Inspection on 21/04/09 for Immacolata House

This is the latest available inspection report for this service, carried out on 21st April 2009.

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

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

Other inspections for this house

Immacolata House 04/12/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Immacolata House Portway Hurds Hill Langport Somerset TA10 0NQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: kathy McCluskey     Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Immacolata House Hurds Hill Portway Langport Somerset TA10 0NQ 01458254200 01458254201 info@notarohomes.co.uk 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) : N Notaro Homes Limited care home 49 Number of places (if applicable): Under 65 Over 65 0 49 dementia old age, not falling within any other category Additional conditions: 38 0 The maximum number of service users who can be accommodated is 49. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) - maximum of 38 Date of last inspection Brief description of the care home Immacolata House is registered with the Care Quality Commission, formally the Commission for Social Care Inspection, to provide nursing care for up to 38 people over the age of 65 years in the category of dementia and 11 service users who require general nursing care. The home was registered with the Commission in August 2007. The home has sumitted an application for the acting manager to be registered manager. Care Homes for Older People Page 4 of 31 Brief description of the care home The home is owned by N.Notaro Homes Ltd. The registered person/responsible individual is Mr Nunzio Notaro. Immacolata House is purpose built and has been designed with the environmental recommendations for service users with dementia. The home is decorated and furnished to a very high standard. Accommodation is over two floors with stairs and a large passenger lift giving access to the first floor. The 49 single bedrooms have been divided into 4 self- contained units to enable smaller group living. The home is set within its own grounds of 5 acres in a peaceful setting not far from the small town of Langport. The homes current fee range is between £555.50 - £800 per week. Fees for one to one care are determined on the assessed needs of the individual. The home does have a number of beds which are block contracted by Social Services. Additional charges are met by service users for personal toiletries, hairdressing, chiropody, newspapers/magazines and any admission fees on trips out. The home provide transport for service users to attend health care appointments and outings. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over one day (7.5hrs) by regulation inspectors Kathy McCluskey and Jane Poole. The operations manager was available throughout this inspection and the acting manager and training manager were available during the latter part of the afternoon. We were given unrestricted access to all parts of the home and all records requested for this inspection were made available to us. The homes completed Annual Quality Assurance Assessment (AQAA) was completed and submitted to the Commission within agreed timescales. The AQAA is a self assessment that focuses how well outcomes are being met for people. It also provides us with some numerical information. Extracts from the AQAA have been included in Care Homes for Older People Page 6 of 31 this report as appropriate. As part of this inspection we sent comment cards to a number of people using the service, staff and health care professionals. The home confirmed that these were distributed appropriately. Unfortunately, we have not received any completed comment cards. During this inspection we were able to meet with the majority of people living at the home and to staff working at the home. We also met with some visitors. Comments received have been included in this report as appropriate. It should be pointed out that the term we used throughout the report refers to we the Commission. We would like to thank all involved for their time and cooperation in the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: Immacolata House enables people to enjoy smaller group living in a environment which has been especially designed for people with dementia. All areas of the home have been decorated and furnished to a very high standard. People benefit from having their own spacious bedrooms which they can personalise. Every bedroom has en-suite facilities. Profiling beds are available in all bedrooms and the home have equipped each bedroom with flat screen digital televisions which have a freeview facility. People also have telephone and internet points in their rooms. Each of the four units in the home have very comfortable lounge, dining and kitchenette facilities. Bedrooms and communal space exceed the recommendations of the National Minimum Standards for size. The home sits within its own very large grounds which are beautifully maintained. Secure garden areas are also available for people to safely utilise. Car parking facilities at the home are very good. People have access to a wheelchair accessible mini bus. The home ensure that anybody thinking about using the service have the information they need to enable an informed decision. A Statement of Purpose and Service User Guide provide people with information about the home and services offered. People are encouraged to visit the home before making a decision to move there. Before a placement is offered, the home ensure that people are fully assessed. This enables the home to be sure that it can meet an individuals needs and aspirations. The home has effective care planning and review procedures in place and people and/or their representatives are encouraged to be involved in this process. The home ensures that people have access to a wide range of health care professionals and systems are in place to ensure that peoples health care needs are met. Health care professionals visit the home though staff support people to attend appointments outside of the home as necessary. Staffing levels at the home have been based on the assessed needs of the people living there and appropriately skilled and trained staff are on duty over a 24hr period. The home has procedures in place that reduce the risk of harm or abuse to the people living there. This includes robust staff recruitment and safeguarding adults procedures. Some people are supported by the home to manage small amounts of money and the homes procedures ensure that people are protected from financial abuse. People have access to a wide range of social and recreational activities. Designated activity staff are employed and care staff are also encouraged to spend quality time with people using the service. People are supported to make choices about their lives and life at the home. Care planning procedures ensure that records are maintained as to peoples preferences and social history. This helps staff to deliver a more person centred approach to care. Appropriate procedures are in place and