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Inspection on 02/02/10 for Elvy Court Nursing Home

Also see our care home review for Elvy Court Nursing Home for more information

This is the latest available inspection report for this service, carried out on 2nd February 2010.

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

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

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

What the care home does well

Care guideline records reflected the needs of residents and their aspirations. These contained information about how residents are progressing, aims of care identified by staff and agreed with residents, their health requirements and risks associated with their daily living and activities. Members of staff contribute to the maintenence of these essential records. Members of staff treated residents with kindness and respect. The manager and staff team has considerable experience in the care of older people and the current staff team is nw well established. This is of significant benefit to residents, their advocates and staff. Members of staff demonstrated a very good knowledge of resident`s needs and were seen to work hard in supporting them. The AQAA referrred to an on-going committment to ensure that each individual is valued and listened too. The garden areas, including the sensory garden area, is suitable for use by residents, staff and visitors. Emphasis is placed on enabling staff to administer medicines safely. The premises are suitable for the support and care of frail older people and has been equipped in ways to make their lives comfortable and safe. Activities and specifically adapted areas of the premises are available to residents to help keep them more mentally and physically alert. The services of an activities coordinator contributes to the provision of a range of suitable activities within and outside the premises. There are good staffing levels at all times to meet the needs of increasingly frail people from admission stage. This includes the presence of nurses and care staff. The evidence from the manager`s review folder was that all placement reviews were up-to-date.

What has improved since the last inspection?

The AQAA referrred to an on-going committment to ensure that each individual is valued and listened too. The AQAA referred to the "tea room and reminiscence museum" being in place and functioning well. The feedback from residents and visitors was that it is very well regarded. There has been introduction of tape and CD as talking brochures for the visually impaired. The number of outings have increased due to the introduction of the mini bus. Visits to the London Eye, local restaurants and picnic areas and shopping trips to out-of-town centres have followed. These have included assisting people with wheelchairs to make such visits. The sensory garden project, initially put on hold, has now progressed. The service continues to provide holistic care based, the AQAA stated, on comprehensive assessment prior to admission for the purpose of maintaining individualised care plans. Procedures have moved towards greater focus on a person centred approach to helalthcare and personal support. Feedback from relatives continues to be important so that staff can keep individual care plans for residents updated and relevant. A quality assurance survey indicated that residents and relatives believed the service remained good. Feedback reflected the opinion that support offered to relatives during the transition to a care home with nursing was appreciated during this critical time. Relatives continue to be directed to support groups when the need is identified. When new staff are interviewed, service users are involved wherever possible in an informal process to gain their views.

What the care home could do better:

The report contains no requirements or recommendations.

