Inspection on 28/05/10 for Chatsworth House

This is the latest available inspection report for this service, carried out on 28th May 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chatsworth House 28/01/09

Chatsworth House 25/01/08

Chatsworth House 14/03/07

Chatsworth House 09/06/06

Chatsworth House 27/02/06

Chatsworth House 13/07/05

Chatsworth House 22/11/04

Chatsworth House 30/07/04

Chatsworth House 31/01/04

Similar services:

Fairfields Country Rest Home

Fairfax House

Claremont Nursing Home

Doveridge Care Home

Dunmore

Chatsworth

Dunraven Lodge

Eastleigh Care Homes, South Molton

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Chatsworth House 9 Belvedere Road Redland Bristol BS6 7JG     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: 2 8 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: Chatsworth House 9 Belvedere Road Redland Bristol BS6 7JG 01179743253 01179743258 chatsworthhouse@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): B & C Care Limited Name of registered manager (if applicable) Mrs Jacqueline Eleanor Shipley Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is 15. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Dementia aged 65 years and over on admission- Code DE(E)- maximum 15 places Date of last inspection Brief description of the care home Chatsworth House is a privately owned care home that was registered by the Commission for Social Care Inspection to provide accommodation and personal care for up to 15 people aged 65 years and over who have dementia. It is situated in a residential area close to Durdham Downs in Westbury Park and is located close to major bus routes. The home is a converted older property providing single room accommodation on three floors, which can be accessed via stairs or a passenger lift. There is one shared room. Six bedrooms have en suite facilities. The home is situated Care Homes for Older People Page 4 of 29 Over 65 15 0 1 7 1 2 2 0 0 9 Brief description of the care home in its own grounds with a courtyard to the rear. Visitors are welcome at any time and refreshments are readily available. In house activities and entertainments are also provided. The range of fees is dependent upon the individual assessed needs of people who live at the home and available upon request. Extra charges are made for services, such as chiropody, continence products and hairdressing. Currently this information is provided verbally prior to admission and then confirmed in writing within a new residents contract. 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: 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 eight hours and was completed in one day. The manager and a representative of the proprietor were present during the inspection and fully participated and engaged in the process. Evidence for our opinions about the service and the quality of care provided was gained from a whole range of different sources, including:- Information recorded within the homes improvement plan. This had been requested from us following our last visit to the service. After our last visit to Chatsworth House in December 2009 we met with the manager and a representative of the owner of the home and discussed the improvements required. At this meeting the manager provided a detailed action/improvement plan and told us how the plan would be followed and how this would improve the quality of service provided to those who live at the home. Each month we have recieved copies Care Homes for Older People Page 6 of 29 of the monthly unannounced visits that have been undertaken at the home and these have enabled us to monitor the progress that has been made. Information of achievements/improvements made at the service as recorded within the monthly reports was confirmed through the records we viewed, the tour of the environments and discussions with those who live, work and visit the home. At this visit we also reviewed the information forwarded to us by the manager in the Annual Quality Assurance Assessment questionnaire (AQAA), completed prior to our visiting the service. The AQAA had been completed in depth and the information provided within this gave detailed examples of how the service meets its aims and objectives, as outlined within the homes statement of purpose. The AQAA was well written and the information provided evidence and examples of the good quality standards provided at the home. During our visit we spent time speaking with people who live and work at the home and reviewed a sample of individuals care records. During our visit we also looked at some of the homes other required documentation, such as fire and complaints records. We also observed staff practices and their interactions with the people who live at Chatsworth House. 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. We also spoke with the manager about the new Health and Social Care Act 2008 and the responsibilities of the service. The home have applied to us (The Care Quality Commission) in order be registered under the new legislation and the manager was able to demonstrate to us during our visit a sound understanding of the essential standards of quality and safety. