside the home, with no extra charge being made by the home. People who cannot weight-bear can now be weighed, as `sit on` scales have been purchased. Radiators have been covered, to avoid burns. Accidents are audited and evaluated, so efforts can be made to reduce the risk of falls whenever possible. Cross-infection risks have been reduced by changing laundry practises and by providing facilities for staff that promote good hand hygiene. Staffing levels have been increased over time, at certain times of the day, with recruitment of care and ancillary staff ongoing, so that people`s needs can be met in a timely way. The range of training available to staff has been increased, and over half of the care staff now have a care qualification (NVQ2 in Care or a higher level). Staff have had fire safety training, to make sure they know what to do in the event of a fire. The home`s written contract has been altered, so that it is clear who is responsible for paying fees for living at the home. Policies and other documentation (such as the home`s job application form) have been revised to reflect current legislation or good practise advice and to indicate who manages the home. What the care home could do better: The home`s reviews of people`s care plans should always be thorough enough to ensure that they reflect the person`s current needs and care, so that people living at the home get the support they currently need. Daily care records should give a clear picture of the care each person has received and how they are, mentally and physically, so that staff can evaluate if the care planned and given is meeting the person`s needs. Assistance given to people must be as indicated in the person`s care plan, to prevent risks to their health, especially if people have swallowing difficulties or are prescribed skin creams. Some people would benefit from more individualised support at mealtimes. Further development of opportunities for recreation, promotion of people`s independence and other positive experiences that are in line with their interests, abilities and personal preferences would ensure people`s social and psychological needs are met in person-centred ways. The effectiveness of recent changes in staffing arrangements should be monitored and adjusted as necessary, to ensure that there are always enough staff on duty to meet in a timely way - the health, social and personal care needs of people living at the home. And staff should undertake further training related to the conditions of people living at the home, so that their current needs and any changing needs are met, and so that the aims of the home can be fulfilled. The home plans to further improve the environment over the next year. However, fittings and equipment should be maintained in the meantime, and any repairs required carried out in a timely way, to keep the home`s facilities in a suitable state for people at the home, especially those who have physical disabilities, to enjoy their usual and preferred daily life. Stabilisation of some aspects of management of life at the home (such as communication, staffing and environmental matters) should be achieved so that people will consistently receive a satisfactory service. The manager is working towards relevant qualifications, and should complete these with other recommended training, to ensure the home will be well-managed in the long term. Key inspection report Care homes for older people Name: Address: Wolfeton Manor East Hill Charminster Dorchester Dorset DT2 9QL     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: Rachel Fleet     Date: 1 8 0 1 2 0 1 0 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 40 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 40 Information about the care home Name of care home: Address: Wolfeton Manor East Hill Charminster Dorchester Dorset DT2 9QL 01305262340 01305257915 info@wolfetonmanor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wolfeton Manor Healthcare Limited Name of registered manager (if applicable) Mrs Samantha Jane Hansford Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Wolfeton Manor provides 24 hour personal care and accommodation for up to 31 older people. It does not provide nursing care other than that which can be provided by the local community nursing services, and does not offer intermediate care. The home is on a hill overlooking the Cerne and Frome rivers to the south and west, one mile north of Dorchester and on the edge of Charminster village. There is ample car parking at the front of the Manor. Accommodation is arranged over three floors. Apart from 8 rooms, all accommodation is at ground floor level in the main house and in the lower level north and west wings. Care Homes for Older People Page 4 of 40 1 1 1 2 2 0 0 8 0 Over 65 31 Brief description of the care home There are 23 bedrooms with en-suite facilities and 5 assisted living suites. Three bedrooms/suites may be used for double occupancy. The suites comprise a hall, bedroom, lounge, bathroom and hideaway kitchenette. The upper floors can either be accessed by stairs or by a lift which is suitable for people who use wheelchairs, with a platform lift or stairs providing access to the west wing, and sloping corridor access to the north wing. Three self-contained flats which can be rented in a house adjacent to the home are not regulated by us. The current weekly fees are from £463.00 - £795.00. Fees include all care and accommodation costs, including meals, laundry, activities (including transport), use of the homes cordless phone and use of the homes communal wireless internet access. Additional charges are made for hairdressing and chiropody. People are expected to pay for their own personal items such as private telephone, toiletries and newspapers. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk. Our latest inspection report about the home is kept in the homes entrance hall, or can be obtained through our website. Care Homes for Older People Page 5 of 40 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 inspection was part of our routine inspection programme. Part of it was a visit to the home, which lasted 10 hours on a Monday in January 2010. The focus of the inspection was to look at the core National Minimum Standards for Care Homes for Older People. We looked at outcomes for people living at the home, in order to judge the quality of the service people received. A management company, Affinity Care, runs the home on behalf of the provider. Mrs Sam Hansford, the acting manager at our last inspection, has since become the homes registered manager. She completed and returned the Annual Quality Assurance Assessment (AQAA) within the required timescale, and information from this is referred to in this report. We sent surveys for people who lived at the home, their relative or other advocate, Care Homes for Older People Page 6 of 40 staff, and healthcare professionals who supported people living at the home. We sent out surveys in the Autumn of 2009, but our visit was then postponed until January 2010. We therefore sent another batch of surveys for people living at the home and their relatives, to get more up to date information about their experience of