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Inspection on 16/03/10 for Astley House Care Centre

Also see our care home review for Astley House Care Centre for more information

This is the latest available inspection report for this service, carried out on 16th March 2010.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The homes assessment processes and the information available about the home ensures that placement is offered to those people whose needs they can meet. People who live in this home will receive the care and support that they need because of the homes care-planning processes. Medication procedures are safe. The people who live in this home will be able to participate in a range of meaningful activities and spend their time as they wish. They are provided with well-balanced and nutritious meals. The people who live in this home are cared for by skilled staff who are trained and competent to meet their care needs. Recruitment procedures are safe. The people who live in Astley House will live in a home that is safe and run in their best interests Those who live at the home can be assured that any complaints they have will be listened to and acted upon and that they will be safeguarded from harm. Astley House is a very homely, safe, comfortable and warm home, and it is fully equipped to meet their needs of the people who live there.

What has improved since the last inspection?

There were no outstanding requirements, all requirements had been met at the previous random inspection, this was completed by us in October 2009.

What the care home could do better:

No requirements were set by us as part of this key visit, some good practice recommendations were made and information about these can be found within the main body of the report.

Key inspection report Care homes for older people Name: Address: Astley House Care Centre 1 Lypiatt Road Cheltenham Glos GL50 2SY     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: Odette Coveney     Date: 1 6 0 3 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 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Astley House Care Centre 1 Lypiatt Road Cheltenham Glos GL50 2SY 08453455742 01242255971 helen.haughton@blanchworth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Sally Anne Manby Roberts,Mr Jeremy Walsh,Mr Roy Harris care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The 7th proposed Dementia Care bed, currently occupied by one named service user without a diagnosis of Dementia, will become a 7th Dementia Care bed when that specified service user no longer requires the bed on their discharge or death. Date of last inspection Brief description of the care home This care home is situated in a residential area very near to Cheltenham Town centre and is in close proximity to local shops, amenities and bus services. It provides nursing and personal care, predominantly to the older person. There are six beds designated to the care of those with dementia. These are not separate but integrated within the home. All bedrooms have en suite facilities; there are ample communal rooms and additional bathrooms and toilets. There is a passenger lift large enough to accommodate a wheelchair dependant person and one escort. Behind the home is a sizeable paved garden area, which provides safe outdoor space, accessible by wheelchair. Off road parking is provided at the front of the building for a number of Care Homes for Older People Page 4 of 31 Over 65 6 27 0 0 Brief description of the care home cars. There are steps to the front entrance but wheelchair access can be gained through a side gate which leads to the paved area and its entrance. The fees depend on the type of care being provided and the room occupied. The homes terms and conditions outline any additional charges. Information about the home can be found in the reception area. Care Homes for Older People Page 5 of 31 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 unannounced key inspection took place over 7 hours and was completed in one day. The manager and representatives from the senior management team were present during the inspection and participated in the process. Evidence was gained from a number of other sources namely: Information provided by the manager in the Annual Quality Assurance Assessment (AQAA) as requested by the Care Quality Commission. Information taken from survey forms completed by people who live and work in the home. Information supplied by three relatives. Directly speaking with some of the people who live in the home. Reviewing the recording pertaining to the care and support provided for a number of people who live at the home. Speaking with those care staff who were on duty at the time of the visit. A tour of some parts of the home. Examination of some of the homes records and observation of staff practices and interaction with the people who live in the home. Care Homes for Older People Page 6 of 31 The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 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. The homes assessment processes and the information available about the home ensures that placement is offered to those people whose needs they can meet. Evidence: As part of this inspection visit we reviewed the homes statement of purpose and the service users guide. We saw that these documents were on display in the entrance hall of the home, along with a copy of the last Key inspection report for the service, this was completed by us in May 2009. We saw that both the statement of purpose and the service users guide outline the admission procedure into the home, how to raise a complaint and provided information about the services and facilities offered at the home. All