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The Registered Manager has ensured that plans of care for people who live at the home are sufficiently detailed. This is in order that specific information is available for staff about how individuals needs are to be met. A requirement was made by us in January 2009, this was that the Registered Manager must conduct an overall review of the quality of care provided at Chatsworth House. This was in order that a service development plan could be devised to demonstrate that the service is run in the best interests of the people who live there. In January 2010 we met with the providers and discussed their improvement plan. Our visit on this occasion confirmed that action has been taken to improve the quality of service provided to those who live at the home. The home have improved the recording and administration of medication, including controlled medication. Records seen by us contained correct information about medication that is administered. This ensures that medication is given as prescribed and as per the GPs instructions. The Registered Person has ensured that the home is kept in a good state of repair. Attention and action has been given to those areas addressed within the environmental section of the homes previous report. This ensures that those living at Chatsworth House are living in a place which is safe, clean and suitable for their needs. Care Homes for Older People Page 8 of 29 Risk assessments have now been completed for the use of bedsides. This was to ensure that all factors relating to this equipments use have been fully considered. The Registered Person ensures that at all times there are suitably qualified, competent and experienced persons working at the home. Since our last visit to the service staff have received training appropriate to the work they are to perform. Training provided has included; fire safety, first aid and manual handling. 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. Information is available to people about the services and facilities provided at Chatsworth House. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the statement of purpose and full assessments of needs are undertaken. Evidence: The manager ensures that no individual is admitted into the home unless there has been a full assessment of their needs and that the home are confident that they are able to support them to maintain their skills and lead a fulfilling life. The pre admission assessments viewed by us were fully completed and informative. The manager meets with prospective residents prior to admission, either in their home Care Homes for Older People Page 11 of 29 Evidence: or in hospital. The prospective resident and family are involved in the assessment and all information is used to determine the suitability of the placement. A detailed assessment of the residents care needs are established over the initial few days and weeks of the placement and are regularly reviewed. This information forms the basis of the Care Plan. All residents have in place admission assessments, activities of daily living, assessments of mental capacity, handling and other relevant assessments. Residents records showed that the persons physical, mental and social needs had been taken account of. Assessments are reviewed at least annually or sooner should this be required. Where possible this involves the resident and their family and key worker. Residents have terms and conditions in place, these contracts outline the terms and conditions of the placement. Those seen by us contained appropriate information. As recommended by us the contracts have been reviewed by the home and have been re- written in order that they contain clear, factual and up to date about the financial arrangements connected to the service provided. The majority of residents continue to be admitted through Social Services. 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. Care plans detail residents care needs and are clearly written and give clear directions to staff. The staff provide appropriate personal care to maintain residents health, well being and dignity. Proper arrangements are in place for residents to access primary health care services. The staff properly store, administer and record medication on behalf of residents. Evidence: At our last visit to the service in December 2009 we were not satisfied with the quality and level of detailed recorded within individuals plan of care. A requirement was made by us that the Registered Manager must ensure that plans of care are sufficiently detailed. This is to ensure that specific information is available for staff about how the individuals needs are to be met. Following a review of some care plans during this visit we are satisfied that this requirement has been met. At this visit we found that the Care Homes for Older People Page 13 of 29 Evidence: home had developed and implemented a new care plan format. This was now in place for all residents. The new care plans incorporate activitys of daily living such as maintaining a safe environment, communication, expressions of fear or anxiety and personal care support requirements. In order to find out how residents are supported to meet their care needs three care plans were read. The care plans were reasonably informative and detailed how to meet the care needs of the person. The care plans stated what actions staff must follow to assist the resident, and included information showing how to support residents who have varying levels of confusion, due to their Dementia. The staff were familiar with the content of care plans and knew what actions they must take to meet residents needs. Now that the home have developed and implemented a new care plan format it is recommended that the information within these documents is further explored in order that a more person centred approach is incorporated. Care plans that we saw had been reviewed and updated regularly. This demonstrates residents needs are being monitored and kept under review. All of the people who live at the home who have a diagnosis of a dementia, we spoke to the manager about the rights and choices that people make and spoke in length about the Mental Capacity Act. The current manager was able to demonstrate a good understanding of their responsibilities to those people who live at the home. People living in the home are registered with a local doctors practice. People are supported with their primary healthcare needs such as the dentist, chiropody and optician, these had all been record in individuals care plans and daily records. We saw that the home contacts individuals GP or any other health service as required promptly. Specialist services are also arranged as and when required and we saw that in the past this has included community mental health support and local authority care managers. The manager also confirmed to us that people