the home. Of the surveys for people living at the home, 8 were returned from the earlier batch of surveys, and 5 from the second batch. We also received surveys from 2 peoples relatives, 6 healthcare professionals, and 5 staff. Their responses are included in this report. While at the home, we talked with 6 of the 25 people living at the home, as well as meeting others but more briefly. We spoke with 2 visitors, and with 6 care or ancillary staff. We undertook a tour of the building, which included bedrooms used by the people we case-tracked, shared areas, the kitchen and laundry. We looked at care files and related information for 3 people living at the home, and three staff files. We also looked at other documentation relevant to the running of the care home. Care Homes for Older People Page 7 of 40 What the care home does well: What has improved since the last inspection? Systems are being established for involving people routinely in the planning of their care. Each person has a care plan that provides detailed guidance for staff so that peoples various and health and welfare needs are met in individualised ways. They are assisted to eat and drink in more sociable ways, so that mealtimes are a pleasant experience for the individual. The quality of the meat served in the home is better, and people living at the home are being involved in how the home should cater for them. They have opportunities to go out on trips and engage in social activities outside the home, with no extra charge being made by the home. People who cannot weight-bear can now be weighed, as sit on scales have been purchased. Radiators have been covered, to avoid burns. Accidents are audited and evaluated, so efforts can be made to reduce the risk of falls whenever possible. Cross-infection risks have been reduced by changing laundry practises and by providing facilities for staff that promote good hand hygiene. Staffing levels have been increased over time, at certain times of the day, with recruitment of care and ancillary staff ongoing, so that peoples needs can be met in a timely way. The range of training available to staff has been increased, and over half of the care staff now have a care qualification (NVQ2 in Care or a higher level). Staff have had fire safety training, to make sure they know what to do in the event of a fire. Care Homes for Older People Page 8 of 40 The homes written contract has been altered, so that it is clear who is responsible for paying fees for living at the home. Policies and other documentation (such as the homes job application form) have been revised to reflect current legislation or good practise advice and to indicate who manages the home. 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 Care Homes for Older People Page 9 of 40 order line 0870 240 7535. Care Homes for Older People Page 10 of 40 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 40 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. Peoples needs are properly assessed before they are offered a place at the home, ensuring that anyone who does move in can be supported and cared for by the service. People can make an informed decision about whether the home is the right place for them in the long-term, because they can get good information on the home and its facilities. The home does not offer intermediate care. Evidence: Surveys from people who lived at the home confirmed that most individuals felt they had received enough information before moving into the home, to decide if it was the right place for them. We saw from minutes of the most recent residents and relatives meeting that people had been notified that changes had been made to the homes information about the Care Homes for Older People Page 12 of 40 Evidence: service it provides (- its Statement of Purpose and Service Users Guide). This information was available by the visitors signing in book, and the manager confirmed that the new version has also been sent to us. Prospective residents and/or their families are encouraged to visit the home and spend time there before they make a decision about moving in. People spoken to during the visit confirmed that they, their families and care professionals already supporting them had been able to visit the home, to see if it would be suitable for the individual. We looked at written records relating to some people who had moved into the home since our last inspection. Pre-admission assessments of their needs had been completed by the manager, sometimes when people had visited to look around the home. Information had also been kept from hospital staff, where individuals had been admitted from hospital. Care needs information had been obtained from care managers, for people whose care was funded through Social Services. Records showed the manager had visited one person in their previous care setting, to assess their needs. She had noted, among other things, their medication at that time, what they could do for themselves and what they needed help to do, their personal grooming preferences (make-up, etc.), that they preferred their drinks in a particular cup, and if they had made any funeral plans or advance directive, etc. The manager told us she had, after assessing someones needs, gone on to discuss with them and their family limits to the care the home could provide (- which we were able to confirm when we met the person). This enabled them to make a more informed decision before moving to the home. Another person who we case-tracked had been admitted in an emergency situation. We saw a full assessment of their needs had been carried out on their arrival, although the home had obtained some information about them when they had visited the home previously, as well as by phone immediately prior to their admission. Healthcare professionals indicated the homes assessment arrangements usually or always ensured that accurate information was gathered and the right service planned for people. Admissions are on a four week trial basis, so people are able to have experience of living in the home before making a final decision about longterm residency. All recent surveys confirmed that individuals had been given a contract or written terms and conditions. The manager showed us these, in relation to people we met. Care Homes for Older People Page 13 of 40 Evidence: The information in these documents had been revised since our last inspection, to detail clearly who was responsible for paying the fees. Care Homes for Older People Page 14 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are ongoing improvements in the planning of peoples care, which will help to ensure that their particular needs are met in an individualised way. However, there is a risk that some peoples health needs may not be met, because the support they receive is sometimes different from the care planned for them. People are treated with respect, and their right to privacy is generally upheld. Evidence: Both batches of surveys for people living at the home indicated that people felt they usually or always received the care and support they needed, including medical care. This was also reflected in surveys from peoples relatives and healthcare professionals. We