people who live in a care home, whether they are self-funding or not should have a contract of the terms and conditions in place which outlines their rights and the responsibilities expected of them and of the people who provide the service. The home Care Homes for Older People Page 10 of 31 Evidence: has previously demonstrated that the people who live in the home are provided with a statement of terms and conditions upon admission The manager visits prospective people who want to live at Astley House, so that an assessment of their needs can be made. This visit could be made to a persons own home or to the hospital depending upon individual circumstances. For those people living at the home who are funded by the local authority we saw that the home had in place a comprehensive care management assessment in order to make a decision on whether the home and the skills of the staff team are able to meet the individuals needs. Prior to their admission into the home a pre-assessment is completed by the manager, this assessment is extremely detailed and covers all areas of individuals support requirements including personal, practical and emotional support. The assessment is made up of a number of documents including; equipment needs upon admission, information about peoples routines (day and night) upon admission, these incorporated individuals choice and preferences. An inventory is completed when a person comes into the home to record their clothing, property and jewellery, we noted that these inventorys have not always been fully completed, it is recommended that this is done in order that an audit of peoples belongings are maintained. For those people living at the home who are privately funded we saw that the home had developed comprehensive care plans, these were based in the homes initial preadmission assessment and also information obtained through observation and discussion with the individual since their admission into the home. Placements are arranged on a months trial basis with a full review meeting at the end of this period with all the necessary parties present. It is possible for the trial period to be extended if someone is taking longer to settle and both parties cannot decide whether the home is the right place for them. Care Homes for Older People Page 11 of 31 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. Those who live at the home benefit from the information that has been recorded about how their needs are to be met. This helps ensure that the staff team provides consistent support, in the way that those living at the home prefer. People are supported to access healthcare services as required. Medication procedures within the home are safe. Evidence: The care planning documentation of four people who live in the home was looked at in order to determine how their care and support is identified and how their care needs are met. The records of two other people were sampled in order to verify information we had been told about their care. One of the plans was for a person who had recently been admitted to the home. The care plans were based upon a detailed holistic assessment. These assessments formed the basis of the care plans that provide detailed guidance Care Homes for Older People Page 12 of 31 Evidence: for the staff on how the identified needs should be met. For one person their plan recorded specific instructions on the amount of support they needed with taking their medication. For another person we saw that they had a diagnosis of dementia and were resistant to support with their personal care and were unable to manage this task alone. The care plan detailed how best to approach them when assisting them with this aspect of their care, recording within the care plan an understanding of balancing peoples rights to refuse support as well as the homes duty of care and the individuals best interests. Included with the care planning documentation is a moving and handling risk assessment complete with a safe system of work devised from the assessment. This means that care staff will be provided with clear guidance about how to support and aid the person they are caring for. During our time at the home we observed staff going about their daily duties and saw them assisting those who live at the home to move and transfer safely with the use of aids such as wheelchairs and hoists. Staff were supportive and patient, explaining to people what was happening in order to reassure them. The home has previously demonstrated that their medication systems are safe and that they have safe procedures in place for the ordering, receipt, storage, administration and disposal of all medicines. It is either the manager or the qualified nursing staff who are responsible for administering medication. At the time of this visit none of the people living in the home look after their own medicines, staff look after and give all the medicines. The pharmacy supplies medicines to the home using a monitored dosage system. We saw that medication is held securely in a locked trolley, in a locked cupboard. There are good arrangements for access to health services including dental, optician, occupational therapy, physiotherapy and chiropody. The community district nursing service also provides a service to the home to support those individuals who are receiving a residential care service and who require regular support with wound dressings. On the day of our visit a community nurse was visiting people in the home and taking blood samples in order to monitor aspects of peoples healthcare. Other specialist services provided to the people who live at the home are the support from the tissue viability nurse, continence adviser and community psychiatric nurse. Records