living at the home are well supported by the community district nursing team. We saw detailed information in the residents daily records that showed us staff observe residents and their overall health. Staff will call the doctor if they are concerned about the person. Staff were observed knocking on residents bedroom doors before entering them and assisting residents in a polite and respectful manner. During our last key visit to the home in December 2009 we were concerned over the recording of medication within the home. Records were unclear and potentially unsafe. A requirement was set by us that medication records, including controlled medication, Care Homes for Older People Page 14 of 29 Evidence: must contain correct information about medication which is administered. This was in order to ensure that medication is given as prescribed and as per the GPs instructions. During this visit we checked how the home look after residents medication (including controlled drugs) to see if they do this safely. We found this requirement to have been met. At this visit we read four residents medication charts. We saw a photo of the person with each record to ensure medication is given correctly to the person named on the chart. All staff administering medication have completed training to make sure they can do this safely. We saw guidelines in place to advise staff of the preferred way that residents like to take their medication. This will guide staff and ensure medication is given to them in the way residents prefer. The stock of medication held in the home was satisfactorily organised. Medication that was no longer required was being returned to the pharmacist. The medication administration charts we read were up to date, we saw the signature of the member of staff who had given out the medication. This shows us residents medication is given out safely. The reasons for any omissions had also been written on the charts. 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. A range of social and recreational activities is arranged that seek to enhance the quality of life for the residents. Residents families are involved and informed of issues related to their relatives and residents are able to maintain close contact with families and friends. The food is of a good standard and provides a balanced diet for residents. Evidence: Residents family and friends said that they are encouraged to keep regular contact with their relatives at the Home. One relative said that the staff team had been very welcoming to them. Relatives and visitors were also observed talking to staff and being made welcome by them during their visit. This helps residents to be able to keep in contact with the friends and family if they so wish. The home operates an open door policy for visitors. Residents are able to see visitors in the privacy of their rooms if they wish. Whilst we were at the home we spoke to visitors. One person told us; I am very happy with the care at the home, the staff are very kind. The dining room was light, relatively spacious and the tables were attractively laid. The four week menu offers traditional meals and those with a choice available, Care Homes for Older People Page 16 of 29 Evidence: however, due to mental incapacity meals are often provided to residents based on known likes and dislikes. The menus are designed with consideration given to colour, presentation, taste and texture for the benefit of the residents. Staff were seen to be assisting residents to eat in an unhurried and respectful manner. The residents who were able to express an opinion stated they enjoyed their meals and felt they received the food they liked. The meal on the day of inspection was well cooked and tasty. The main meal times are set, however, staff can access beverages and snacks 24 hrs a day for those who would like them. Residents were observed walking around the Home and sitting in the enclosed garden. Residents looked relaxed and settled in their environment, and seemed to particularly enjoy sitting and talking with staff and reminiscing about the past. Staff were relaxed and spoke to people in a clam and reassuring manner. There is one person employed part - time to co ordinate social activities. We spoke to this member of staff who had only been in post for a week, we were impressed by their motivation and enthusiasm for their role. They demonstrated a good understanding of the needs of people with a dementia and spoke of supporting and enabling people to enjoy activities at the home. We saw that each person at the home had an activity planner in place, this recorded what people had done and where and evidenced that people are offered a choice of activities and are able to participate or not as per their choice.We would recommend that the design of the activity records be reviewed in order to ensure that clear outcomes for people participating in activities can be fully recorded. This will demonstrate the benefits, or not, of the activity. This will also provide a basis in order to identify for individuals what they most enjoyed and benefited from and to explore other opportunities. We would also recommend that the home further develop activities specifically for those who have dementia in order to provide stimulation, relaxation and reminiscence that is provided on an individualised basis. A weekly timetable is on display on the notice board. Recreational activities included sing-along, bingo, crafts, games, quizzes and gentle movement. A range of visiting entertainers perform in the home. Care Homes for Older People Page 17 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. There are policies in place to protect residents investigate complaints or manage allegations of abuse. There are good arrangements in place for staff training and awareness of Protection Of Vulnerable Adults matters. Evidence: A copy of the complaints procedure is on display in the reception area, which includes the name of the Care Quality Commission, for anyone who wishes to contact us and make a complaint. The