looked at the care records of 3 people in detail. All care plans had the same wording initially. This was then altered or added to, to create a more unique care plan for each person, for meeting their needs in a more individualised way. Thus, one persons plan included special attention needed to their bedding and pressure-relieving equipment in order to meet their particular needs, and personal grooming products they liked. How often a persons catheter drainage bag should be emptied was stated. Care Homes for Older People Page 15 of 40 Evidence: It was noted, under Communication, what staff should talk about if one person was sad about a certain matter. A care plan alerted staff that someones condition was very variable, guiding staff to ask the person each time they assisted them about the support they needed or wanted. Information had been obtained about some peoples life to date, although it didnt always clarify what the current situation was - such as, did people still practise their given faith. Where such information was not available, staff we spoke with were able to tell us much about the person, their family, things important to them, etc. We noted that peoples dietary dislikes were recorded, although there was much less about what they liked to eat. Besides being of use to plan meals to suit peoples preferences, this could be important information for encouraging someone to eat. Peoples wishes about their care should they become seriously ill or collapse were also sought. It was clearly identified if someone had made an Advance Directive, for example. Assessments in relation to risks of pressure sores, malnutrition, and falls were in place, reviewed and updated as necessary to reflect peoples current circumstances. Other more individual risks had also been identified (such as a risk of choking), with guidance on how the risk was to be managed. We discussed how the home assesses individuals risks of falling. We were told us that if someone begins to fall more often, an NHS assessment tool is used. Care needed to be taken that all entries in care records were dated, as noted at our last inspection. Staff we spoke with appeared familiar with individuals general needs and preferences. However, while senior carers we spoke with were familiar with the care plans, other care staff said they were not really involved in care planning and the written care plans. Surveys from staff indicated they felt they were not always given up to date information about the needs of the people they supported. A visitor felt there was a lack of co-ordination between senior carers and other carers, giving an example of something agreed with a senior carer that other staff didnt seem to know about or adhere to. Some people told us their care plan had been discussed with them, while others didnt seem to know about it or said it was several months before this happened. The manager explained that systems had now been set up for regular discussion with senior care staff, and we also found positive evidence of this. In reviews of their care, people were asked, for example, if there was Anything we can do better? and what Care Homes for Older People Page 16 of 40 Evidence: the person liked about the home, with their responses recorded as part of the review. One persons care plan said that, on the advice of a mental health professional, their mood was to be recorded daily, but we saw this was not being done on a daily basis. Monthly reviews of another persons care plan stated that they remained in high spirits, yet when we met them they were sad and staff told us that the persons mood was very variable (as indicated by their care plan). The home monitored peoples weight. We pointed out that in one persons case, their weight gain could impact on their health. One person had a safe eating plan, drawn up by a relevant healthcare professional. This stated they were to have a soft diet. Staff we spoke with were seemingly unaware of this, saying they would cut up the persons food but that there was no other requirement regarding the texture of the food the person ate. Another person told us that staff who did not work at the home often sometimes forgot to cut crusts off bread. One persons safe eating plan stated that they were to have smaller meals more often. We asked staff how this was addressed practically, as it was not reflected in the persons daily care notes. They said the person had 3 meals a day and was offered supper - which was the same provision as for everyone else at the home. Care records showed that people had eye tests, chiropody, input from community psychiatric nurses and other specialist nurses as well as community nurses, they attended diabetes clinics (where relevant), and had reviews of their medication. A visitor told us that their relative had been prone to illnesses requiring hospitalisation before their admission, but since moving into the home, they had not been admitted to hospital at all, staff being vigilant for signs that the persons health was changing. The home facilitated free access to a counselling service, to meet peoples emotional needs and promote their overall wellbeing. We observed that someone had bruising, which they explained the cause of but which was not reflected in their care records,and staff we spoke with seemed unaware of it. We discussed with the manager that staff should be more proactive about reporting bruising, as there can be various and serious causes. People looked attentive, several were independently active around the home during our visit, and they generally looked well cared for. However, we noted that someone who was given biscuits with a mid-morning drink had dirty fingers, which we pointed out to staff. When asked what the home could do better, a survey from a healthcare professional Care Homes for Older People Page 17 of 40 Evidence: had the comment Communication, especially about blood tests. We discussed this with the manager, regarding the homes duty of care to ensure peoples needs are met even though community nurses are responsible for taking the blood. We saw that some people had pressure-relieving cushions on their chairs and specialist mattress, as indicated in their care plans, to help ensure they didnt get pressure sores. A survey from a staff member said correct equipment was needed - without being more specific - if staff were to work well. Staff we spoke with felt they had sufficient equipment to care for the people currently living at the home, although another comment was made that some carpets affected the movement of hoists. People we asked were satisfied with how staff managed their medications for them. All but 1 survey from healthcare professionals indicated that the home usually or always supported people to administer their own medication, or manage it correctly when this was not possible. We looked at how the home managed the medications of the people we case-tracked. There was secure, suitable fixed and mobile storage facilities, including appropriate storage for controlled drugs and a dedicated fridge for medication (with appropriate temperature checks recorded). Each persons photograph was with their medication administration record, as well as