were kept of the appointments that people had with their GPs and other healthcare professionals. Records had been completed after each appointment, which provided a good report of the outcome and any action that needed to be taken as a result. Care Homes for Older People Page 13 of 31 Evidence: Those who live at the home told us that they are well cared for, that staff are kind, respectful and polite. People also told us that they see their doctor when they need to and have access to healthcare support. People told us they are supported to attend hospital appointments. The daily records of people who live at the home confirmed that people access a range of healthcare support. A relative we spoke to told us how their family member had been well supported by staff from the home to attend hospital appointments, that this had been done in a caring, professional manner. In talking with individuals who live in the home they all spoke positively of the approach of staff always speak to me as I would like, they treat you as individuals, staff here are kind and thoughtful. The staff were observed going about their duties in a friendly and calm manner and responding to the people who live in the home in a familiar style. There was a lot of friendly banter between the residents and the staff, and between the residents, evidencing that the home is a good place to live. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home will be able to participate in a range of meaningful activities and spend their time as they wish. They are provided with well-balanced and nutritious meals. Evidence: The home has an open visiting policy and visitors can come in at any reasonable time. Discussions with visitors and the staff evidenced that the home has very good relationships with the families of the residents. The visitors book showed that a number of people come to visit those who live at the home and people we spoke with confirmed that their visitors are made welcome by staff at the home and that there are no restrictions on visiting hours. We spoke with a visitor at the home who said they had looked at a number of care homes before choosing Astley House, they said; my relative is very happy here, she has settled well and I would recommend the home. The homes practices and routines are flexible and enable those who live at the home to exercise choice and have control over their lives. We saw in review meetings that Care Homes for Older People Page 15 of 31 Evidence: people are asked about the care service and the support they receive at the home, they are asked for their opinion about life at the home and how this can be improved for them. There is a comfortable dining area for individuals to have their meals in. The Home operates a rotating menu. The lunch served on the day of our visit was a steak and mushroom pie, served with mashed potatoes and vegetables, an alternative was available for those who did not wish to have the pie. Dessert served was a rhubarb and ginger cobbler. The lunch was seen and looked appealing and individuals all spoke positively of the food provided in the home; its always good, always a choice. On the day of our visit the meal was well presented and staff were available to assist individuals. One of the relatives told us that as a family they are able to come and share a meal with their relative and that a recent sunday roast was; the best lamb I have ever tasted !. It should also be noted that in December 2009 the home was visited by environmental health officers from Gloucestershire County Council and were awarded four stars for their food hygiene controls in the kitchen. The interactions between staff and people living at the home were observed and heard during the routines during the day, all were polite and respectful. One person commented that; The carers here are lovely, nothing is too much trouble. Visiting relatives were spoken with; one person expressed their gratitude of the care by staff at the home for their relatives health improvement since admission into the home. Another person told us that it was their birthday recently and the family had visited their relative at Astley House, they told us that they had celebrated their birthday in the home and were made to feel very welcome by the staff. There is a person who is employed by the home to organise activities both inside and outside of the home for people who live at Astley House. Care staff get involved in supporting residents when this person is not available, at the time of our visit the activities co-ordinator was arranging a forthcoming trip to a local garden centre. On the residents notice board in the entrance to the home we saw an activity weekly programme for the forthcoming week, it outlined both morning and afternoon activities that were available for people who live at the home to participate in, if they wished to. These included; board games, reminiscence activities, pampering events, musical movement and quizzes. One of the people who live at the home told us that they particularly enjoyed the baking and cake making activities. We saw photographs on the homes notice board of the recent social event Care Homes for Older People Page 16 of 31 Evidence: surrounding mothers day celebrations at the home. People told us they had a special tea and were looking forward to St Patrick day celebrations at the home as there was going to be Guinness tasting and an afternoon of Irish singing. We also saw in the dining room and lounge that those living at the home had been assisted in making decorations for both Mothers day and St Patricks day as craft work was on display for these events in both of these areas. Newspapers had been delivered for people who live at the home. Care