Key inspection report Care homes for older people Name: Address: Elvy Court Nursing Home 204 London Road Sittingbourne Kent ME10 1QA     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: Eamonn Kelly     Date: 0 2 0 2 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) 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 29 Information about the care home Name of care home: Address: Elvy Court Nursing Home 204 London Road Sittingbourne Kent ME10 1QA 01795437449 01795437450 elvycourt@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd care home 57 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 57 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 Dementia - DE Date of last inspection Brief description of the care home Elvy Court Nursing Home, a care home with nursing, provides care and support for up to 57 older people. Together with nurses on duty at all times, there are care assistants and other staff on duty for the comfort, safety and care of residents. Residents who have dementia are supported at the service. The service is operated by Southern Cross Healthcare and information about it and other care homes owned by the company may be viewed on www.schealthcare.co.uk. Care Homes for Older People Page 4 of 29 Over 65 0 57 57 0 Brief description of the care home Bedroom accommodation is provided over 2 floors. Residents, visitors and staff have the benefit of a passenger lift. There are lounge areas and quiet meeting rooms on each floor. There is a dining room on each floor. The service offers mostly single bedrooms but there are two bedrooms for people who wish to share. Most bedrooms have an en-suite facility. Car parking space is available at the front of the premises. Gardens surround the premises. One area is being developed as a sensory garden. Information about weekly fees and additional charges may be obtained from the manager. Information on the homes services (Service Users Guide) and a copy of CQC reports may be obtained from the manager on request by prospective residents and their advocates. A number of documents and reports that may be of interest to prospective residents and their advocates are on display in the reception area. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3-Star. This means that people who use the service experience excellent quality outcomes. The inspection visit took place on 2nd February 2009 . It comprised discussions with the manager, nursibg staff on duty, carers, three sets of visitors and four residents. A case tracking exercise relating to three residents was carried out to assess how they were being supported. The care needs of residents were discussed with members of staff who had a good knowledge of their support needs. Care practices were discussed and all parts of the premises were visited. Some records were seen during the visit principally those addressing the personal and healthcare support of residents. Care Homes for Older People Page 6 of 29 The Commission received an annual quality assurance assessment (AQAA) from the manager, Mr Keith Bartlett. This provided information about how residents are currently supported and how the service is being developed. The previous inspection report and annual service review were checked as part of this inspection visit. The evidence of this inspection visit and that contained in the AQAA (annual quality assurance assessment) indicated that progress is continuing to be made in the interests of resident welfare and comfort and towards meeting the overall objectives of the service. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The AQAA referrred to an on-going committment to ensure that each individual is valued and listened too. The AQAA referred to the tea room and reminiscence museum being in place and functioning well. The feedback from residents and visitors was that it is very well regarded. There has been introduction of tape and CD as talking brochures for the visually impaired. The number of outings have increased due to the introduction of the mini Care Homes for Older People Page 8 of 29 bus. Visits to the London Eye, local restaurants and picnic areas and shopping trips to out-of-town centres have followed. These have included assisting people with wheelchairs to make such visits. The sensory garden project, initially put on hold, has now progressed. The service continues to provide holistic care based, the AQAA stated, on comprehensive assessment prior to admission for the purpose of maintaining individualised care plans. Procedures have moved towards greater focus on a person centred approach to helalthcare and personal support. Feedback from relatives continues to be important so that staff can keep individual care plans for residents updated and relevant. A quality assurance survey indicated that residents and relatives believed the service remained good. Feedback reflected the opinion that support offered to relatives during the transition to a care home with nursing was appreciated during this critical time. Relatives continue to be directed to support groups when the need is identified. When new staff are interviewed, service users are involved wherever possible in an informal process to gain their views. 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 excellent 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 supporters receive initial advice and guidance to help them assess the facilities and suitability of the service. An assessment is carried out to see if the service can provide support that meets their needs. Evidence: The AQAA stated that the service has striven to maintain the standards already set for encouraging senior staff to be knowledgeable and skilled in the assessment process. It also affirmed that there is continuous dialogue with placement teams and care managers to maximise the success of each placement. According to care plan records seen, the manager and/or nursing staff carries out an assessment of prospective residents support needs with assistance where necessary from Social Services care managers and healthcare representatives. There is a waiting list for prospective residents interested in taking up residence. Care Homes for Older People Page 11 of 29 Evidence: Prospective residents and their advocates/family receive assistance and guidance to help them decide if the home is able to meet their support needs. Many