information about any allergies they had. When we checked two controlled drugs, we found relevant records had been completed. However, as one item had not been dated on opening, staff could not be certain of its remaining shelf-life as indicated by the manufacturer. The AQAA stated that all staff who administer medication have undertaking training and subsequent assessment of their skills. We saw that staff had refresher training on medication administration, and discussed that competency should also be re-assessed. Some peoples care plans included guidance on use of their prescribed skin creams, but there was little in others. One persons plan stated that if there was no improvement staff should report this, but without indicating how long staff should wait to see if any improvement was occurring, and staff we spoke with gave us various timescales. It was unclear where staff recorded the application of prescribed skin creams, when this was not recorded on the medication administration record from the pharmacy; one carer was not aware that a record was to be kept. Care Homes for Older People Page 18 of 40 Evidence: We were told that 2 people were self-administering, 1 of who was at the home for a respite stay. Staff explained how each person was supported in this, and we saw related records. Staff told us that the double rooms were rarely occupied by 2 people, to avoid the issue of 2 people unknown to each other sharing a room. People we spoke with confirmed that staff respected their privacy as much as possible, as we observed during our visit. Bathrooms and bedrooms had locks for enabling privacy. We heard staff use peoples preferred name or form of address. Most surveys from healthcare professionals indicated that the home usually or always respected peoples privacy and dignity. One said this was improving, especially in terms of care and ancillary staff having consideration for peoples privacy when their door was shut, when they were using a commode in their room, keeping them covered up whilst assisting them to wash, etc. Care plans included what personal care people could do themselves, unaided, and in what circumstances their door should be kept open. Such detail promotes peoples independence and privacy. Care Homes for Older People Page 19 of 40 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 living in the home are offered a range of activities and enjoy links with the community around the home, including continued relationships with family or acquaintances. They are helped to exercise control of their lives where possible, through offering them choice and respecting their decisions. Varied and balanced meals are offered, in pleasant surroundings, meeting peoples dietary and social preferences, although some people would benefit from more individualised support at mealtimes. Evidence: Asked in the recent surveys what the home did well, one person living at the home commented on the entertainment provided. Another said Giving kindness and reassurance, plus help giving residents both physical and mental activities. Asked what the home could do better, someone commented Provide booster TV aerial reception to rooms. People surveyed and people we spoke with seemed satisfied with the activities and other recreational opportunities offered at the home. Some occupied themselves, keeping up their hobbies, etc. However, some staff reported that people told them they were bored, and it was not clear that peoples identified interest were used as the Care Homes for Older People Page 20 of 40 Evidence: basis for planning of activities, etc. Other staff told us that the Activities co-ordinator was careful to spend time individually with people who didnt want to take part in group activities. The activities co-ordinator currently worked 9 hours a week (although there were plans to double this), leaving other staff with responsibility for offering people opportunities for recreation. For example, a quiz was held during our visit - a daily event, we were told, because it was so popular. This was run by the kitchen assistant or a care assistant. We noted that some peoples daily notes did not reflect how they spent their spare time or what recreational opportunities had been offered to them. We were told that such notes were kept separately, but this might not promote holistic care. Most planned events took place Monday - Friday. These included musical entertainment, music and movement sessions, and outings using the homes people carrier, with a bus hired occasionally that could transport people who used wheelchairs. The home has a small library that includes large print books. A computer with internet access and Skype facilities in one of the day rooms, enabled some people to keep in touch with family abroad, etc. A news board in the same lounge had information on planned entertainments and other events, the homes latest newsletter and photos of occasions enjoyed in recent months. People we met in their rooms confirmed they had read the newsletter. A digital photo frame by the Visitors book showed pictures of social occasions organised by the home. We saw people using the garden during our visit, some out walking on their own and some taken out in a wheelchair, by their family or the activities staff. People told us that they were taken out singly or in twos, in the homes car, with one saying people could request such outings. People felt their visitors were made welcome. A pay-phone - as well as use of the homes cordless phone if required - was available, though several people had their own line installed. Wireless internet access was also available. There was a post box people could use if they wished, with staff then posting any letters. Surveys from peoples relatives indicated they felt the service usually or always responded to individuals different needs, and that the home always or usually helped people to live the life they choose. This was reflected by most healthcare professionals. For example, Holy Communion was held at the home twice a month. Some people told us they had a shower every day or a bath more than once a week, Care Homes for Older People Page 21 of 40 Evidence: as they wanted. Staff giving out hot drinks offered individuals a choice of drinks, although we noted that they were given biscuits without being offered a choice. The home has links with a not-for-profit, confidential counselling service (paying associated costs) should anyone living at the home wish to find an advocate, etc. When peoples preferences had not been met, staff had fully recorded why - such as when bathing was hazardous for individuals who would have liked a bath, or when it was not safe for someone to self-medicate, with alternative care or support planned. The home had plans for improving its bathing facilities, making it more likely in future that more people could enjoy a bath safely. Food was commented on positively in both batches of surveys - especially regarding the cooked breakfasts, and choice of where to eat meals. Asked what the home could do better, a visitor commented Continue to expand the home cooking. Most people we spoke with said they enjoyed the food, and confirmed the quality of the meat served had