Homes for Older People Page 17 of 31 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. Processes are in place for people to complain and people are given opportunities to raise any issues they may have. Those who live at the home are protected by the homes policies and procedures and incidents that affect the wellbeing of those who live at the home are reported to us. Evidence: The homes complaints procedure is included in the homes statement of purpose and is displayed in the main reception area. Those who live at the home who we spoke with during the course of our visit said they would talk to the staff if they were not happy about anything. The people who completed Care Quality Commissions survey forms all said that they knew who to speak to if they were unhappy about anything. One person wrote. The staff do their very best to sort things out in the best way. In the last 12 months the home has received no complaints and the operations manager told us that issues are dealt with promptly in order that problems are resolved amicably. The home maintains a record of all concerns and complaints and records the action taken as an outcome. The Care Quality Commission has received no complaints regarding this service. There had been no safeguarding adults referrals during the last year. The home had written policies and procedures which covered safeguarding adults, the prevention of abuse and whistle blowing. There was a copy of the Gloucestershire County Councils Care Homes for Older People Page 18 of 31 Evidence: Safe Guarding Procedure, which recorded the action that needed to be taken if there was a concern involving possible abuse. Staff spoken with during our visit demonstrated a good awareness of adult abuse issues and of their responsibility in reporting any bad practice. We viewed the homes computer database for staff records and viewed a sample of these, including a recently employed member of staff. We saw that within the records we viewed there was evidence to confirm that personal information and record of identity had been obtained by the home, prior to their commencing work. Other information seen included, records of previous employment, and satisfactory Criminal Records Bureau disclosures. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of people who live at the home had been reported to the Commission. Care Homes for Older People Page 19 of 31 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. Astley House is a very homely, safe, comfortable and warm home, and it is fully equipped to meet the needs of the people who live there. Evidence: Astley House is situated in a residential area very near to Cheltenham Town centre and is in close proximity to local shops, amenities and bus services. It provides nursing and personal care, predominantly to the older person. There are six beds designated to the care of those with dementia. These are not separate but integrated within the home The home is wheelchair accessible. There are gardens to the rear of the house these were seen to be well-tended. There is parking available at the front of the house. The home is set over three floors and there is a small passenger lift for those with limited mobility. There are two spacious, well furnished, comfortable communal lounges, residents were seen relaxing in these areas. Within the lounges we saw an array of flowers following recent mothers day celebrations. These areas had been made homely due to ornaments and plants. Within one of the lounges we saw some sensory equipment in place and one of the residents commented those lights are very relaxing. The room Care Homes for Older People Page 20 of 31 Evidence: is well decorated, however, we did note some watermarks on the ceiling and would recommend that this be re-painted. Adjacent to this lounge is a toilet, we noted that this had no lock and informed that manager of this as people using this facility should be assured of their privacy. We were informed that this would be dealt with promptly. There is a separate dining area and a quiet lounge area, known as the memory room that overlooks the garden, all were comfortable areas for residents use. Since our last visit the home have invested in six new profiling beds, additional pressure relief cushions, and have provided additional signage around the home in order to assist with orientation for those residents who have dementia. Upon arrival to the home we found that new carpets were being laid in bedrooms, enhancing these areas for the people who live in the home. The home has a memory room, this room has been tastefully decorated and furnished to recreate a lounge that is reflective of the 1940s era. This room has artifacts from this bygone age which include a fully functioning gramophone, cigarette collecting cards, ornaments and crockery as well as an authentic fireplace. Within this room is also a trunk which contain reminiscence memorabilia such as wartime ration books, newspapers and magazines of the time. There are three rooms which are double rooms, however, all are currently occupied by one person.All have en-suite facilities. There are some suites within the home, these comprise of a bedroom, bathroom and a private lounge area. People are encouraged to personalise their own rooms and to bring in any items of furniture they wish. One person was keen to show off their room and said I have the best room in the house. Each bedroom is fitted with a door lock and the resident can have a key if they wish. The bedroom furniture is varied throughout the home. Each bedroom has a window and the degree of opening has been limited on each. All radiators throughout the home are guarded with boxed radiator covers. There are adaptations in place