residents have support needs associated with the onset of dementia as well as substantial mobility problems and other disabilities and illnesses. The evidence from care plan records seen on this occasion indicated that notes are taken at this stage that form part of subsequent care plan records. The care plan record begun at this stage of assessment/admission outline the support needs of the prospective resident and how these needs would be met. To some extent, the assessment predicates the area of the home (ground or first floor) where appropriate support is available if there are available places. A review of three care plans that contained pre-admission assessments suggested that relevant information was gathered at this stage of admission. Care plans have been reviewed and improved over the past few years. The manager and other senior members of staff try to ensure that sufficient information is recorded at this stage to enable nurses and carers to subsequently care for the resident. During the visit, two residents said they have been well looked after and that the manager and staff were fully up to date about their support needs. The evidence was that potential residents may not always visit the home prior to taking up residence. However they (and their representatives) are invited to do so. New residents receive a personal contract that contains information on the rights and responsibilities of both parties. Prospective residents and their advocates receive a range of written materials about the service to enable them to make a decision about entering a residential care environment. There is a number of documents available to them also in the reception area. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal needs are met. Individual plans of care contribute to good knowledge by staff of residents changing support needs. Evidence: Care plan folders seen for three residents contained information about residents support needs and how these were being met. These included risk assessment information, pre-admission outline, fluid charts, weight records pressure sore prevention/treatment record, healthcare checks/access to healthcare services and care plans outlining assessed needs and how to address the needs. The care plan information seen (that related to residents met during the visit) were accurate and up-to-date. It was clear that they are effective mechanisms that contribute to residents extensive health needs. In each case, the residents needs were seen to have been assessed and goals of care identified. Nursing staff support the manager in maintaining these essential records. Care Homes for Older People Page 13 of 29 Evidence: The evidence was that issues relating to resident support and care were identified and when support needs changed the plans were updated with new goals of care added. Members of staff complete daily records in respect of important aspects of residents health and changes in health or disposition. These issues are discussed during staff changeover to enable in-coming staff to be aware of changes in residents temperament or health. During the inspection, members of staff were seen to be completing daily records. During the inspection visit, members of staff treated residents with understanding and respect. Discussions about the profiles of residents and how they are supported also indicated a high level of understanding of and respect for them. There was evidence that care managers and family members are involved in reviews and any necessary changes in the levels of support. According to three profiles of residents, GPs visit as necessary. Nurses are on duty on both floors of the premises. Residents have good access, according to profiles of residents, to local NHS community services. Two residents and their visitors said that nurses and care staff have a good understanding of the difficulties residents faced and are skilful in providing the healthcare, social and personal support needed. A nurse administering medicines explained how medications are administered. Part of medication administration was observed on each floor. MAR sheets are completed at the time of administration. A monitored dosage system for dispensing medication is used. The service maintains equipment for the storage of medicines including secure controlled drug storage. According to nurses administering medicines, there are constant reviews by them in accociation with the manager and GPs of the types of medicines prescribed. They gave examples of instances where GPs reduced or changed medicines on the basis of information they provided about residents changing disposition. Nurses administering medicines receive training to enable them to keep up to date. An important declared aim of support is to help residents remain as independent as possible. This involves encouraging them to move around on their own with any necessary staff observation. The layout of the premises contributes to this objective and residents were seen to be able to move about safely. The evidence was that Care Homes for Older People Page 14 of 29 Evidence: residents move about less than previously because of their higher dependency needs at admission stage. The activities co-ordinator provides assistance and encouragement to residents to be as involved as they can possibly be in activities both within and outside the premises. The evidence according to residents and three sets of visitors met was that members of staff help residents who have hearing aids to keep them in working order and they encourage them to continue using the aids. Records indicated that residents weights are recorded monthly or more often if necessary. According to the AQAA, there has been training for and introduction of the Liverpool Care Pathway to enhance the standard of end-of-life care. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive support on a day-to-day basis to remain mentally and physically active and alert. Social activities and opportunities for mental stimulation are well managed and as much as possible provide daily variation and interest for residents. Residents are helped in maintaining contact with friends and family who are made welcome at the premises. Evidence: The manager and activities co-ordinator demonstrated how members of staff help residents to remain physically and mentally active. There are a number of activities provided in the mornings and afternoons by staff and some were observed on this occasion. The AQAA provided examples and notice boards indicated the types of planned activities. Residents have access to a tea and reminiscence museum where they can have tea and meet other people in a comfortable area of the premises. Residents said that relatives and visitors provide good support and that they may visit at any time. Three sets of visitors were met. They provided views about how residents were being supported at the premises. Care Homes for Older People Page 16 of 29 Evidence: Because of the increasingly high level of healthcare and personal support needed at admission stage, residents generally cannot continue the patterns of their former lives. The good staffing levels however enable staff to have time to spend time with residents outside the perameters of expected healthcare and personal support. According to residents and visitors, this is of significant benefit to residents and their families. Weight charts and nutritional assessments are maintained. Residents are able to have their meal over an extended period and members of staff were seen to give them assistance as needed. The manager is considering ways of enhancing the dining experience. In one example, a group of residents are encouraged to have their main meals in a separate area to enable them to converse more easily with each other. The menu is displayed prominently and alonside this is a pictorial representation. The AQAA indicated that residents and family members are encouraged to say what they feel and to give their views about any issue they feel affects them. Residents and members of staff gave examples of particular activities promoted by the service. There were a number of examples seen during the inspection that suggested they are helped in a number of ways to remain mentally and physically active. This included staff assisting residents on a one to one basis, helping them to walk about the premises, provision of books and newspapers, talking to them, providing music and helping them visit the garden. During the inspection, there was a positive atmosphere and carers were working actively with residents when they were not engaged in nursing or household activities. The AQAA outlines how special consideration is given towards enabling residents to continue practicing their religion. Residents were met during their mid-day meal and aspects of the procedires at this time observed. Some also gave their views whem met in their bedrooms. Many residents received their meal in their bedroom. Residents attending the dining room received the main meal served from heated containers. The chef said she is aware of residents preferences and information about allergies. Care Homes for Older People Page 17 of 29 Evidence: The AQAA referred to the introduction of a sensory garden during 2009/10. There was reference to the possiblility of having a social activities committee involving the service users and other stakeholders. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents views and concerns are taken notice of and acted on. They are protected from abuse. Evidence: The AQAA stated that the views of residents are sought and all views are treated seriously. The evidence gained during the visit was that residents are encouraged to talk to staff about any concerns they may have. There was an undertaking that all new staff joining the team would have full and comprehensive induction including an overview on adult safeguarding issues and information on the implications of whistle blowing. The AQAA also stated that the service encourages relatives to express their views, to make comments or make suggestions in order to enhance the service. Examples discussed with the manager suggested that careful consideration is given to outcomes of direct contact with users of the service. Policies and procedures for safeguarding adults are available to all members of staff. These give specific guidance to those using them. The manager said that, following staff training and day-to-day advice to staff, those working at the service know when incidents need external input and who to refer the Care Homes for Older People Page 19 of 29 Evidence: incident to for guidance. He was confident that nurses and carers understand Local Authority procedures for Safeguarding Adults. The Commission has been notified of incidents that occurred and reflection on these is reportedly used as part of quality assurance measures for the protection of residents. The recruitment procedure includes the checks (including CRBs) necessary to help contribute to the protection of residents and all members of staff receive training for their responsibilities under current POVA arrangements. The manager said that all staff are receiving updates about the implications of the new ISA (independent safeguarding authority). The AQAA stated that all members of staff are aware of the rights of residents and of how their interests must be identified and promoted. It outlined how the quality assurance system focuses on issues consistent with current care standards with emphasis on making residents quality of life progressively better. It also highlighted the fact that current stable management conditions have had a positive effect on residents and on the staff team. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable for use by frail older people. Evidence: The premises contain mostly single bedrooms for residents (with currently two rooms for people wishing to share), a kitchen, a dining area on each floor, several lounge areas and quiet rooms for visitors and residents. Most bedrooms have an en-suite facility. Residents bedrooms are situated on the ground, first floors. A passenger lift assists of residents, staff and visitors. Garden areas are a major asset for staff, visitors and residents. Separate garden areas surround the premises and one is being maintained as a sensory garden. Handrails have been fitted throughout the premises for residents safety. Bedrooms have been personalised with residents possessions. The premises have excellent laundry facilities. The AQAA referred to the practice of identifying areas which require maintenance and some areas that are earmarked for refurbishment were outlined. It also included a declaration that all essential safety