Care Home: Woodlands Nursing Home

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What the care home does well The residents are cared for in a very dedicated and respectful manner in wellmaintained and comfortable surroundings. Residents were relaxed and all spoken to stated that they are treated with care and respect. Activities provided in the home are varied. The residents stated that they enjoy these activities and have choice on whether to join in. Staff said they are well supported and that their training provides a good knowledge base to meet residents needs appropriately. The quality of the care files and documentation in the home is in good order, up to date and readily available. The home has a dedicated ancillary staff, who ensure the home is clean, hygienic and fresh smelling throughout. Residents stated that they enjoy the meals, which are produced to a good standard. What has improved since the last inspection? Since the last inspection, several aspects of the home have been improved upon; Care plan documents contain more comprehensive information about the nursing and care needs of the residents. The home has established links with more community agencies to gain specialist advice in the care they provide Additional training relating to Mental Capacity and Deprivation of Liberty has been undertaken. Several areas of the environment have been improved upon (see environment section) What the care home could do better: The home needs to continue to develop on identified areas of improvement, outlined in their AQAA. A requirement was made to ensure that risk assessments are undertaken in respect of storage of equipment in corridors. Where possible, alternative storage is to be used within the home. A recommendation was made that the home undertakes more in depth social profiles and to promote individual interests and activities where possible. A recommendation was made that the manager ensures a training matrix is put in place and certificates of completed staff training are kept on staff files. This will ensure the management is aware of staff training needs and requirements. Key inspection report Care homes for older people Name: Address: Woodlands Nursing Home 23 Silverdale Road Burgess Hill West Sussex RH15 0ED     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: Beth Tye     Date: 2 3 0 9 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 30 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 30 Information about the care home Name of care home: Address: Woodlands Nursing Home 23 Silverdale Road Burgess Hill West Sussex RH15 0ED 01444243579 01444246342 btratnasinkam@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Sri Krishna Ratnasinkam care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Woodlands is a care home registered to accommodate 23 service users, both male and female, in the category Old Age with nursing care. The provider/ manager is Mr S R Ratnasinkam who is in charge of the day- to -day running of the home. The home is a large Victorian property situated in a residential area of Burgess Hill, West Sussex. The accommodation is laid out over 3 floors, ground, first and second floor. There are 19 single rooms and 2 doubles. The home has large grounds with a patio area to the rear and a decking area at the front of the house. There is a vertical lift to access all floors. Care Homes for Older People Page 4 of 30 Over 65 23 0 Brief description of the care home The current fees are #531-#595 per week. Care Homes for Older People Page 5 of 30 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 service has been rated as two stars, which is a Good quality rating. The site visit was undertaken by Ms Beth Tye, as part of the inspection process. It took place on 23rd September 2009 between 10.30 and 3pm. The registered manager and clinical manager facilitated the inspection during the visit. An Annual Audit Questionnaire Assessment had been completed by the manager and forwarded to the Commission prior to the visit. All documents required on the day were made available. Three comment cards were received from residents, all filled out with the aid of relatives who added their own comments. Two were received from professionals. Three by staff working at the home. These comments were all positive. Comments from residents, families and professionals elicited by the homes own quality assurance Care Homes for Older People Page 6 of 30 systems were seen in the home and these were also very positive. We looked at three residents care plans, daily recording, health charts, risk assessments, health and safety records, staff personnel files and medicine administration charts. We spoke to five residents, three staff members and one visitor, all spoke well of the home and the care offered, which they said was delivered in a respectful manner. They also stated that the activities were appropriate and the residents were given choices. The atmosphere in the home was very relaxed and sociable. Many of the residents were sitting in the lounge socialising. Others were seen in their rooms listening to music, reading, watching television or with visitors. This report is compiled using information as described above and also information held on file at the Commission. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to continue to develop on identified areas of improvement, outlined in their AQAA. A requirement was made to ensure that risk assessments are undertaken in respect of storage of equipment in corridors. Where possible, alternative storage is to be used within the home. A recommendation was made that the home undertakes more in depth social profiles and to promote individual interests and activities where possible. A recommendation was made that the manager ensures a training matrix is put in place and certificates of completed staff training are kept on staff files. This will ensure the management is aware of staff training needs and requirements. Care Homes for Older People Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 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. To ensure residents needs can be met appropriately by the home, the manager undertakes a full assessment prior to admission. Each resident is provided with a written contract of terms and conditions, which is signed by all involved parties, so residents are clear about their rights within the home. Evidence: The manager assesses individuals prior to admission. During the visit, pre-admission assessments were examined for three residents. These identified relevant areas of need including, nursing, mobility, communication, health and social needs. Files seen contained correspondence from external health professionals such as social services and health. Records demonstrated the information collated prior to admission is then translated into care plans and reviewed on a regular basis by the manager. All records are kept in a locked office only accessible by care staff to ensure confidentiality. Care Homes for Older People Page 11 of 30 Evidence: Residents spoken to confirmed they are given up to date information about the home prior to admission, including a Service Users guide and complaints procedure. Copies of these were seen in residents bedrooms during the visit. Pre admission visits and printed literature helps residents (and their families) to make an informed decision about moving to the home and what to expect. All residents have received a copy of their Terms and Conditions for the home, which they or their families had signed following admission. This informs residents of their rights and what to expect of the home. Information provided in the homes Annual Quality Assurance Assessment (AQAA) returned to CSCI prior to the visit to the home reported that there are both male and female care staff working at the home of various ages between eighteen years of age and sixty five years of age and who are from diverse social, cultural, and religious groups. Intermediate care is not provided at Woodlands Nursing Home. Care Homes for Older People Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is Good Staff have appropriate training and information to ensure they are able to meet residents health needs. Risk assessments and daily recording promote the welfare and well being of residents. Medication is dispensed in line with the homes policies and procedures. Current care practices ensure residents feel they are treated with respect and their right to privacy has been upheld. This judgement has been made using available evidence including a visit to this service. Evidence: During the visit we looked at three care plans. Each plan is collated from the initial pre-assessment, a long term needs assessment (completed soon after admission) and a detailed care plan (completed within a two to four week period following admission) Each care plan contains relevant details relating to the residents health needs and social well-being, they also detailed aspects of health, personal and social care and the actions staff needed to take to meet these needs. Care Homes for Older People Page 13 of 30 Evidence: Information seen on care files was up to date and easily accessible. There was evidence to demonstrate that the clinical manager and key workers undertake regular care reviews for residents, and up dates the care plans as changes occur. Included in the care plan was a section for mental capacity and deprivation of liberty issues. The appropriate forms had been applied for and completed for one resident. Records seen demonstrated that staff had undertaken training in these areas. This provides them with knowledge of recent legislation and how this is relevant to people living in the home. Health and social care records demonstrated that the care provided was relevant to individuals assessed needs and links are established with community health professionals to provide this. These includes regular visits to the home by a GP, chiropodist (six weekly) dentist (six monthly) and optician (annually). The home has good links with social workers, PCT, continence advisor, tissue viability team and the local mental health team who offer advice and resources as required. Records of visits and correspondence from community agencies were seen on residents files. The completed AQAA and discussion with the clinical manager reflected the ethos of the home to provide care both in house and from community resourses to ensure residents needs were fully met. Daily records and a monthly observation sheets are kept for each resident. Records seen were up to date and in good order. Each resident is assigned a key worker from the care team who ensures records are kept up to date and changing needs are recorded accurately in the care plans. Risk assessments are in place for residents in respect of individual need, moving and handling, pressure areas and nutrition. Risk assessments and appropriate action plans for staff promote a better understanding of need and responses in addition to supporting residents to maintain independence safely where possible. Records demonstrated that staff complete a full induction which covers all aspects of the mandatory training programme. More than 50 of staff have undertaken the National Vocational Qualification Level 1, 2 and/or 3 in Care Skills. This provides staff with the skills and knowledge base to respond appropriately to residents health care needs. Feedback and discussion with the residents and their relatives confirmed good practice is maintained in the home and residents are treated with dignity and respect. We Care Homes for Older People Page 14 of 30 Evidence: observed staff directly and indirectly and noted that they were friendly, caring and professional with the residents and the residents were at ease with the staff. One resident commented the staff here are wonderful. We are