improved since our last visit. One person who needed a special diet said they had gone off their meals but still said that the food was very good, and they liked the desserts provided for them. We saw that lunch during our visit was a social occasion, with the meal served in an informal yet organised way, with covered plated main courses brought from the kitchen. A dessert trolley was taken around afterwards, enabling people to see what was being offered and make a choice at the time. Dishes of vegetables were provided to the dining tables, for people to help themselves. This was a suggestion made in the earlier batch of surveys we received, so it was positive to see that this had also been discussed with the home and acted on. Breakfast began at 8.30am, lunch at 12.30pm, with tea at 5.30pm. Fresh fruit could be provided on request. Menus we saw were of mainly traditional English fayre - with roasts, fish on Friday, treacle tart, etc. At tea, soup (home-made on the day of our visit), a hot light meal, sandwiches, salad, cake, icecream and fruit were offered - and people could choose all of these if they wished. The days menu was available by the Visitors book and on the dining tables. We were told by the manager that since our last visit, there was more consultation with the people living at the home about the meals provided - hence cooked breakfasts were now available daily if people wanted them, for example. W saw that pureed meals were served attractively, with the components of the meal Care Homes for Older People Page 22 of 40 Evidence: presented separately on the plate, so that people could enjoy the different colours and tastes if they wished. People who needed assistance from staff to eat their meal were helped on a one-toone basis, in an unhurried manner. They were told what the meal was, what the next mouthful would be, etc. They chatted with them about their day so far, etc. We noted that someone with confusion, who was eating in their bedroom, did not protect their clothes with the napkin provided on their meal tray. Although staff went in to check on them during the meal, they did not notice this or that food was falling on the persons clothes. In recent surveys for people living at the home, when asked what the home could do better, someone had commented More help with meals. See also the previous section, where it was noted that people with swallowing difficulties might not receive the diet they needed. Care Homes for Older People Page 23 of 40 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 using the service are listened to and taken seriously, as well as being safeguarded by the homes policies and procedures, to promote and protect their welfare. Evidence: The majority of the first batch of surveys we received from people living at the home said they did not know how to make a formal complaint, but more recent surveys from people and their relatives indicated they did know how to do this. Healthcare professionals surveyed said that the home always or usually responded appropriately if they or someone else had raised concerns. One commented that staff didnt get defencive about complaints, viewing them constructively as a way of improving matters, which reflected what was written in the homes self-assessment in their AQAA. We saw from very recent care plan reviews, people had been able to discuss with staff issues that they had told us about, with support or care then agreed to address the matter. Minutes of Residents/relatives meetings included some issues raised by attendees, which we found had since been addressed. All but one survey from staff said they knew what to do if someone had concerns about the home. Care Homes for Older People Page 24 of 40 Evidence: People we spoke with felt they could make a complaint if necessary, and that it would be dealt with, although one person said they would tell someone outside the home rather than anyone at the home. One person told us about an issue they had had recently with the home. We saw this was recorded in the homes complaints log, along with action taken to try to prevent the issue arising again. Although the complaints procedure on display in the home did not include all the recommended or required information, each bedroom had a file of information that included a complaints procedure with full details - such as contact details for Affinity (the managing company), Social Services and us. The manager said she would bring this to peoples attention, and update the version on display. We have not received any complaints about the home in the last year, and the homes AQAA indicated they had not received any either. Nor have there been any safeguarding alerts in relation to the home. At our last inspection visit, we found the homes written safeguarding policy to be satisfactory. The written policy on managing aggression has since been revised, in the light of our observations about it on that visit. The home continues to use robust recruitment procedures in order to ensure new employees are fit to work in care settings. People who lived at the home confirmed that they felt safe with staff, because they felt they were trustworthy individuals, who also had good care skills. Some staff we asked were not able to give many examples of what abuse is, which we discussed with the manager. But they importantly included poor care, inappropriate tone of voice, and not giving people choices. The AQAA told us that all staff have had safeguarding training, but also that the homes plans for the next 12 months include an ongoing training programme, and first line managers are to attend the local authoritys safeguarding training. Staff were clear that they would report any concerns to senior staff within the organisation, or go to outside agencies such as Social Services or the police if necessary. Care Homes for Older People Page 25 of 40 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 generally well maintained, safe and clean, with ongoing investment in the facilities to provide an attractive and suitable environment for people to live in. Evidence: The home looked very welcoming and homely when we arrived, feeling warm throughout, and with easy access to natural light and outdoor views. There were a variety of interconnecting day rooms, furnished or set up for various purposes, with people moving between these areas as they wished. We asked people about the facilities in their bedrooms. People who enjoyed reading told us the lighting was sufficiently good in the evenings. Heating, ventilation and furnishings were also to their satisfaction. Top floor rooms had very attractive views across the country side. A new boiler was installed in December 2008, according to the AQAA, but one person said the hot water supply to their room was variable, and a member of staff reported a problem in another part of the home. We reported this to the manager, who told us the thermostatic valves in the plumbing were due to be serviced later in the month. We received some comments suggesting there wasnt enough bedlinen, although we saw plenty around the home. The manager confirmed there were ample supplies, but Care Homes for Older People Page 26 of 40 Evidence: a shortage