throughout the home and specialist equipment including hoists, bathing aids, mobility aids, sensory aids and handrails. We further noted that extra wide wheelchairs and commodes had been provided for those people who are of larger build. All equipment is serviced and checked for safety as required in order that it is fit for use. Toilets are situated in readily accessible parts of the home near to communal areas and bedrooms. The bathrooms and toilets were clean, and were well-stocked with hand towels and soap to help minimise risk from cross infection in the home. Care Homes for Older People Page 21 of 31 Evidence: As well as routine maintenance and redecoration, as expected, work has been carried out on the safety of exits in the home with a new key pad lock placed on the back garden gate. The companys maintenance team complete all repairs and redecorations and will arrange for specialist trades people where appropriate. The home was clean, tidy and well maintained and there were no odours throughout Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are cared for by skilled staff who are trained and competent to meet their care needs. Recruitment procedures are safe meaning that they will be looked after by suitable workers. Evidence: The home employs a team of care staff, plus domestic and catering staff, led by the manager. Visiting relatives who we spoke to at the home told us that they were very happy with the care and attention their family member receives, comments made to us included; The staff here are 1st class, The staff are superb !!. The home currently has a number of staff who are trained to at least an NVQ level 2, and others are working towards achieving the award. Certificates of training courses each staff member has attended, evidence that the staff group have received training in a wide range of relevant subjects. Examples include; dementia awareness, fire safety, manual handling, wound care, palliative care and safe use of equipment. Care Homes for Older People Page 23 of 31 Evidence: There have been new members of care staff employed since the last inspection. An examination of the homes database, which included images of scanned original documents evidenced that the home follows safe vetting and recruitment procedures. An application form is completed and prospective employees are expected to attend for interview. Two written references, POVA first checks and CRB clearance are in place for each person. The home has complied with a requirement notice issued following the last inspection for their recruitment procedures to be tightened up. All new staff will complete an induction-training programme at the start of their employment, to ensure that they are aware of the homes procedures and are competent in the areas of their work. Staff spoken with were fairly motivated and happy at the home. Staff told us; I enjoy working here, we have a good team. We recieved four surveys completed by staff who work at the home. Within these they told us that they are given up to date information about the needs of people who they support, that employment checks were carried out before they started work and also that they had an induction which covered all that they need in order to do their job. Additional comments recorded by staff included; We provide good care, staff work well together as a team we have good support from senior managers. We are given the training we need, We try to involve relatives with joining us with entertainment and to have lunch with their family member. Care Homes for Older People Page 24 of 31 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 run in the best interests fofthose who live there, ensuring that individuals interests and rights are promoted and protected by a committed staff team. Evidence: The home does not currently have a registered manager in post. The home has a manager in place who is covering the position. This person is a qualified nurse and has a National Vocational Qualification at level four and has also achieved a Registered Managers award. The person who has been covering the managers position has maintained standards of care delivered to those who live at the home and has ensured that staff have been appropriately and sufficiently supervised in order that they are effective in their role. We have spoken to the providers of this service about the permanent, long term management arrangements for this home. They are aware of the importance of having a manager who is registered with us and have been proactive in their recruitment process for this position. The registered person must appoint a suitably qualified and competent person to manage this home, who in turn will be interviewed by us in order to determine their fitness to manage this service. It Care Homes for Older People Page 25 of 31 Evidence: is important to note that residents and visitors we spoke to spoke highly of the person who has been covering this position, comments made to us during our visit included; She always has time for us, She is kind and helps us. The home has a number of methods in which to monitor and review the quality of service provided at the home and to also establish the levels of satisfaction for the people who live at the home, these include staff meetings, care planning reviews, staff supervision and training. The home has also established a formal process which involves surveying the views of people in the home in areas such as the quality of care, the support they receive from staff, the quality of food and determining whether people have any areas of complaint or concern about their care. The home surveyed the views of people in the home in June 2009. We reviewed the results and those seen by us indicated