like a family. Other comments on feedback forms included The home does really well looking after its residents and we have always found staff pleasant and co-operative Staff were observed communicating with residents in a caring and respectful manner. All residents spoken to said they were very well looked after. The medication administration procedures were observed during the lunch period and policies and procedures are in place to ensure safe medication administration. A random selection of medication was checked and found to be in order. Medication administration charts are completed correctly, which indicated that residents are receiving their medication as prescribed. Photographs of residents are displayed on records as an extra safeguard towards safe administration. Medicine Administration Records seen were in good order and up to date, demonstrating nursing staff, follow appropriate procedures. The home has good links with the local hospice nurse and a link nurse who specialises in terminal care. This ensures residents have the specialist care they need at the end of their lives. At present the care plans in the home do not include detailed plans for all residents final wishes in respect of palliative and end of life care. The managers stated they have raised this previously at the staff meeting and are is in the process of working with families and residents to gain information to include in the residents care plans. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make decisions and choices in their lives. A range of activities is offered to residents. Residents are encouraged to maintain contact with family and friends and links with the local community are maintained. Residents are offered a varied diet of good home cooked food. Evidence: An activities plan is on display in the home to enable residents to plan their time. However on the whole, routines are flexible to meet residents needs. Residents confirmed that they can choose what they want to do as far as social events, routines and also what times they go to bed and get up in the morning. A member of staff we spoke with confirmed that residents have a daily choice in the clothes they wear, routines for the day ahead, what they have to eat and where they eat it. This was confirmed during observations of the lunchtime meal, some residents ate in the dining room, others in the lounge and a few in their rooms. The chef stated that one resident never eats what is offered on the daily menu and always decides in the morning what she would like. Flexibility enables individuals to have choice and express Care Homes for Older People Page 16 of 30 Evidence: a preference in their daily lives. The activities programme observed advertised in the entrance hall included bingo, music and movement, musicians and reminiscence work. Two retired nurses come into the home and spend one to one time with the residents. The home also takes the residents out on occasion in a community mini bus. One resident we spoke with expressed her love of sport in her younger days. This was recorded on her care plan and staff were prompted to encourage her to watch sport regularly on the television. This demonstrates the home encourages individuals to pursue areas of interest and promotes choice in the activities on offer. The inspector noted that most of the residents experienced confusion and/or had been diagnosed with dementia. The social profiles seen for residents were brief and although preferences are recorded, both managers acknowledged that residents would benefit from more in depth social profiles and provision of activities that were more specialist to their mental health needs. The manager stated he would be contacting local agencies to gain more expertise in devising and implementing a social care plan for individuals. Through talking to residents and a visitor to the home and feedback in surveys returned by relatives it was evident that the home is able to be flexible to individual peoples needs, helping people to live a life they have some control over and making visitors welcome with the open door policy. Residents and relatives confirmed that the visiting arrangements for the home are open and visitors can come and go as they please and are made welcome by the staff. Feedback forms confirmed relatives felt welcomed and involved by the home. Records confirmed that the home holds regular residents meetings and the staff have regular contact with family members to ensure involvement in their relatives care is promoted. During the visit staff were observed interacting with the residents. Staff were seen throughout the day being respectful, kind and sensitive to residents needs. The menu offered at the home takes in to account the preferences of residents and specialist dietary needs, which are recorded on care plans. The meal served on the day (roast beef, roast potatoes and vegetables) looked very appetizing. Some residents were served alcohol with their meal. One resident stated she likes a drink Care Homes for Older People Page 17 of 30 Evidence: every day with my food and staff are always very good about providing this. An alternative meal is on offer at lunchtime and teatimes. Residents spoken with said they really enjoyed the food and it was always very good Food that is liquidized was served in individual portions and some residents were observed being assisted to eat by care staff, who did so, in a sensitive and respectful manner. Care plans seen contained information and risk assessments in respect of nutrition and dietary needs. These are monitored and reviewed on a monthly basis by keyworkers to ensure information is up to date and relevant. Care Homes for Older People Page 18 of 30 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. Quality in this outcome area is good Residents who use this service or their representatives are able to express concerns, and have an access to an effective complaints