contact details of the owners are included in the service users guide and with residents contracts, if residents or representatives wish to contact the owners directly to make a complaint. Staff have received training on safe guarding vulnerable adults. The Local Authority adult protection procedure document is available. In addition to this the Home has its own policy and procedure in relation to the Protection Of Vulnerable Adults. This is readily available so that all staff are aware of it and what they need to do to protect residents from harm and abuse. A number of staff are undertaking the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Care Homes for Older People Page 18 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. The standard of furnishing and decor is good to the benefit of residents. The home provides a safe and well maintained environment for the residents. The bedrooms and communal rooms and facilities are suitable and well presented for their purpose and meet the residents needs. Specialist equipment is in place for the residents safety and well being. The standard of cleanliness is good. Evidence: Chatsworth House is a large Victorian House built over three floors, which can be accessed by stairs or lift. The building is situated in Clifton/Westbury, close to Bristol city centre. The home is near local shops, a church and an area of the city known as The Downs, this is an area of land where community events are held. Specialist equipment and adaptations are in place throughout the Home, to assist residents and visitors who may have reduced mobility. At our last visit to the service we were concerned to find that risk assessments for the use of bed sides were not in place. A requirement was made by us that the Registered Person must ensure that any activities in which service users participate is free from preventable risks. We reported that risk assessments should be completed for the use of bedsides to ensure Care Homes for Older People Page 19 of 29 Evidence: that all factors relating to this equipments use have been fully considered. At this visit we saw that assessments had been developed, implemented and all risks associated with the use of this equipment had been recorded, dated and signed. This requirement had been met. At our last visit we also recommended that the home obtain consent for the use of this equipment in order to demonstrate that all risks and the purpose for the use of this equipment had been agreed and understood. Evidence of this was in place. This recommendation had also been met. All of the bedrooms and all the communal areas were viewed. The majority of bedrooms are for single occupancy, however there is one double room. Rooms were satisfactorily decorated and maintained. The environment was clean and free from unpleasant odours. The home employs domestic staff on a daily basis. Bedrooms have been personalised to reflect the tastes of residents with photographs, mementos and small items of furniture. The standard of furniture and fittings is satisfactory. Three residents said they liked the environment of the Home. None of the bedrooms have en suite facilities. There are bathrooms and toilets located within close proximity to rooms. There is a washbasin in each bedroom. There is a dining room and a lounge area. Residents were observed sitting in communal areas looking very relaxed and comfortable in the surroundings. When we last visited the home in December 2009 we were not satisfied with some areas of decor at the home and the quality of some furnishings. A requirement was made by us that the Registered Person must ensure that the home is kept in a good state of repair. Furthermore that attention and action must be given to those areas raised to the manager during our visit. This was to ensure that those living at Chatsworth House are living in a place which is safe, clean and suitable. We are pleased to report that since the last inspection there have been a number of significant improvements to the environment. Improvements have included; new emergency lighting, new fire door closures, new heat/smoke detectors. Bedrooms have been redecorated and the kitchen has been refurbished. The visitors toilet has been repainted and the ground floor shower room and a toilet area have been totally refurbished, making these a much more pleasant, hygienic environment for those who live at the home. Care Homes for Older People Page 20 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 recruitment procedures and records are in good order to protect residents. The home is well staffed with appropriately trained and experienced staff for the number of residents. Good progress is being made training care staff for the benefit of residents, however, staff would benefit from further dementia awareness training. Evidence: The recruitment process was examined and staff records showed that the home follows correct recruitment procedure and policies. Records contained application forms, references, and a Criminal Records Bureau (CRB) disclosure. We saw records to confirm that staff have completed an induction programme which covers the routines of the home, effective communication, Health & safety procedures as well as discussing the rights of those who live at the home. The home have in place a clear audit of core training that has been undertaken by staff at the home, this and individual training records and certificates seen showed us that staff have undertaken training in areas such as first aid, food hygiene, malnutrition in the elderly, sensory deprivation, medication competency, infection control and protection of vulnerable adults. We found that there are some staff in Care Homes for Older People Page 21 of 29 Evidence: need of dementia awareness training and a requirement about this has been made, this is to ensure that staff are fully aware of the impact that this illness can have for people and in turn equip staff with the skills necessary to support people in the appropriate way. There are a total of eleven staff who