Inspection on 07/09/09 for Chatterwood Nursing Home

This is the latest available inspection report for this service, carried out on 7th September 2009.

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.

Other inspections for this house

Chatterwood Nursing Home 21/09/06

Chatterwood Nursing Home 03/02/06

Chatterwood Nursing Home 20/07/05

Chatterwood Nursing Home 16/02/05

Chatterwood Nursing Home 13/08/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Chatterwood Nursing Home Huntsbottom Lane Hillbrow Liss Hants GU33 7PA     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: Christine Bowman     Date: 0 7 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Chatterwood Nursing Home Huntsbottom Lane Hillbrow Liss Hants GU33 7PA 01730893943 01730890363 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Milkwood Care Limited care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Physical disability - PD Date of last inspection Brief description of the care home Chatterwood offers nursing for 24 residents over the ages of 55 years. There are five shared bedrooms and thirteen single, nine of which have en-suite facilities. There is a large communal area that is divided into four separate areas, lounge areas and dining areas, and the home has a shaft lift. There is a very large garden at the front of the home, which is not easily accessed by the residents because of the steep sloping paths and there is a large patio, which is accessed via the conservatory. The home is in a rural area and the local shops in Liss are accessible with assistance. Care Homes for Older People Page 4 of 31 0 24 Over 65 24 0 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: 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: This inspection report includes information gathered about the service since the previous site visit on 18th October 2007 under the Inspecting for Better Lives (ILB) process. An Annual Quality Assurance Assessment (AQAA) was completed by the manager, and returned within the required timescale, giving up to date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service, and of their plans for further improvements. Six people living at the home completed surveys, some with support from relatives, giving their views on the service they were receiving. Five staff also completed surveys commenting on the support given to the residents and the support they received as employees at the home. One health care and one social care professional returned completed surveys informing us of their experience of the service with respect to their clients. The collated results of these surveys and comments have been included in the report. An unannounced site visit, conducted on 7th September 2009, was completed over six and a half hours commencing at 11:00am, to assess the Care Homes for Older People Page 6 of 31 outcomes of the key inspection standards for older people with respect to the people living at the home. The registered manager, Mrs Joyce Gilfroy, assisted with the inspection process by making service user and staff files, the staff training matrix, quality assurance documentation, the complaints and compliments log, the service user guide, the statement of purpose, samples of policies and procedures and other documents and records available to be sampled. A representative of the provider organisation was also available for consultation. We sampled the communal living areas of the nursing home and spoke with a number of residents, visiting relatives and a visiting activities provider. We also visited two residents in their bedrooms and observed the staff as they carried out their duties. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Environmental improvements, for the comfort and enjoyment of the residents, included new dining room tables and chairs, moving and handling equipment, bedroom furniture, carpets and curtains, new bedding and pictures. A new call bell system had also been installed over the previous twelve months. The provider stated that recent improvements to the fabric of the home, including double glazing for windows and doors, loft insulation, a more efficient boiler, the recycling of waste and the prospect of a new sewage plant were intended to support sustainability, in addition to keeping the residents warm in the winter months. The gardens had been landscaped for the pleasure of the residents. Infection control had improved to protect the residents, in that soap dispensers had Care Homes for Older People Page 8 of 31 been purchased and anti-bacterial gel was available throughout the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 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 10 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. Prospective residents and their representatives can decide if this home will be able to meet their needs because accurate and up to date information is available to inform them. Good pre-admission assessment processes ensure the home has sufficient understanding of residents before they move in to support them appropriately. The home does not offer intermediate care. Evidence: The information available to prospective residents in the form of the statement of purpose and the service user guide was viewed. These documents informed anyone considering using the service of their aim to provide a comfortable atmosphere with comfort and companionship, high standards of care, lovely surroundings, an appreciation of the individual residents needs and a focus on promoting independence. Values included recognising the residents right to privacy, dignity, independence, choice, rights and fulfilment. The philosophy of care included employing tact and sensitivity in understanding and resolving emotional conflict which Care Homes for Older People Page 11 of 31 Evidence: might occur in community living and offering community involvement that is rich in opportunities for social, intellectual and spiritual development. All of the six residents, who completed surveys, confirmed that they received enough information to help them to decide if this home was the right place for them before they moved in, and that they had been given written information about the homes terms and conditions. Three files of three residents, who had been admitted