might be perceived because bedroom furnishings were co-ordinated and sometimes the matching linen might be harder to find. A relative told us that the large garden was usefully designed, such that people in wheelchairs to be taken around it easily. There was ramp access from various points around the home, pathways constructed, and garden furniture provided. The Sun room looked out over the garden at the back of the home, whilst there was a more sheltered Conservatory to the front of the home, besides other lounge areas. Armchairs in one area appeared to be of the same height, but the manager assured us that a range of seating was provided, which could be moved around to suit individuals needs. Most people we spoke with felt there were enough environmental adaptations for their needs and to promote their independence where possible. We saw a variety of beds in use around the home - some high, some adjustable, etc., to meet peoples different needs. Baths had adaptations such as fixed bath hoists and grab rails, to assist people with impaired mobility. People who used walking aids told us they got around the home using these without encountering problems in the environment or hazards. People had pendant-type call-bells, so they could summon help wherever they were. The AQAA indicated that certain equipment and services (such as electrical circuitry and gas systems) had been serviced, by suitable people, within appropriate timescales. People living at the home that we spoke with, as well as the staff, felt the environment was kept well maintained, with repairs attended to in a timely way. However, we found the platform lift was out of order, as at our last inspection. People told us it had broken down 3 days previously, having just been serviced, with a new part needed. Asked in a survey what the home could do better, a visitor commented Maintaining of the lift by a competent firm. We also found repairs needed in 2 bathrooms, also similar to our last inspection, which people we met and staff commented on too. One person had an en suite shower, but because it wasnt level access they couldnt use it, and they wished there was a suitable facility. The manager showed us the annual development plan for the home, which included projects that would address these matters, with wet-rooms to be created in the 2 bathrooms, 1 of which would also have a much better adapted bath than the current one. An area in the kitchen with broken tiling, which was highlighted in a recent Environmental Health Officers report, was still to be addressed. The manager said alternatives to tiling were being considered. Care Homes for Older People Page 27 of 40 Evidence: The door bell sounded very loudly outside certain bedrooms, disturbing some people particularly. The manager said she was aware and was trying to get a better system installed. Both batches of surveys for people living at the home reflected that people felt the home was kept fresh and clean. The home looked clean, and was generally free of unpleasant odours, during our visit. People we spoke with were generally satisfied with the usual standard of cleanliness, including shared areas such as bathrooms or toilets. They told us that their rooms were bottomed out weekly ie furniture moved, etc. for thorough cleaning. We saw evidence that carpets are shampooed on occasion. One bedroom had a persistent malodour, and we were told that the usual weekly deep clean had been missed. A more proactive approach should be taken, to protect peoples dignity. We saw staff using disposable gloves and aprons if to assist people with personal care. They wore tabbards to serve food and drinks. Information for visitors included measures for preventing cross-infection. Action had been taken to address infection control issues identified at our last visit soiled items were not soaked but were machine-washed using particular procedures, for example. There were more supplies of liquid hand-wash and paper towels for staff to use, around the home, and foot-operated bins had been purchased. We queried that there are no facilities in peoples en suites for staff to dry their hands, and advise that this is discussed with relevant community-based professionals to ensure crossinfection risks are managed appropriately. Although staff we spoke with described correct procedures for dealing with such items, we noted incorrect storage of a someones catheter bag, which we discussed with the manager as infection risks were being increased. Care Homes for Older People Page 28 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living the home are cared for by staff who are fit for their role and who as a team provide a safe basic level of care. There have been recent improvements in staffing arrangements, although these are yet to be fully felt by the people living at the home. They would benefit further if care staff had timely training related to the more diverse needs of the people they care for. Evidence: One person told us that the staff were all wonderful, and very patient. Asked what the home did well, someone commented that the home had a friendly and kind atmosphere, and the right staff were chosen for the home. We heard staff being helpful, and friendly in a respectful way; we observed that they used good communication skills when engaging with individuals. There was one brief exception to this, which we discussed with the manager. We looked at the staff files of three people who had started working at the home since our last inspection. We noted that no-one had begun employment until 2 positive references, a full police check and other required information had been obtained, even though an initial police check had been obtained sooner. Interview notes had been kept, and photocopies of certificates, etc. signed to verify that the original had been seen. Staff contracts and job descriptions had been updated since our last inspection, to reflect changes in their employer. We were told that the home is considering ways Care Homes for Older People Page 29 of 40 Evidence: in which people who live at the home might be involved in new staff recruitment. These indicate very robust recruitment practises. When we arrived at the home, there was a deputy manager, a senior carer and 3 care assistants on duty, looking after 25 people and also responsible for doing the laundry. The manager arrived soon after us. There were to be 4 care staff on duty in the afternoon until 10pm, with the manager and deputy also at the home until 5pm approximately, and then 2 care staff overnight until 8am. Care staff were supported during that day by 2 kitchen staff, an administrator, an activities co-ordinator, 2 domestics and a gardener, although most of these staff worked part-time. The AQAA had indicated that a number of residents were relatively able, and a very small number needed help from 2 members of staff rather than one. This was confirmed by staff and our observations during our visit. Surveys from people living at the home indicated that they felt staff were usually or always available when they needed them, although one person also commented that the home should employ more staff. During our visit, staff told us that because