followed to ensure the health and safety of persons at the home. Care Homes for Older People Page 8 of 31 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out 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. The home ensure that people have the information needed to enable them to make an informed decision about using the service. People are appropriately assessed before a placement is offered to ensure that all parties are confident that the home can meet their assessed needs and aspirations. Evidence: The home have produced a Statement of Purpose and Service User Guide which provides people with information about the home and the services offered. Copies are displayed in the main reception area of the home along with the homes last inspection report. The completed AQAA told us that these documents are due to be reviewed to reflect the recent changes in the management structure. People using the service receive a contract from the home which identifies the fees to Care Homes for Older People Page 11 of 31 Evidence: be charged and the terms and conditions of occupancy. The homes completed AQAA told us that contracts have been reviewed and updated since the last inspection to reflect the current services offered. We were able to see evidence that people were appropriately assessed by the home before a placement was offered. Care plans examined contained pre-admission assessments which identified the individuals assessed needs, abilities and preferences. Assessments had also been obtained from other health care professionals where appropriate. The homes completed AQAA told us that people are encouraged to visit the home before making a decision to move there. The home ensure that staff have received the training required to enable them to meet the needs of people at the home. Staff spoken with during this inspection were very positive about the training available especially the recent training they had received in dementia care. Suitably qualified registered nurses are on duty over a 24 hour period. The home has been designed to meet the needs of people with dementia and mobility difficulties and there is a good supply of specialised equipment available. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes care planning procedures ensure that care is delivered in a consistent manner and that people receive person centred care. People have access to a range of health care professionals and the homes procedures for the management of wound care have improved. The homes procedures for the management and administration of peoples medication have improved and now provide safer and more robust systems. People are treated with respect and are supported to make choices about their lives. Evidence: During this inspection we were able to meet with the majority of people using the service, staff and some visitors. We examined four care plans and tracked the care of those people. Care plans contained a range of assessments which had been used to formulate the plan of care. Assessments included reducing the risk of pressure sores, Care Homes for Older People Page 13 of 31 Evidence: moving and handling, nutrition, falls and environmental factors. We were able to see that care plans had been raised where risks had been identified. Care plans contained clear information as to the individuals assessed needs and abilities and there were clear instructions for staff as to how the assessed needs should be met. It was positive to note that care plans had been written in a manner which promotes a person centred approach to care. Peoples preferences and aspirations had been recorded. When we spoke to staff, they demonstrated a good knowledge of peoples needs and preferences. Staff were very clear about the importance of delivering person centred care and of the need to encourage and support people to maintain any skills they may have so as to promote Independence; We make the most of what people can do and encourage people to be independent, We try to keep people happy and we value them. Detailed social historys had been recorded within care plans and information was recorded as to peoples preferences with regard to their care and daily life. We were able to see evidence that people using the service or their representative had been involved in the care planning process. We spoke with two relatives and both were very positive about the care their relative received; we are well informed and are always made to feel welcome when we visit, It is wonderful and the care matches the surroundings, We are invited to attend care reviews. Throughout the day we were able to observe staff interacting with people using the service. The atmosphere was very relaxed and people were seen to move freely around the home. Staff were heard communicating with people is a kind and respectful manner. Staff were also heard offering people choices about their day. People appeared comfortable and relaxed in the presence of staff and people told us that the staff are very kind. People appeared well attired. Care plans contained evidence that people have access to a range of appropriate health care professionals and that advice is sought where concerns are identified. We looked at three care plans for people who were being treated for pressure sores and found these to be much improved. Wound care plans contained information about the size and status of the wound and of the treatment prescribed. The frequency of treatment and review date had been recorded in all but one of the care plans examined. Running records reflected the treatment prescribed and photographs had been used to track the progress of wounds. There was evidence that the home had requested further specialised input where concerns had been identified with the progress of a wound for one individual. Improvements were noted in the homes procedures for the management and administration of peoples medication. We examined medication administration records (MAR) and found them to be fully and appropriately completed. The amount Care Homes for Older People Page 14 of 31 Evidence: administered for variable doses had been recorded and hand written entries had been confirmed by two staff signatures so as to reduce the risk of errors. Clear protocols were in place for the use of as required medication. Correct procedures were being followed with regard to controlled medicines. All medicines were found to be securely stored and there were no excess stocks apparent. Medicines are only administered by the registered nurses on duty. We were informed that there was nobody currently self medicating. The home has systems in place to ensure that the management and administration of medication is regularly audited. 