since the previous site visit, were sampled. The pre-admission assessments included personal information and details of the involvement of health and social care professionals. Care needs including mobility and self-care were explored and assistance required to enable the individual to remain as independent as they were able, was recorded. Special needs with respect to feeding and special diets, sensory and communication needs were included, in addition to health care and medication needs. Recreation, social religious and cultural needs were recorded to enable an holistic plan of care for each individual to be drawn up. A relative wrote to the home, my mother has rung me a couple of times to let me know how happy she is and to give me news of all her visitors. She sounds so happy and content with life at Chatterwood that I must let you and your entire team know how much I appreciate the exceptional care you are giving her. When she moved in she was apprehensive and even fearful, but you have made her feel confident, cared for and safe, to say nothing of the excellent food she so clearly enjoys, The health and social care professionals, who completed surveys, both confirmed that the care services assessment arrangements ensure that accurate information is gathered and that the right service is always planned for the residents. The home does not offer intermediate care. Care Homes for Older People Page 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents health, personal and social care needs are met. Each individual has a detailed plan of care, which they have been involved in compiling. Medication is managed safely. The residents rights to privacy is respected and support is given in a way that maintains their dignity. Evidence: The three residents care plans sampled had been drawn up from the assessment documentation and covered all areas of their care and nursing needs. A resident profile, containing a large colour photograph of the resident to ensure their identity would not be confused, had been placed in the front of their care plan giving, full and detailed information about each resident to ensure the staff would know about their personal preferences and abilities to carry out self-care activities independently or with support. The residents preferred form of address was recorded, the time they prefer to rise in the morning, exactly what they like to eat for breakfast, detailed instructions to the staff about how any support required, with respect to personal care should be given, and the use of aids to support the residents independence. One resident; prefers to have breakfast at approximately 8.30 am and requires assistance Care Homes for Older People Page 13 of 31 Evidence: with feeding. Preferences for breakfast included cereal (named) with warm milk, sugar and prunes and a cup of tea, with no sugar in a beaker with a lid. They need to be in an upright position, well supported with pillows, whilst eating and drinking. They are assisted with personal care by two members of staff. Another resident; likes to go to bed between nine and ten pm depending on what programme they are watching on the television. They like a cup of tea before they go to bed. They like to wear pyjamas and lie on their back with three pillows and they have a pressure mattress. Care plans and nursing assessments were in place covering mobility, sensory needs, skin care and nutrition. Care plans viewed recorded interventions to inform the staff, had been reviewed within the previous month and included a signed statement by the resident to confirm acceptance, I have been actively involved in my care plan, and were also signed by a registered nurse. 100 of the surveys completed by the residents recorded that they, always receive the care and support and the medical care, they need. The manager recorded in the AQAA, we ensure that a comprehensive life history is obtained from the resident and their family so that person-centred care can be delivered, and plans for the next twelve months included providing memory boxes for the residents to improve reminiscence work. The five staff members, who completed surveys, confirmed that they are always given up to date information about the needs of the people they support or care for in their care plan. Records of consultations with the General Practitioner (GP), the Community Psychiatric Nurse (CPN), the dentist, optician, chiropodist and social workers were recorded in the residents files sampled, confirming access to remedial and health care services. Moving and handling risk assessments were included for those with mobility needs, and recorded the equipment used and the support required. Observations of staff supporting residents to move from their wheelchairs to easy chairs in the living area, confirmed that guidelines were followed for the safety of the residents, and that the staff explained each step as they supported and encouraged the residents to move. The health and social care professionals, who returned completed surveys, both recorded that the residents healthcare needs are always properly monitored, reviewed and met by the service and that advice is always sought and acted upon to meet the residents social and health care needs and to improve their well-being. Medication was stored in a locked walk-in cupboard, which contained a suitable metal cabinet for the storage of controlled drugs. The medication cupboard also contained a medication trolley, a sink for hand washing and a refrigerator for dugs which needed cool storage. A controlled drug register was in place but no resident had controlled drugs prescribed to them at the time of the site visit. The manager stated that she Care Homes for Older People Page 14 of 31 Evidence: and the deputy manager, who was also a registered nurse, took responsibility for the medication and carried out regular audits. Only registered nurses, who were trained in the administration of medication, carried out this task. The manager and deputy stated that they were pleased that recent General Practitioner assessments had recommended the reduction of the quantity of drugs taken by some residents and that consequently their health had been improved. Accurate records were kept of drugs received and disposed of requiring two signatures