procedure. Residents are protected from abuse and have their rights protected. This judgement has been made using available evidence including a visit to this service. Evidence: The home has a complaints procedure, which is outlined in the statement of purpose and displayed in the home. A copy of which was seen in each residents room, alongside a comments/feedback book. Complaints are recorded and investigated with feedback to complainant within 28 days with the actions taken. All residents and visitors spoken with said they knew who to complain to and that they would do so if they thought it appropriate. Staff induction and training records indicated that all staff receive training in safeguarding vulnerable adults. Staff spoken to, did know what to do if they suspected abuse. Care Homes for Older People Page 19 of 30 Evidence: Staff personnel files seen during the visit, were in very good order and held all appropriate checks and references. This ensures residents are safeguarded from risk of harm. Regular staff and relatives meetings within the home encourage feedback about how the home is run and could be improved upon. Information on advocacy services is available and this was also seen in each residents room. Care Homes for Older People Page 20 of 30 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. Quality in this outcome area is good The home provides a homely environment to the people who live there. All areas are clean, tidy, well maintained. The bathing facilities are able to meet the needs of all residents. Equipment and safety checks necessary to ensure the welfare of the residents are in place. A requirement has been made to address the storage of equipment in the corridors of the home. This judgement has been made using available evidence including a visit to this service. Evidence: Since the last inspection the service has improved the environment in several areas. There is a new walk in shower for residents and a new sluice room. There are two new rooms being built at the rear of the property (this was near completion at the time of the visit). The aim of the extension is not to increase occupancy but to move two existing residents who are currently sharing rooms. Alongside the extension a conservatory and garden decking has been built which will provide addition seating areas overlooking the garden. The garden at the home is mature and very attractive with a large central water feature, mature trees and several flower beds. A new stair lift has been fitted on the main staircase and all rooms have now been fitted with an overhead hoist. Care Homes for Older People Page 21 of 30 Evidence: There are ancillary staff employed to maintain the home and gardens. Records seen demonstrated that the home has all relevant health and safety checks in place, which are up to date and in good order. This means the residents environment is kept safe and well maintained at all times. Residents are encouraged to personalise their own bedrooms to give them a sense of ownership. All bedrooms seen during the visit were clean and tidy. The owner is in the process of fitting each room with a flat screen television. Communal areas provide a large space for residents to sit and participate in daily routines. There are hoists, bath aids and specialist equipment to promote the independence of those who require assistance with personal care and nursing needs. Anti bacterial soap was evidenced at shared sinks. Laundry and sluice facilities are provided. Policies and procedures are in place for infection control, and all of the staff have attended relevant training for infection control and health and safety procedures. This promotes good practice in the area of safety and welfare for the residents and reduces the risk of infection spreading within the home. New fire safety closures have been put on all fire doors since the last inspection. This meets the outstanding requirement made at that time. There is a passenger lift for residents with limited mobility to access all floors of the house. All radiators throughout the home have been covered. Records indicated that the temperature of the baths, are taken before bathing residents to prevent risks of scalding. A call bell system is provided in every room so staff can attend an emergency situation swiftly, should it arise. It was noted whilst walking around the building that the corridors are quite cluttered with wheelchairs storage and in the upstairs corridor a hoist was seen to be blocking free flow access outside a residents room. We spoke to the clinical manager about this who stated that storage is an ongoing problem in the home. A requirement was made to ensure all corridors are kept clear due to fire and health and safety hazards. The manager agreed to risk assess all corridors and find alternative storage where possible. This will minimize risk to residents and staff. Care Homes for Older People Page 22 of 30 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. Quality in this outcome area is Good Residents are protected by the homes recruitment policies and procedures and by an induction and training programme. The manager needs to ensure certificates for completed training are kept on staff files. People who use this service experience good outcomes because their needs are met by suitably recruited and trained staff. This judgement has been made using available evidence including a visit to this service. Evidence: Staff rotas reflected that there are enough skilled staff on duty at all times in the home. Both staff and residents fed back how this had helped to allow more time for one to one care. In addition, the home has dedicated catering and house keeping staff which enables care staff to focus on their roles and responsibilities providing care for residents. Following examination of staff records it was concluded that, recruitment procedures in the home are good and in line with the homes