Inspection on 26/05/10 for Bebington Christian Nursing Home

This is the latest available inspection report for this service, carried out on 26th May 2010.

CQC found this care home to be providing an Excellent 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.

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Key inspection report Care homes for older people Name: Address: Bebington Christian Nursing Home 165 Heath Road Bebington Wirral CH63 2HB     The quality rating for this care home is:   three star excellent 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: Beate Field     Date: 2 6 0 5 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 29 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 29 Information about the care home Name of care home: Address: Bebington Christian Nursing Home 165 Heath Road Bebington Wirral CH63 2HB 01516091100 01516089098 bebington@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Trinity Care Limited Name of registered manager (if applicable) Mrs Michelle King Type of registration: Number of places registered: care home 87 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users that can be accommodated is: 87. The registered provider may provide the following category of service only: Care home with nursing - Code 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 - Code OP (48). Dementia - Code DE (39). Date of last inspection Brief description of the care home Bebington Christian Nursing Home is situated in Bebington and is close to all local amenities and accessible by public transport. The home was purpose built for care of older people and comprises of two floors. Trinity Care Ltd own and manage the home. The upper floor provides care for older people with general nursing care needs. The ground floor provides care for the older person with dementia. There are thirty nine Care Homes for Older People Page 4 of 29 Over 65 0 48 39 0 Brief description of the care home single bedrooms on the ground floor and forty eight bedrooms on the first floor. All bedrooms have an ensuite facility. There are lounges and dining areas available on both floors and a selection of bathrooms with assisted baths on both floors. A statement of purpose and service user guide which describe the services on offer at the home are available from the manager. A copy of the most recent inspection report is available in the reception area. Fees range from £315 to £625 per week and include both local social services rates and privately negotiated agreed amounts and are dependant upon which room is to be occupied and the needs of the resident. Care Homes for Older People Page 5 of 29 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: three star excellent 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: A site visit took place as part of the unannounced key inspection. It was conducted over 7 hours. As part of the inspection process most areas of the service were viewed including some of the residents bedrooms. Care records and other documentation was viewed. Discussion took place with residents, relatives and staff. The inspection was conducted with the manager Michelle King. Surveys asking residents and staff about their views of the service were distributed to a sample of staff and residents prior to the inspection. 6 residents and 10 staff returned surveys. The responses are reflected in this report. An AQAA (Annual Quality Assurance Assessment) was completed by the manager prior to the visit to the home and the information in it was also used to inform this inspection. The AQAA consists of two self assessment questionnaires that focus on the outcomes for people using the service. The self assessment provides information as to Care Homes for Older People Page 6 of 29 how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including staff numbers and training. Care Homes for Older People Page 7 of 29 What the care home does well: All prospective residents have their needs thoroughly assessed prior to admission which ensures that a service is only offered to people whose needs can be met. Prospective residents and their families are encouraged to visit the home to ensure that the service being offered is right for them. Relatives confirmed that visits had been made to meet the staff, other residents and discuss the service with a member of the management team. Residents health and care needs are well managed. Residents privacy and dignity is promoted. Residents and relatives confirmed they were happy with the care and support provided. The care documentation is written well and promotes residents dignity. The care documentation for the sample of residents seen was clear, well organised and easy to follow. There was evidence that a review of the residents care needs takes place at least every 6 months. Staff were observed to be respectful in their approach to residents. Residents were relaxed and comfortable in their environment. Staff provided support to residents in an unobtrusive manner and interacted in a friendly and respectful way. Relatives are encouraged to visit the service and are welcomed by staff. On the day of the visit a number of relatives were visiting. A sitting room has been set aside for when residents and their families wish to spend time privately. A good range of activities is available for residents to take part in. The range of activities and opportunities for residents to socialise has been further enhanced by the provision of a movie room and residents bar. Residents are protected by the policies and procedures of the home. The service has an open door policy so that anyone who wishes to, can approach senior staff with any concerns. The home is well maintained and provides a pleasant environment. Residents bedrooms have been personalised. The plans to make the home environment more suited to people with dementia will further enhance the environment and encourage the independence of the people using the service. Staff at the home enjoy working there, they feel they have the training they need to carry out their duties effectively and are well supported by management. Over 75 of care staff have