as confirmation. Medication not blister packed at the pharmacy but everything was in the original container with details of administration recorded by pharmacist. Samples of two residents medication in stock confirmed the medication administration records were correct. Observations of the staff throughout the day confirmed that relationships with the residents were empowering. Staff encouraged and supported residents in their independence and were respectful and polite in their interactions with them. Residents responded by laughing and smiling and appeared relaxed and happy in their home. New staff had completed the Skills for Care common induction standards, which provide an introduction to the caring role and promote the residents rights to be treated as an individual, with respect for their privacy and dignity. All of the five staff members, who completed surveys recorded that they always felt they had the right support, experience and knowledge to meet the different needs of the residents with respect to equality and diversity issues. A staff member commented on what the home does well, it provides the best individual care and promotes each individuals dignity and preferences. A relative commented in the survey they completed on behalf of a resident under the section on what the home does well, looks after my wife. She cannot communicate, but they observe her reactions with her eyes. They respect her dignity and they are always welcoming. In my opinion there is nothing the home could do better. Screens were provided in shared bedrooms for privacy and private spaces could be offered for confidential meetings, the manager stated. Care Homes for Older People Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated as individuals with respect to equality and diversity issues. They live interesting lives, are involved in the community, take part in activities of their choice, maintain relationships, remain as independent as their individual abilities allow, and are provided with nutritious and attractive meals. Evidence: Care plans showed how residents exercised choice and recorded their preferences with respect to leisure and social activities, including meals and mealtimes, the routines of daily living, personal and social relationships and religious observances. One residents care plan recorded that they enjoyed participating in exercises for health and reminiscence, and that their family take them to church on Sunday. Residents files contained full and detailed information submitted by relatives with respect to the residents lifestyle and interests to ensure an holistic care plan could be compiled, and to give the staff a full picture of the residents lives prior to being admitted to the home to promote their understanding of each individual and for reminiscence purposes. Details of residents families, working life, hobbies and interests, important people, special days, pets and special memories and thoughts were included. Care Homes for Older People Page 16 of 31 Evidence: The weekly schedule was posted on a notice board in the entrance hall. Flower arranging, trips out to places of interest, hairdresser visits twice weekly, exercises for health, reminiscence, quizzes, memory games, art and craft and bingo were some of the activities provided. On the day of the site visit the hairdresser was providing a service to the residents throughout the day, and those receiving the treatment were smiling and chatting to the visiting hairdresser, who stated she knew all the residents well and had been visiting the home for a number of years. An afternoon session of exercises for health was observed, which consisted of ball catching and leg movements. Residents were given individual attention by the two visiting practitioners and laughed as they participated, indicating that they were enjoying the experience. The manager stated that activities were provided by an external organisation and that the home provided minibuses, which were designed to transport people with mobility needs in their wheelchairs safely. Trips to local pubs, the seaside with fish and chips, the Milestone museum in Basingstoke, Staunton Country Park, the D-Day museum and other places of interest had been organised for the residents enjoyment. Photographs on the notice board at the entrance to the home, and in the monthly newsletters, showed residents at the seaside eating fish and chips, enjoying a drink at the local, and dressed up for the occasion at the museum. The manager stated that there was no charge to the residents for the trips and that the provider also covered the costs of meals out. A barbecue had been held on the terrace for the residents, their relatives and friends the weekend prior to the site visit. The newsletter informed of regular visits from the guitar man and his dog, and there was a photograph of him playing easy listening music and taking requests, on the notice board and in the newsletter. A resident cat was asleep on a residents chest of drawers, providing a homely feel and fulfilling an emotional need for some of the residents. Minutes of residents meetings confirmed their involvement in the planning of the entertainment provided. Ideas the residents had provided for future trips included picnics, and visits to garden centres. Their comments on the recently landscaped gardens were very positive (everyone agreed the gardens looked lovely), and comments on the D-Day celebrations, when the staff had dressed in war time clothing, were that both pleasant and painful memories had been evoked. A resident recorded in the survey they completed, activities are well planned for example; Michael and dog Kate entertain us fortnightly with musical entertainment, singing songs to the guitar. There are trips and excursions to seaside towns such as Worthing and farm visits etc., and recently there was a barbecue, which relatives were invited to. 100 of the residents who completed surveys recorded that, the home Care Homes for Older People Page 17 of 31 Evidence: always arranges activities they can take part in if they want to. In the living areas there were two televisions, videos, DVDs, a music centre, compact discs and books for the residents to enjoy. Newspapers were delivered as the residents required. There was a large