peoples needs were changing so that they needed more help, a staffing shortage was felt, especially in the mornings. People we spoke with described shortages occurring at different times - one saying week-ends were more of a problem, others saying teatime, mealtimes in general, or bedtimes were problem times for them. One person thought call bells could be answered quicker, and we observed that it was several minutes before someones bell was answered during our visit. Heavy snowfall and an illness affecting several residents and staff had recently impacted on usual staffing arrangements. One person felt the home kept saying matters were going to improve, through recruitment, but this was never actually achieved. We were told that staff rostered for domestic duty sometimes worked on the care team instead, although staff thought this would lessen as recruitment was underway. One of the ancillary staff said they now made beds, relieving care staff for more direct care duties. Senior staff told us afternoon numbers were increased before Christmas, from 2 to 3 carers on duty along with a senior carer. A new cook was starting employment soon, which would ensure that there were catering staff to help daily at teatime. As of the day of our visit, the senior day carers shift had been extended by an hour, increasing the staff available for assisting people earlier in the night. Other staff hours were to be increased shortly, to give the manager more time to be out and about around the home. Senior staff also told us that the homes call bell has Care Homes for Older People Page 30 of 40 Evidence: a system that enables monitoring of response times, which they would consider using. Surveys from peoples relatives and healthcare professionals indicated they felt staff usually had the right skills and experience to look after people properly. A healthcare professional felt that this had improved in recent months, since new staff have been employed. The AQAA stated that over half of the care staff have achieved a care qualification (NVQ Level 2 in Care, or higher), and during our visit we were told that ancillary staff were to undertake relevant qualifications also. Two care staff were undertaking NVQ Level 4 in Care, while others would be undertaking the NVQ2. We were told by staff that although no senior carers were employed on night duty, night staff had achieved a care qualification and been given medication training. The AQAA stated that all care staff had undertaken an induction that was to nationally recognised standards, with indication that staff employed before this level of training was used had been re-inducted. We were told that induction sessions for new staff are held monthly, and that they shadow colleagues until they have attended this. Staff surveyed indicated that their induction had generally covered everything they need to know before starting their job, and that they were getting helpful training and updating, including knowledge about health care and medication where relevant. A training overview kept by the manager showed that small groups of staff had attended a variety of training sessions since our last visit. Topics included diabetes, nutrition, Equality & Diversity, continence, and falls prevention. Topics planned for the year ahead included some of these, as well as dementia, principles of care, and challenging behaviour. Three people we spoke with thought staff didnt always understand their particular physical or medical conditions, and how it could affect them. We saw from training records that less than half of the care staff had attended training on one persons condition, although more training sessions were planned and there was information available in the persons care file. In another persons case, relevant staff training was due to take place shortly, again with information on their condition included with their care records; we noted the person had lived at the home for several months. Training on impaired sight - a condition experienced by people at the home - was not on the training programme. Staff we asked about the needs of certain people at the home told us they said they had not had training on assisting people to eat safely; the training overview showed that 3 of 38 staff had had training on nutrition and health. Two staff surveyed felt they sometimes had enough support, experience and knowledge to meet peoples different needs (including needs related to disability, gender , age, etc.). Some staff confirmed that training on meeting peoples social Care Homes for Older People Page 31 of 40 Evidence: needs would be helpful, given their role in promoting peoples wellbeing through meaningful occupation of their time and other positive experiences. A senior carer told us that staff could request training, and some staff were very positive about the amount of training that had been offered in the last year; one staff member told us they had attended 12 courses in the previous 3 months. Another carer felt they hadnt been told enough about someones condition and how it affected them, but was aware of relevant training soon to take place. Care Homes for Older People Page 32 of 40 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 being run in the best interests of those who live there, although stabilisation of some day-to-day arrangements at the home is still to be achieved so that people will consistently receive a satisfactory service. Evidence: The manager told us she hopes to complete NVQ4 by the end of March 2010, and will then commence the Leadership & Management Certificate. When she was interviewed by us to become the Registered Manager, it was recommended that she undertook further training on Equality & Diversity matters. She confirmed that she will be addressing this in the coming year. Hours for senior carers, activities staff and the administrator were also to be increased shortly, so that the manager could be more available, some people having commented during our visit that they did not see her often. Staff said they found the manager approachable. A visitor was also very positive about the area manager, who we met and who seemed to know the home well. Care Homes for Older People Page 33 of 40 Evidence: We noted that 4 of the 5 more recent surveys from people at the home had been completed with help from the manager - it would be better practise to find more independent assistance, if possible. She had prepared for our visit by putting together evidence of improvements since our last visit and of how requirements made after our last inspection had been met. Policies and procedures had been reviewed, and updated to include the contact details of the current management company, for example. We spoke with a member of staff who had worked in other care services until recently. They felt the care provided at Wolfeton Manor was better than at their previous employment, with better supervision for staff, and supportive management. A senior carer told us they had formal supervision (one to one) sessions every 3 months as well as being able to request meetings as necessary. A more junior carer, however, said that their supervision sessions were not pre-arranged, taking place if and