completed the NVQ Level 2 qualification so this standard has been exceeded. The service is well managed and residents can be assured that it is run in their best interests. The manager of the service has many years experience in a senior capacity. There are excellent systems in place to ensure the quality of the service. This includes auditing systems, development plans, regular meetings with staff, residents and relatives and evidence of regular supervision of staff. Care Homes for Older People Page 8 of 29 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 9 of 29 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 29 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. A thorough assessment takes place to ensure that a service is only offered to people whose needs can be met. Evidence: The Statement of Purpose and Service User Guide provide good information for prospective residents and their families. These documents need to be updated with the recent change of name of the registered provider. Surveys were returned by 6 residents. 5 out of the 6 said that they were given enough information to help them decide if the home was right for them. The service has a spacious relaxing reception area for any visitors to the service and copies of the service user guide, statement of purpose and the most recent inspection report by the Care Quality Commission is available for people to look at when they visit. A television information screen in the reception area gives residents and visitors photographic images with regard to activities that residents have recently taken part Care Homes for Older People Page 11 of 29 Evidence: in. The assessment documentation was viewed for 6 residents and all evidenced a pre admission assessment of their needs had been carried out. The assessments evidence a detailed and comprehensive account of residents needs. All prospective residents and their families are invited to the service to view the accommodation on offer and meet with residents and staff prior to making any decisions. Relatives spoken with confirmed they had visited the service prior to their relative being admitted. Some comments made were:we visited a lot of homes and this one stood out as the best. The home came on recommendation. We made a few visits before we made the decision and each time we were welcomed. Care documentation evidences that residents care needs are monitored throughout their stay and re assessed when needed. Care Homes for Older People Page 12 of 29 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. Residents health and care needs are well managed and their privacy and dignity is promoted. Evidence: Before a resident moves in to the home a draft care plan is made up following a full assessment of their needs. We looked at the records for 6 residents and found that each one had a full care plan in place dated on admission to the service. The care plans covered all areas raised from the pre admission assessment of the resident. Each care plan was detailed and individual to the resident. The care plan information covers many areas including mobility, safety, continence, mental health, social needs, pressure area care, personal hygiene, communication and diet. Risk assessments around nutrition, weight, falls, moving and handling and pressure area care and the use of bed rails are also available. Records show that care plans are reviewed at a minimum every 6 months and that the opinion of relatives and the person using the service is sought. Records show that Care Homes for Older People Page 13 of 29 Evidence: relatives are happy with the service provided. Records show that residents have access to health and social care professionals as they are needed. Visits to the home by GPs, specialist consultants, opticians, dentists and chiropodists and their outcome are clearly documented. 6 residents returned surveys, 4 said they always receive the medical care they need and 2 said they usually receive this. Relatives said that access to medical care is appropriately supported by the staff at the home. The residents we spoke to were happy with the service provided at the home. Some comments made were:We like it here very much. The staff are good to you. The staff are helpful, kind and come when they are needed. 6 residents returned surveys. 2 said they always receive the care and support they need, 3 said they usually receive this and 1 said they sometimes receive this. 2 said the staff always listen and act on what they say, 3 said the staff usually do this and 1 person said they dont know. Relatives interviewed were happy with the care provided. Relatives interviewed made the following comments:The care is excellent. I couldnt praise the staff enough they are brilliant. The care is second to none, 1 carer in particular is outstanding, the staff do a great job, they have always got a smile and they are polite and courteous. My relative is very happy here. There is a good standard of care. The privacy of our relative is respected. When we ask the staff to do something for our relative it is done. Care documentation it is written well and promotes residents dignity. The care documentation for all residents was clear, well organised and easy to follow. Care plans and other care documentation was detailed and particular to the individual resident. Care Homes for Older People Page 14 of 29 Evidence: All medication was secure and each floor has a secure room to store all medication received into the service. Medication trolleys were in use and can be secured to the medication room wall. All trolleys looked at were well organised. Blister packs are used to provide the majority of medication with packaging and bottles to supplement them. The medication documentation was viewed and found to provide clear instructions from the pharmacy with amounts, dates and signatures of medication received into the service in evidence. There was documented evidence of regular audits of medication. The audits evidenced where issues had been raised and how these have been addressed. Residents dignity and privacy is promoted. Staff were observed to be respectful in their approach