memory box on the wall displaying reminiscence objects from the war, and the manager stated that there were plans to provide memory boxes for all the residents. Two relatives were spoken with throughout the day and both were very complementary about the care and attention received by their relatives at the home, and the communication they received to keep them informed about any changes to their relatives needs. Both stated they were always made very welcome at the home and could visit any time. A relative commented in a survey they had supported a resident to complete, we are very pleased that dad has been taken out on a trip every Wednesday. This has made his life more interesting and we appreciate it, and another wrote, Mum has settled into Chatterwood because of the consideration and care shown to her and the rest of her family. I know she likes her room and is beginning to feel confident enough to sit out in the conservatory. She has enjoyed trips out. Although she does not use the garden, she has noted the changes to the flowerbeds and it is a topic of conversation. The health and social care professionals, who completed surveys, wrote that, the care service always supports the residents to live the life they choose, and always responds to the diverse needs of the residents with respect to equality and diversity issues. The AQAA recorded that plans for the next twelve months included more community involvement through open days, coffee mornings and trips out. Observations of the midday meal confirmed that residents chose where they preferred to eat. Most of the residents chose to sit at the dining tables and socialise, one resident preferred to eat in the sitting room whist watching a DVD, and another resident was eating a soft diet in their bedroom. The soft diet was presented well, and a staff member was giving encouragement to the resident and supported them to drink from special cup. Residents spoken with at the table stated they really liked the meals. Lunch was chicken, carrots, roast potatoes, spinach, with gooseberry and apple crumble and cream or fresh fruit to follow. Residents chatted at the table about activities they had taken part in and outings they had been on to places such as South Sea, Hayling Island, museums and pub lunches. A resident wrote in a survey, the home is always lovely and friendly. The staff are so kind. The manager, Joyce, will buy a lovely salmon for me as she knows that I enjoy it. Another resident wrote, the food is well prepared and of a high quality. Care Homes for Older People Page 18 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. Residents and their representatives are confident to voice concerns to the home knowing that they will be responded to promptly and with respect. A workforce that has a good understanding about safeguarding adults protects service users from the effects of abuse. Evidence: The AQAA recorded that there had been no complaints over the previous twelve months. The complaints policy and procedure was available in the service user guide and displayed on the notice board to inform the residents, their representatives and the staff. All the residents confirmed, in the surveys they completed, that, there is always someone they can speak to informally if they are not happy, and that they know how to make a formal complaint. The AQAA recorded that the service openly welcomes complaints and suggestions in order to be able to improve the service. The health and social care professionals who returned completed surveys recorded that the service always responds appropriately if they or the person using the service have raised concerns. The home had received a large number of complimentary letters and comments from satisfied relatives, some of which have been included in the appropriate sections of the report. The local authority safeguarding adults policy and procedure were available to inform the staff and included a flow chart to show how referrals are processed. The protection of vulnerable adults training was included in induction, and the staff training matrix Care Homes for Older People Page 19 of 31 Evidence: confirmed that this training was updated on a regular basis to ensure the staff were kept up to date on how to protect the residents. The manger had completed the local authority safeguarding adults training, and training on the Mental Capacity Act and the Deprivation of Liberty Safeguards in order to cascade this training to the staff team. The AQAA recorded that there had been no safeguarding referrals over the previous twelve months. Care Homes for Older People Page 20 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 excellent 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 homely, comfortable, safe and well-maintained home, which fulfils their needs and is clean, fresh and odour free. Evidence: The home was a large red brick country house, which had been built as a hunting lodge in the late nineteenth century, and had subsequently been adapted for use as a nursing home. Access was down a short drive from country lane and there was limited car parking to the front of the building, which was attractive and well maintained. The large windows had been double glazed to preserve heat, and displays of brightly coloured potted plants at the entrance were a welcoming feature. The large front door led into the carpeted entrance hall, with high ceilings and original mouldings. A vase of fresh flowers and a notice board with photographs of smiling residents engaging in activities, outings and social occasions, greeted visitors and created a warm and friendly ambiance. The manager wrote in the AQAA, decorative floral displays are always present inside and outside the home to provide a welcoming burst of colour, and for the enjoyment of the residents and their visitors. Communal space included a sitting and dining area, which was open plan and included a conservatory area extension. The old part of the house retained a large fire place and other original features. Residents benefited from having the choice of a variety of sitting areas furnished with comfortable chairs, and two of the areas had been Care Homes for Older People Page 21 of 31 Evidence: provided with televisions. Plants, ornaments, pictures, lamps, mirrors, a