when staff were not busy. Ancillary staff confirmed that they attended staff meetings and had formal supervision sessions also. Two relatives surveyed said they and the person at the home always got enough information about the care service to make decisions, and that they were kept up to date with important issues affecting the person living at the home. Another relative felt communication wasnt always good within the staff team, although staff we asked knew about one of the examples the person gave. Staff surveyed gave mixed views on information-sharing within the care team, saying it usually or sometimes worked well; a member of the ancillary staff, asked what the home could do better, said More communication. A staff member we spoke with reflected this, saying care staff were not always updated sufficiently on their return after days off, etc. People we asked felt the home was run for the residents, rather than to suit the staff. A Suggestions box was kept in the hallway. Minutes were kept of Residents meetings. The last was in November 2010, when people had been notified that the homes quality assurance surveys were available to them, and that changes had been made to the homes information about the service it provides. Most requirements from our last inspection had been fully addressed. It was also positive to find that, regarding suggestions for improvement on the earlier batch of surveys, many of these matters had been addressed by the time we visited - that is, before we had raised them with the home. The managing company had requested an independent overview of the home by an external consultant. The manager told us that action had been taken as a result of the subsequent report, including additional Care Homes for Older People Page 34 of 40 Evidence: trolleys for transporting medication, and more information being recorded in care plan reviews. The manager told us that accidents are audited, to include the time, person, staff on duty, and location, among other factors. The need for professional input or other action is also considered. Staff we spoke with were able to describe what action to take in the event of a fire, with training records showing that all but 2 relief staff had had recent updating on procedures. The manager confirmed that the 2 staff would receive an update within a month. Information for visitors included action they should take in the event of a fire. Records showed that fire safety checks and fire drills had been carried out regularly, and there were personal evacuation plans for each person. Radiator covers have been fitted through the whole home since our last visit, to prevent scalds. Water temperatures were checked and outlets were flushed weekly, to monitor control of risks from Legionella as well as scalding. No records were kept to show that window restrictors were still effective, however. This would be good practise. One staff member told us that they had been employed for 2 months before receiving manual handling training of any substance. The manager told us that the induction course for new staff now included better manual handling training. Staff we spoke with felt they had a safe working environment, apart from some difficulty when moving hoists on certain carpets. The manager said she was looking into this matter. The kitchen was organised, with safety information on cleaning products available, records kept of food provided, cleaning schedules and temperature records completed. Portions in fridges were covered and dated. The registered manager had attended training on the latest legislation on safe food handling, since our last visit. Care Homes for Older People Page 35 of 40 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 36 of 40 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 8 12 You must ensure that people 15/03/2010 with swallowing difficulties receive appropriate care to help them eat and drink, as detailed in their care plans To avoid serious risks to their health. 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 It is recommended that you ensure that the homes reviews of each persons care plan are thorough enough to ensure that the plan reflects their current needs and care, so that they will consistently get the support they currently need. Daily care records should give a clear picture of the care and support each person has received, as well as how they are mentally and physically, so that staff can evaluate if the care planned and given is meeting the persons physical and social needs. It is recommended that a) Effective system are put in place for monitoring the shelf-life of medication as indicated by the manufacturer; b) That a record is kept of all applications of prescribed Page 37 of 40 2 7 3 9 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 creams and ointments, with clear guidance for staff on the use of the prescribed product. 4 12 It is recommended you continue to develop effective ways of meeting peoples social and psychological needs through recreation, promotion of their independence and other opportunities for positive experiences that are in line with their interests, abilities and personal preferences. It is recommended that you ensure that everyone receives the individual support that they require at mealtimes, especially those with particular dietary needs and those with cognitive impairments. It is recommended that you take more timely and appropriate action to ensure that the fittings and equipment (such as showers, lifts and food preparation areas), are in a good state of repair and usable. It is recommended that you seek advice from relevant community professionals to ensure cross-infection risks are managed appropriately, with regard to facilities or procedures required for staff to maintain appropriate hand hygiene between providing personal care to people living at the home. It is recommended that you continue to monitor the effectiveness of recent changes in staffing arrangements, and continue to adjust them, to ensure that there are always enough staff on duty to meet - in a timely way - the health, social and personal care needs of people living at the home. It is recommended that staff receive, in a timely way, the training they need to support and care for people currently at the home and those who are likely to use the service, to meet peoples needs safely and properly, as well as to meet the aims of the home (as given in the homes Statement of Purpose). It is recommended that the registered manager completes the training recommended when she was registered by us, and achieves the recommended management qualification. It is recommended that issues identified in both this report and our last report (such as in relation to communication, staffing and the environment) are monitored and addressed, through the homes quality assurance 5 15 6 19 7 26 8 27 9 30 10 31 11 33 Care Homes for Older People Page 38 of 40 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 processes, in a timely way, to provide positive outcomes fro those who live at the home. Care Homes for Older People Page 39 of 40 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. 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