recruitment policies. All staff files seen were found to contain the necessary documentation required by Schedule 2 of the Care Regulations. Care Homes for Older People Page 23 of 30 Evidence: Training records of four staff files were looked at during the visit. They showed that staff have received induction training which includes all aspects of care in the home, health and safety and best practice guidance. The staff induction pack includes reference to appropriate policies and procedures and a checklist covering all aspects of the home which is overseen by the manager. The mandatory training for staff covers fire safety, manual handling, health and safety, adult protection, and infection control. In addition the home has provided some specialist training to meet assessed needs of the residents. This includes; Dementia, Deprivation of Liberty, The Mental capacity act, Peg feed training, Managing continence, Parkinsons and Diabetes. The home employs an in house trainer who supplies all training to staff. At the time of the visit some certificates were outstanding for staff which the manager was advised to chase up and put on files. This, and the implementation of an annual staff training matrix will provide evidence of which staff have completed appropriate training and which staff have outstanding training needs. During the visit we were able to talk directly to staff who confirmed which training they had completed this year. All staff spoken to had undertaken an induction, mandatory training and some specialist topics relevant to the needs of the current residents. The majority of the staff employed by the home have completed the National Vocational Qualification in Level 1, 2 and/or 3. Observation and feedback from surveys and during the visit highlighted that staff are skilled and competent in their roles. Staff spoke with during the visit were clear about their roles and responsibilities and how to respond appropriately to residents needs. Feedback from the staff during the visit included we are very supported by the manager we receive lots of training and the there is always support and advice if we need it the home is very family orientated and this is a great place to work. All the staff spoken with confirmed they know what to do in the event of suspected abuse within the home and in the event of fire. Comments made about the staff by the residents and their families included staff treat the residents as individuals, compassionate, pleasant and co-operative and the staff are very good at offering choices. This was supported by observation of care Care Homes for Older People Page 24 of 30 Evidence: practice and examination of care records during the visit. Care Homes for Older People Page 25 of 30 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 quality of this outcome area is Good. Residents and staff benefit from the leadership and management approach within the home. Overall the residents welfare is a priority within the home, and this is supported by administration systems, policies and procedures. This judgement was made from available evidence including a visit to the service Evidence: The manager, Mr Krishna Ratnasinkam has many years experience in the care of older people. He is a registered general nurse and registered mental nurse and has an NVQ Level 4 in Management. The clinical manager for the home has been in post for over four years and is a registered RGN with management experience relevant to her post. Staff confirmed they are supervised though a line management system within the home, which is displayed in the staff office. Records of staff appraisals, supervisions and staff meeting were available during the visit to the home. Care Homes for Older People Page 26 of 30 Evidence: A quality assurance system is in place, which includes the surveying of residents and their relatives twice a year, the presence of a suggestions book in each the residents bedrooms and a suggestions box in the hallway by the front door demonstrates they home encourages feedback from involved parties. Meetings are held for relatives twice a year and staff meetings are held on a regular basis. Minutes are kept for these meetings. This promotes good practice in the home, helps identify learning needs and gives them the opportunity to contribute to the way the home is run. The manager told the inspector that no changes had been made for the arrangements for handling service users monies. The home invoices relatives and representatives direct for any services and purchases not covered by the fees. The home has very clear and up to date administrative procedures in place to support care practice within the home. All care records and documentation seen was in good order and information was easily accessible. Health and safety is maintained through record keeping, training and servicing of necessary equipment. All equipment checks and servicing is carried out within the safe guidelines. Policies and procedures are in place and reviewed on a regular basis. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 19 13.4 (a) (c) All fir doors must be risk 30/11/2007 assessed and risks are eliminated or reduced. Advice must be sought from the fire officer with regard to keeping these doors open. All fir doors must be risk 30/11/2007 assessed and risks are eliminated or reduced. Advice must be sought from the fire officer with regard to keeping these doors open. 2 38 13.4 (a) (c) Care Homes for Older People Page 28 of 30 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 25 23 To ensure accomodation meets the relevant health and safety requirements The registered person must ensure that all fire exits and corridors are clear and suitable storage is provided for wheelchairs and equipment. 31/10/2009 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 29 of 30 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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