music centre and a memory box display with objects from the First World War, made this a homely and comfortable place for the residents to relax in. Dining tables were set out with up to four place settings and table cloths. Radiators were safely covered to protect the residents from burning themselves and a fan was available to enable them to keep cool in the warmer weather. A storage area was provided for wheelchairs with a shelf above for cushions, and one section was used by the visiting hairdresser. Outside, and accessible through the French windows, was a terraced area with outdoor seating, tables, brollies, a barbecue, a bird table, more potted plants, hanging baskets, and a colourful garden to provide the residents with interest and enjoyment. Corridors were nicely decorated with tasteful pictures, displays of china plates and potted plants making this nursing home feel homely. A bathroom, which was viewed, contained an adjustable bath to facilitate the experience for the residents and to enable the staff to carry out personal care more comfortably. Bedrooms were on three levels and a lift was provided to enable easy access. On the ground floor in the new wing, the single-story bedrooms had en-suite facilities and French windows, which opened onto the terrace, with views of the garden. All the bedrooms sampled were light, bright, beautifully clean and very individual. It was clear that residents and their relatives had been involved in personalising them with photographs and other small items to create a homely feel, and residents had televisions and radios in their bedrooms for entertainment. The manager stated that these rooms had all been recently refurbished with curtains, carpets and good quality, solid and attractive modern furniture and that colour schemes had been chosen by the residents. All areas were well-equipped with aids and adaptations to support the residents to remain independent, to prevent the development of pressure sores, and to support the staff when carrying out the tasks of personal care. The AQAA recorded that new dining room tables and chairs, moving and handling equipment, bedroom furniture, carpets and curtains, new bedding, pictures and a new call bell system had been installed over the previous twelve months to improve the environment for the residents. The provider stated that recent improvements to the home, including double glazing for windows and doors, loft insulation, a more efficient boiler, the recycling of waste and the prospect of a new sewage plant. These improvements were intended to support sustainability, in addition to keeping the residents warm in the winter months. Care Homes for Older People Page 22 of 31 Evidence: The laundry was spacious and well equipped with an industrial washing machine, two dryers and a rotary iron to enable the staff to care for the residents clothes. A hand basin, liquid soap and paper towels were available to promote good hygiene and the floor had a non-slip surface to prevent accidents. Throughout the home anti-bacterial gel was available to promote the control of infection. The staff training matrix confirmed that the staff had received infection control training and the home was beautifully clean throughout and odour-free. The six residents, who completed surveys, all confirmed that they thought the home was always fresh and clean. A relative commented in a survey they supported a resident to complete, I always visit unannounced and at different times of the day and the only thing I ever smell is lovely cooking. Care Homes for Older People Page 23 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 residents have safe and appropriate support because the staff, providing their care, are safely recruited for their protection, stable, committed and well-trained to support them with their nursing, personal and social care needs. Evidence: Staff rotas indicated that sufficient staff were on duty to cater for the needs of the residents and that a trained nurse was always available. The staff observed carrying out their duties did so in a cheerful, calm, unhurried manner, taking time to talk with and to assist the residents. A total of twenty nursing and care staff were employed at the home, some of which were part-time, and another five staff provided domestic support. The AQQA recorded that six staff had left the homes employment over the previous twelve months, but the manager stated that a core team of loyal staff offered consistency and continuity to the residents. All of the six residents, who completed surveys, confirmed that the staff were always available when they needed them, and that they always listen to them and act on what they say. A resident, who completed a survey, wrote about what they thought the home does well, they provide kind, caring and thoughtful staff, who are very courteous and caring. The AQAA recorded that seven of the thirteen permanent care workers had completed a National Vocational Qualification (NVQ) in Care or Health and Social Care at level 2 or above to support them in their role. The staff training matrix showed that four staff Care Homes for Older People Page 24 of 31 Evidence: had achieved a NVQ at level 3. New staff had completed the Skills for Care common induction standards, which provide an introduction to the caring role and promote the residents rights to be treated as an individual with respect to their equality and diversity issues. Two staff members whose files were sampled, and who had been recruited since the previous site visit, had received all the necessary pre-employment checks for the protection of the residents. Files had been bound to protect the confidential documents contained in them, and were well-organised making information easy to locate. An audit sheet showed clearly that all important checks had been carried out before the staff members started work, and the application form required breaks in employment to be explained, and reasons for leaving to be recorded to ensure that only applicants suitable to work with vulnerable adults would be considered. The five staff members, who completed surveys recorded that their employer had carried out checks such as Criminal Record Bureau checks and references before they started work. The manager recorded in the