certificates are in place and are up-to-date. Care Homes for Older People Page 21 of 29 Evidence: The premises were maintained in a clean and tidy way at the time of the inspection visit. The service has an infection control policy: observation suggested that this policy and operational guidelines are closely adhered to. Paper towels and liquid soap were in evidence in all communal bathroom areas. Residents have the benefit of a hairdressing salon. Bathrooms were well equipped. Mobile hoists for safe transfer of residents were in evidence. The evidence was that members of staff are trained in their use. Residents had individual mobility equipment which was being maintained as necessary. The AQAA stated that domestic staff would now be encouraged to obtain NVQ 2 in Housekeeping Skills as they have successfully achieved NVQ Level 1. Care Homes for Older People Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the use of a range of checks in the recruitment of staff. Staff are supported to enable them to provide care based on residents changing healthcare and personal care needs. Evidence: The evidence gained during the visit was that members of staff undertake training in moving and handling, infection control, health and safety, and medication administration. Most members of care staff have achieved an NVQ 2 or 3 qualification and all are encouraged to do so. The manager said that the service places a high priority on enabling members of staff to receive relevant training focussed on delivering improved outcomes for residents. This is included in the process of formal supervision carried out at intervals with each member of staff. A training matrix and other records outlined the types of support being put in place for staff. Two nurses met during the visit had successfully completed adaptation training that enabled them to practice nursing in the UK. Care Homes for Older People Page 23 of 29 Evidence: The range of short courses outlined in the training matrix evidenced the good progress made over the past few years. Members of staff are encouraged to attend a substantive course in dementia care. They also are encouraged to attend an NCFE Certificate in Nutrition and Health. Increasingly, the manager is arranging substantive training of this type rather than shorter introductory training sessions. There was evidence that job descriptions and specifications define the roles and responsibilities of staff. Residents and visitors met during the inspection reported that staff work hard in caring for residents. New staff are subject to full checks before they start work. These include CRB checks, references and other recruitment checks. The evidence was that the manager and senior members of staff have successfully recruited a full staffing complement from which to construct staff rotas to meet the support needs of residents. This success has played a central role in the continuing success of the service and its high reputation in the area. The evidence for this is also seen in the significant waiting list for admeission. Many residents and visitors made complimentary comments about the support they received. The AQAA referred to the possible inclusion of service users informally in the selection process. It reiterated the intention to maintain the stability of the work force to improve its quality and performance. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a residential service that acts in their best interests. Residents benefit from an effective staff team that receives regular formal and informal supervision and identification of their training needs. Residents financial interests are safeguarded. Their safety and welfare is promoted through regular maintenance of the premises and equipment safety checks. Evidence: The service aims, according to the AQAA, to provide a good quality of life for residents. There is a focus on person centred thinking with residents centrally involved in shaping the support they require. The level of training as listed in the training matrix and other records is crucial to the safety and support for residents and staff. The training of staff to meet the high care needs of residents needs has been reviewed and improved over the past several years. This is reflected in the high reputation enjoyed by the service and stated Care Homes for Older People Page 25 of 29 Evidence: determination of the manager and staff to maintain this hard won reputation. A qualitative example is that the manager is progressing training ooportunities for staff so that they receive in-depth training in dementia care. Another example of such in-depth training is the NCFE Certificate in Nutrition and Health. The evidence was that the two separate sections of the service are well staffed at all times with the numbers of nurses and carers on duty carefully attuned to the assessed needs and numbers of residents. Appropriate records are stored close to where they are needed by staff, for example, at nurse stations on each floor. Residents and staff are likely to benefit from improvements in the way staff are trained and in how staff induction is promoted through competency testing over variable periods of time. The AQAA contained a declaration that all necessary safety checks and associated certificates are in place. The service has a file of policies and procedures that are said to be available to staff for their information and professional updating. Quality assurance and monitoring procedures are in place for efficient running of the home, to give value for money and deliver effective outcomes for the people who use the service. A copy of a recent weekly report was seen during the visit. The owner organisation has also recruited quality inspectors whose purpose is to carry out inspections of all aspects of the service and make recommendations on how improvements may be necessary. Residents receive advice on how to obtain impartial legal and financial advice if they need this. The service does not act as an appointee for any resident. The manager stated that a written record of all financial transactions is maintained where additional charges are made to residents. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 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. 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. 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