high levels of satisfaction, additional comments recorded, made by the people who live in the home included; The staff are very kind and general health has improved since being at the home. I have settled in well at the home. It is a lovely place and staff are so friendly and helpful. Staff are excellent and very caring. Responses from relatives during regulation 26 visits confirm that staff are very helpful and have made residents and relatives at ease. Other comments recieved included; The care here is very good as I am able to come in and have meals with my wife. Memory room is excellent and is a relaxing place to be. In the homes completed Annual Quality Assurance Assessment (AQAA) document we asked the home to demonstrate how do they know they give value for money. They replied that this was partly due to the feedback they had recieved within their internal quality assurance audit. This had recorded improved outcomes following the Quality Assurance questionnaires that were sent out in June 09. The home had 9 responses. 90 of people reported that they felt the care was good or better, this is an improvement on last years figures, 70 of people said that cleaning was good or better, which is a great improvement on last years figures, 87 of people said that the food provided was good or better, this shows great improvement on last years figures and is now at its highest level since the results of 2004. In the homes audit of their quality assurance results we saw that 57 of residents said hair care was good or better, which is an improvement on last years figures. 100 of people said admission procedures were good or better. We asked about equality and diversity and how the home can ensure they uphold these within the home. In the completed AQAA the home told us that within the past Care Homes for Older People Page 26 of 31 Evidence: twelve months the equality and diversity policy for the home has been extended and staff informed, future plans include accessing diversity training for staff from an external provider to ensure that staff have a sound understanding of this important area within their role and the work they do. Staff supervision was reviewed. Evidence from the records viewed showed that staff have received supervision. Formal, recorded supervision provides staff with the opportunity to express their opinion about the services provided at the home and to discuss areas of concern in relation to individuals care and to also discuss staff development and performance. We also saw that during the past few months the manager has been completing staff appraisals, in order to evaluate their work performance, this is undertaken on an annual basis. The appraisal covers individuals strength within their role, achievements which have been made as well as evaluating working relationships with other members of the staff team and identifying training needs. We also saw that regular staff meetings are held at the home, the most recent meeting was held on 4th March 2010 and was well attended. A review of the minutes of staff meetings demonstrated that management listen to the views of staff and value their feedback in order to improve the service delivered to those who live at the home. The home has good systems in place to manage any monies they hold on behalf of the residents. A number of the accounts were checked against the records held and they tallied. A review of the fire logbook found that appropriate checks are undertaken to ensure the systems to detect fire are maintained and equipment is provided to deal with a fire. Daily, weekly and monthly checks and staff training are completed as required. No concerns over fire safety were noted during this visit. We did note that when fire training has been completed by staff they sign to confirm their attendance, however, there were some occasions when the name of the instructor providing the training, and the date of the training has not always been completed, improvements in the recording for this are recommended. We saw that the home had displayed in the entrance hall a copy of its public liability insurance, valid until July 2010. We reviewed accidents and incidents which had occurred at the home, those seen by us were situations that could be expected to occur. Accident reports had been well written and showed what had happened, what injuries had been sustained and what the home had done to support the person involved and measures taken in order to try to prevent recurrence. We saw that an audit of events is completed every month in Care Homes for Older People Page 27 of 31 Evidence: order to monitor for trends, a good example of a proactive approach in preventing avoidable incidents. A record of staff supervision sessions was available to see and showed that people receive supervision regularly. Staff confirmed this. We also saw that regular staff and residents meetings are held more often and these are recorded. Minutes of meetings read by us showed that there is an open management approach at the home; the management wants to hear ideas and suggestions for improvement from those who live and work at the home. Care Homes for Older People Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 19 Inventorys of individuals possessions upon their admission into the home should be recorded. We recommend that the lounge ceiling should be repainted, also that a lock to be fitted to the toilet door identified during our visit. Records of fire training should include the name of the instructor conducting the training and the date that this was undertaken. 3 38 Care Homes for Older People Page 30 of 31 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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