AQAA, we have a safe, robust recruitment policy and are highly selective when recruiting staff. We make sure we have the right person. We are well-staffed to provide person-centred care. The home retains staff so we have a very low turnover, and agency staff are never used. The staff training matrix confirmed the regular up-dating of mandatory training including moving and handling, health and safety, fire training, infection control, first aid, food hygiene, the protection of vulnerable adults, and showed that all the care staff and registered nurses had attended sessions within the previous year. All the registered nurses, who were responsible for the administration of medication, had received this training. Dementia care training had been accessed by all the staff and equality and diversity training was planned for later in the month. The manager stated that she cascaded the local authority training including safeguarding adults and care of the dying, for which she had completed an accredited course. She also planned to provide training on the Mental Capacity Act and the Deprivation of Liberty Safeguards in the near future. Other training accessed by the registered nurses included skin care, continence care, falls risk assessment and Multiple Sclerosis to support the residents assessed needs. Three of the five staff, who completed surveys, recorded that they are being given training, which is relevant to their role, helps them understand and meet the individual needs of the residents with respect to equality and diversity issues, and keeps them up to date with new ways of working. Two staff recorded that they would like more knowledge about health care and medication. Health and social care professionals, who completed surveys, recorded that they thought the services managers and staff always have the right skills and experience to support the residents social and health care needs. Care Homes for Older People Page 25 of 31 Evidence: A staff member commented on the homes attitude to equality and diversity within the staff group and recorded in the survey they completed, Chatterwood is a really good place to work as all the carers are equally respected regardless of their ethnic backgrounds. A relative commented in a survey, the staff have been helpful and cooperative whilst our relative has been at Chattterwood, another wrote, I have nothing but praise for the staff and the care administered to my mother, it couldnt be better. I always visit unannounced and at different times of the day and the only thing I ever smell is lovely cooking. All the staff are friendly and helpful. For someone in my mothers condition it couldnt be any better! and another recorded, I cannot praise highly enough the commitment and care shown by all members of staff. Care Homes for Older People Page 26 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. Residents live in a well managed home, in which their opinions are sought and acted upon for the improvement and development of the service. Effective systems are in place to promote the residents health, safety and welfare creating a safe environment for them to live in. Evidence: The registered manager, who was a State Registered Nurse, had been in post since the previous site visit, and for five years previously. She had many years of experience in working in residential and nursing care and had completed the Registered Managers Award to support her in the management role. She keeps herself up to date with current practise by accessing the local authority train the trainer training, all mandatory training, and is currently undertaking specialised palliative and dementia care training along with the deputy manager. Further training in the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DOLS) was planned to support residents and to ensure that all decision making was in their best interests. The manager stated that the provider was very supportive and always made resources Care Homes for Older People Page 27 of 31 Evidence: available to ensure the home was well-equipped to meet the service users needs. The home sends out surveys to relatives and healthcare professionals to gain feedback for the improvement of the service. Resident and relative meetings are held regularly and minutes taken, views are listened to recorded and acted upon. The manager completed an AQAA (Annual Quality Assurance Assessment), which contained information on how the service had improved since the previous site visit and plans for further improvements in the quality of the service for the benefit of the residents. The collated results of the homes quality assurance questionnaires completed by residents, their relatives, staff, healthcare professionals and entertainment facilitators confirmed a high level of satisfaction with the service provided. The home does not hold residents money in safekeeping but cheques paid for items such as hairdressing, chiropody, newspapers and relatives pay invoices. The health, safety and welfare of the residents was promoted by regular staff training in moving and handling, fire safety, first aid, food hygiene and infection control, which was recorded in the staff training matrix. The Annual Quality Assurance Assessment, completed by the manager confirmed that policies and procedures with respect to health and safety were in place to keep the staff up to date with current practise, and that the essential maintenance of equipment had been carried out according to manufacturers recommendations to ensure it was safe to use. A sample of certificates, seen on the day of the site visit, confirmed that maintenance checks had been carried out in a timely fashion. A staff member wrote in a survey, I really appreciate the trust and opportunity that this home gives me. I always feel privileged working here and work with the best people and the best staff team. I love my work, another recorded, as compared with other homes I have worked in, I find this is the best home because they really care for the residents with dedication and full of love. A resident wrote in a survey, Chatterwood is excellently managed. 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 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. 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