to residents. Residents were relaxed and comfortable in their environment. Staff provided support to residents in an unobtrusive manner and interacted in a friendly and respectful way. The home has been registered on the Dignity in Care website and a Dignity in Care Champion has been appointed. Care Homes for Older People Page 15 of 29 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 encouraged to live as full a life as possible with family involvement and staff support. Evidence: An activities organiser is employed for 40 hours each week and we met with him during the inspection visit. The activities programme shows that there are a range of activities on offer and include arts and crafts, gardening, cake making, reminiscence activities and quizzes. The home has access to a minibus 2 days a week so some trips out can be made. Entertainers also visit the home. 6 residents returned surveys, 2 said the home always arranges activities they can take part in, 3 said the home usually does this and 1 said the home sometimes does this. Residents spoken with during the visit said they are happy with the activities on offer but also like to choose to follow their own interests such as reading or watching television in private. Special days are also celebrated including, St Patricks day, St Georges day and residents birthdays. Pictures of the most recent events were displayed in the reception area. The activities organiser told us that they spent time with residents on a one to one basis. Residents also have access to televisions and the radio was playing a suitable programme in the lounge. Regular visits from representatives of different Care Homes for Older People Page 16 of 29 Evidence: churches are made to the home to visit residents that have requested this. At present there are no services held at the home. The activities organiser is currently trying to address this. Prior to admission, residents are asked about their preferences. Families are also able to provide additional information with regard to the residents previous lifestyle and history. This gives the staff a better understanding of how the resident would like to live their lives. Care plans show how residents preferences are promoted. Residents interviewed confirmed that they were able to spend their time as they wished and staff supported them in making choices. The chef also meets with residents on admission to discuss their likes and dislikes. This was documented in care files. Residents are encouraged to lead an independent life where possible. Residents have access to all public areas of the service except residents bedrooms. Hand rails are situated throughout the service. Where wished, residents can choose to share their rooms as evidenced with the married residents. Staff try to encourage residents to participate in activities but where they decline, this is accommodated. Since the last visit to to the home a film room has been made available, with a large screen to give a cinema experience. A residents bar has also been made available which has been used for family events such as a bistro evening as well as being used by residents from the different units as a change of scenery during meal times. Daily living picture cards have been introduced at the home to aid communication for some residents. The treatment room name is being changed to a chemist sign to make it more familiar to residents and one room is to be named post office. This is where residents can visit to speak to staff and get information and stamps. Signs are also being developed for the home to aid residents to access areas as independently as possible. These changes have been recommended by the specialist Dementia consultant as good practice for the residents living environment. Residents have been very involved in the upgrading of the gardens. Some of the families who visit the service have volunteered to help with this facility and have been actively involved in helping the residents develop the gardens. Residents with family help now grow flowers and produce such as tomatoes, courgettes, beans and herbs. Care plans show that family involvement is encouraged. Families participate in providing support for their relatives by visiting them regularly and keeping up to date with their individual care needs. Residents interviewed confirmed that the were able to receive visitors. Residents and relatives interviewed said that visitors are welcomed at the home. On the day of this visit we noticed that there were many visitors to the Care Homes for Older People Page 17 of 29 Evidence: home. The menu is displayed for residents to view. Choices are available for residents and alternatives to what is on offer can be made available also. Residents interviewed about the food were complimentary and stated, the food is good and there is an abundance. 6 residents returned surveys 3 said they always like the food and 3 said they usually like it. The dining rooms are pleasantly decorated with quality table clothes in contrasting colours, table mats and matching crockery and cutlery making it a pleasant dining experience for residents. Matching tables and chairs are provided for residents at suitable heights. Residents looked at ease in their surroundings and staff were seen to provide assistance to residents discretely. Residents who are on specialist diets are accommodated also. We confirmed this with relatives and the chef. Care Homes for Older People Page 18 of 29 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. Residents are protected by the policies and procedures of the home. Evidence: Residents and their families have access to a clear and easy to follow complaints procedure. Each resident has a copy and there are further copies available and on display in reception. It is available in other formats including other languages, large print and audio. The complaints log was viewed and evidences complaints made, the investigation and outcomes. Further information with regard to local advocacy contacts and helplines including the companys elder abuse line and are on display. Relatives interviewed were aware the service had a