are (or are currently undertaking the training) of a National Vocational Qualification, in care. The staff we spoke were were very motivated and told us that they were happy working at the home, comments made included; It is much better working here now, Our manager is very supportive, she listens to us and supports us. Another person said; They have invested in the home now, making it a much nicer place for the residents to live and a better place for us to work. Care Homes for Older People Page 22 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 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 home that is well run and run in their best interests. There are creative and effective ways being used to monitor the quality of care and service in the home. The health and safety of residents and staff is well protected. Evidence: A requirement that was made by us in January 2009 this was that the Registered Manager must conduct an overall review of the quality of care provided at Chatsworth House. This was in order that a service development plan could be devised to demonstrate that the service is run in the best interests of the people who live there. When we visited the service in December 2009 we found that this requirement had not been met and it was again repeated by us. After our visit in December we invited representatives of the registered provider to meet with us. At this meeting a detailed improvement plan was given to us outlining how the areas of deficit would be addressed. This improvement plan also recorded other areas requiring attention in order to ensure better outcomes for the people who live at Chatsworth House. At this Care Homes for Older People Page 23 of 29 Evidence: visit we reviewed the homes improvement plan and found that all identified action had been taken and standards had improved at the home. This requirement had been met. In addition to this the manager Mrs Shipley is undertaking a quality-monitoring audit of the Home and the overall service. She has sent out surveys to all residents representatives to find out their views of the service. This is a good way to check on the quality of care, the overall service, and the general standards in the Home. The home have a number of other 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 residents, relatives and staff meetings, care planning reviews, staff supervision and training. Prior to our visiting the service the manager had completed an Annual Quality Assurance Assessment about the service, this was well completed and sufficiently detailed, within the section of What the service does well ?, the manager had written; The staff confirmed that staff meetings are held regularly, records were looked at on the inspection and these evidence that appropriate subjects were covered and clear direction and guidence is provided to staff in these forums. Staff said that they felt able to express their views to the manager and to the owner. We found the residents records we saw were satisfactorily maintained and in order. The records relating to the management of the home were up to date and in order. The records are kept secure in the home and are available to staff when needed. We have referred to other records in other sections in the report. Policies and procedures are in place at the home and all are of the standard expected for a care home, we saw that staff are familiarised with these as part of their induction At our last visit to the service in December 2009 a requirement was made by us that the Registered Person must make arrangements for staff to receive training in fire prevention. This training was to provided be in sufficient quantities. This was to ensure that staff have the knowledge in order to keep people safe and be able to respond appropriately in the event of a fire emergency. At this visit staff confirmed to us that they had recieved fire training and instruction, records and certificates also confirmed to us that this requirement had been met. We checked the fire book and we saw that the required weekly and monthly tests of Care Homes for Older People Page 24 of 29 Evidence: the fire alarms and the fire fighting equipment are done and are up to date. Staff are provided with regular training in health and safety matters including fire safety, food hygiene training and moving and handling practices. This should help protect residents health and safety if staff are knowledgeable and well trained in these health and safety principles and practices. 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 25 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 26 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 1 30 18 The Registered Person must 27/08/2010 ensure that that staff are provided with the training appropriate to the work they are to perform. This is to ensure that all staff have a clear understanding of the impact that having a diagnosis of dementia has on the people who live at the home. This will enable staff to understand individuals and support them as required. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Now that the home have developed and implemented a new care plan format it is recommended that the information within these documents is further explored in order that a more person centred approach is incorporated. Care Homes for Older People Page 27 of 29 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 2 12 The design of the activity records should be reviewed in order to ensure that clear outcomes for people participating in activities can be fully recorded in order to demonstrate the benefits, or not, of the activity. This will provide a basis in order to identify for individuals what they most enjoyed and benefited from and to explore other opportunities The home to further develop activities specifically for those who have dementia to provide stimulation, relaxation and reminiscence that is provided on an individualised basis. 3 12 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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