complaints procedure and they knew how and who to approach with a complaint. The service has an open door policy so that anyone who wishes to, can approach senior staff with any concerns. The manager holds a surgery one afternoon a week so that any resident, their family or staff know that she is available to talk with them on a one to one basis at that specific time and day. This is advertised in the reception area. Residents interviewed said they would approach the manager if they had any concerns. The service has a copy of the local adult protection procedures and company policies and procedures for this area are also in place. Staff have had training in this area and all staff spoken with understood the adult referral scheme. Service documentation evidences staff have been vigilant in this area and the Commission have been informed where needed. Care Homes for Older People Page 19 of 29 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. Residents live in a well maintained and pleasant environment. Evidence: A tour of the service took place, which included looking at a sample of bedrooms and communal areas. The service has a pleasing, relaxing and comfortable atmosphere. There are plenty of lounges and dining rooms to accommodate the residents needs. One sitting room has also been made available for residents and their visitors when they wish to have more privacy. There are tea and coffee making facilities for residents families to use and chilled water is provided in reception. All bedrooms and communal areas of the home were clean and tidily presented. The majority of the home was maintained to a good standard. Some areas of Willow unit were showing signs of wear and tear. The manager was able to provide us with a development plan that showed the actions to be taken to improve the appearance of this part of the home. Residents interviewed about the accommodation gave positive views. Residents interviewed stated, that they have enough space, the home is modern and it is kept clean. Residents mobility is promoted through hand rails fitted throughout and easy access to gardens. A lift is in use to access the upper floor. Equipment such as specialist beds, mobility aids, hoists and specialist baths are provided for residents Care Homes for Older People Page 20 of 29 Evidence: use. Bedrooms for residents have been personalised and contain many items that residents have chosen to bring into the service. Residents have a lockable facility in their room. The manager advised that a door lock can be made available following a risk assessmet. We saw that 2 bedrooms had a hook and eye lock on the outside of the bedroom. The manager reported that relatives had requested these to prevent other service users from entering the bedrooms. It was discussed that a more appropriate means of providing this security should be looked into. The manager agreed to do this. Each resident has an en-suite facility and there are eight bathrooms and additional toilets throughout the service to accommodate their needs. Residents communal rooms such as lounges and dining rooms are decorated in a pleasant style and all are provided with comfortable chairs and suitable seating in the dining room. A call bell facility is provided to all residents rooms and public areas. This facility was upgraded last year and has been serviced within the last 6 months. Garden grounds surround the service and residents have level access to them. Suitable seating is provided for residents and their visitors with covered areas for those who wish shelter. The service is well maintained. A maintenance person is employed full time and a temporary maintenance person is employed in addition also. Maintenance records are in place. Many areas of the service had been redecorated and new furnishings including specialist beds provided. One relative asked for their views was impressed with the maintenance of the building and commented, they just have to ask for something to be done and its addressed. A sample of safety certificates and maintenance checks were seen and were in order. The fire alarm had not been tested for 2 weeks due to the maintenance person being on holiday. The manager said that she will ensure that these checks are carried out weekly in the future. Care Homes for Older People Page 21 of 29 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 service provides residents with a well trained and knowledgeable team of staff. Evidence: Sufficient staff were on duty during the visit to care for residents needs. When staff call in sick other staff who work at the service are generally called in to cover. There are sufficient housekeeping staff which includes kitchen, laundry and domestic staff. Care and nursing staff interviewed confirmed there were sufficient staff on duty as did housekeeping staff spoken with. 10 staff returned surveys, 4 said there are always enough staff on duty, 5 said there are usually enough staff on duty and 1 said sometimes there are enough staff on duty. Staff spoken with on the day of the visit made the following comments:There are enough staff and enough time to meet the residents needs. There is a good standard of care here. I would recommend this home. Its a good quality service, we all work well together as a team. I think its a good home and would recommend it. We get good training opportunities, we are well supported and have regular supervision. There are enough staff and sufficient time for at least one member of staff to sit with residents daily. Care Homes for Older People Page 22 of 29 Evidence: The staff team are good, the care is good and residents needs are well met. Residents and relatives gave positive comments about the support provided by staff and the standard of care. A relative raised an issue about the numbers of staff available at certain times of the day. This was brought to the attention of the manager who addressed this issue following the inspection and informed the Care Quality Commission and the relative of the outcome. Over 75 of care staff have completed the NVQ Level 2 qualification. We saw the recruitment records for 3 staff during our visit. These showed that pre employment checks were carried out to include two written references, application forms, previous and present training attended, date of commencement, medical questionnaire, photographs and other forms of identity, interview notes, enhanced police checks and contracts. Documentation looked at, evidenced that all staff had only commenced employment following robust pre employment procedures. Staff employed in the service attend an induction programme in the first few days of employment. Following this mandatory training is provided for all staff throughout the year to ensure all staff including night staff are included in the training programme. All mandatory training including, first aid, fire, adult protection, manual handling, basic food hygiene, health and safety and infection control are addressed. The service has a manual handling trainer on site who is able to provide training for all new staff and update the others. Staff interviewed about training in the service said that they are given the training they need to enable them to carry out their duties and care for residents appropriately. The 10 staff who returned surveys confirmed this. Staff said that they received an induction before commencing work at the home and that this covered what they needed to know well. Staff said that their line manager provides them with good support. Additional training is provided with regard to understanding and caring for people with dementia, tissue viability, care plans, customer care, challenging behaviour, medication and nutrition. All of the training provided is evidenced with staff names and training dates attended. Staff files also show copies of training certificates. Staff spoken with said they like working at the service and said the staff are friendly and work together well as a team. Care Homes for Older People Page 23 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is well managed and residents can be assured that it is run in their best interests. Evidence: The manager of the service has many years experience in a senior capacity. She has been in this post for 2 years. She is a qualified nurse and holds many recognised training certificates including a BA Hons in clinical studies. The manager has also kept up to date with all mandatory training and has also gained further certificates and updates including palliative care. The ethos of the service is to be open and transparent. The manager has a surgery one afternoon a week that is advertised to residents and visitors to the service. This ensures that people who wish to can be sure that the manager will be free to speak to at this time. Residents, their families and staff are encouraged to approach senior staff for advice, assistance and help when they wish. Relatives spoken with described the manager as aproachable and the sort of person who would act promptly on any Care Homes for Older People Page 24 of 29 Evidence: concerns they may have. One relative stated, that if they had any problems they would not hesitate to go to the manager. Staff interviewed about how the service was run stated, the manager is very fair and supportive, the home is well run, the manager makes sure we get the training we need. 10 staff returned surveys, some comments made were:The manager has been brilliant she is so supportive The manager is unlike other managers ive known she interacts with the residents as well as being a manager. The home is run very well. The home manager is extremely supportive and is also very thorough with us all, I have worked here for a number of years and she is the most supportive towards residents and staff. She is best manager we have had here. The registered provider visits are carried out monthly and are available to look at. Some of the recorded visits were viewed and show that residents, their relatives and staff are spoken with. Premises and records are also inspected with documentation evidencing that. Residents meetings are held 6 monthly. The most recent residents and relatives meeting took place in February of this year with the area manager in attendance also. Staff meetings are held three monthly with the last one in April this year with minutes published from this also. Staff interviewed confirmed that regular staff meetings took place. Head of department meetings are carried out weekly and look at any issues that affect the running of the service. Meetings are carried out for all departments with regard to health and safety, usually one or two each month. The manager also attends the team meetings held by the operations manager once a month. Financial records of some of the residents were looked at and evidence that all financial transactions are recorded with a record of receipts and signatures. Monies kept are held in a pooled account that gives residents a share of the interest gained according to how much is held. Policies and procedures are in place so that staff are informed and aware of company processes. The manager carries out audits on a monthly basis and this includes areas such as health and safety, care records, medication, pressure ulcers, accidents, complaints, finance, bed rails, supervision, activities, privacy and dignity. There is also a catering audit carried out with the chef. A sample of audits were looked at and showed validation also from the operations manager. Care Homes for Older People Page 25 of 29 Evidence: Maintenance records show all maintenance checks are carried out including water temperatures, disinfection of baths and showers, window restrictor checks, call bell system and wheelchairs. Care Homes for Older People Page 26 of 29 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 27 of 29 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 19 The fire alarm system is to be checked weekly to ensure it is operating effectively. An alternative method of securing bedroom doors should be identified to replace the hook and eyes that are occasionally used to prevent residents accessing bedrooms that do not belong to them. 2 19 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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