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. People have access to a range of activities and people are supported to make choices about their day. People benefit from a wholesome and varied menu and staff are aware of peoples preferences. Evidence: Since the last inspection the home have recruited a new activities co-ordinator and feedback from both staff and people using the service was very positive. The activities co-ordinator, who is employed on full time hours, also works alternate weekends and is supported by an additional activity worker who works two days a week. We were informed that activity hours are increased when required, for example for trips out and special events. A programme of activities is developed each month for each of the four units at the home. The activity programme for April looked varied and interesting and provided activities ranging from cross words to gentle exercise. The home has a wheelchair accessible minibus and we were able to see that a trip to Montacute House had been planned for later in the month. One person told us that they were looking forward to a shopping trip to the local town of Langport. We were informed that one to Care Homes for Older People Page 16 of 31 Evidence: one support is offered to those people unable to join in with group activities. Photographs of recent events taken place were displayed throughout the home and each unit displayed orientation materials and information of interest for example, facts about St Georges day. In one unit, tactile objects had been left around the unit and for people to touch and feel and we observed some people who appeared to find this very comforting. During this inspection we observed care staff initiating activities for people. We were informed that this is something that the home actively promote. Care staff were positive about the quality time they were able to spend with people. Records are maintained as to each persons involvement in an activity as is the outcome for the individual. On the ground floor, patio doors were opened and people were seen wandering freely in and out of the secure garden areas. We observed staff offering to assist people on the first floor to access the garden areas. Throughout the day it was evident that people are supported to make choices about their day and were being supported to choose where to spend their day. Doors between the units on the ground and first floor are not locked thus enabling people to move freely around the home. To ensure the safety of people using the service, doors to the reception area, which give access out of the home, can only be accessed via a key pad. Relatives spoken with told us that they could visit at any time and were always made to feel welcome. They told us that they were offered refreshments and were able to use the kitchenette facilities on the units as they wished. Next of kin contact details and preferences had been recorded in individuals care plans. People can choose where to see their visitors and can use the privacy of their own rooms if they wish. All meals are prepared and cooked at the home by the homes catering staff. The home have been awarded five stars excellent rating by the Environmental Health Department for their food hygiene standards. As previously mentioned in this report, peoples dietary preferences are recorded in individuals plan of care. Meals are transported to from the kitchen to each unit in heated trolleys where meals are plated and served to people by either the catering or care staff. Choices are available for each meal and as recommended at the last inspection, the home have produced picture symbols and photographs of meals to enable people to make their preferred choice of meal. We were able to see lunch being served in all four units. Tables had been attractively laid and condiments and drinks were available. Specialised cutlery/plates were available for those with an assessed need. The meal served looked appetising and plentiful. Staff were observed eating with people and the atmosphere was relaxed and unhurried. People using the service were very positive about the food. Care Homes for Older People Page 17 of 31 Evidence: It was positive to note that throughout the day drinks, biscuits and fresh fruit were available on each unit for people to help themselves to. We observed staff offering this to those who were unable to help themselves. Staff told us that there was always plenty of food and snacks available in each units kitchenette so that snacks are always available to people at any time during the day or night. 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. The home has a satisfactory complaints procedure in place and people feel confident in raising concerns. Robust procedures are in place to reduce the risk of harm or abuse to the people living at the home. Evidence: The home displays an appropriate complaints procedure. The complaints procedure is also available in the Statement of Purpose and Service User Guide. People who were able to express a view told us that they would feel confident in raising concerns if they had any. Staff confirmed that they found the acting manager very approachable and would not hesitate in raising concerns. They also stated that they felt confident that any concerns would be taken seriously and acted upon. This was also confirmed by the visitors we spoke to. The home maintains records of all complaints received. We were able to see that complaints had been responded to within agreed timescales and that complainants had been satisfied with the outcome of the homes investigations. No complaints have been received by the Commission since the last inspection conducted in April 2008. The home has a range of policies and procedures in place to reduce the risk of harm or Care Homes for Older People Page 19 of 31 Evidence: abuse to people using the service. Training records indicated that staff had received training in abuse awareness. During this inspection we were able to speak with the majority of staff on duty and all confirmed that they were aware of action to be taken should they suspect abuse. Staff were also aware of the whistle blowing policy. The senior management team have followed robust procedures when investigating safeguarding issues which have arisen at the home and have informed all relevant bodies, including the Commission. 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. People benefit from an environment which has been designed to meet their needs. The home promotes a homely feel and decor and furnishings are of a very high standard. People have their own very well equipped bedrooms which they can personalise. Environmental aids and adaptations within the home assist people with mobility and orientation. The home has good procedures in place to reduce the risk of the spread of infection. Evidence: The home is purpose built and was designed with the environmental recommendations for people with dementia. Decor and furnishings are of a very high standard and a routine programme of maintenance and decoration is in place. The home consists of four units and each unit has its own lounge, dining room and kitchenette area. Two units are located on the ground floor and two on the first floor. This allows for smaller group living. Rosetta and Sofia are located on the ground floor and these provide 10 and 15 bedrooms respectively, for people with dementia nursing needs. Patio doors open up onto secure garden areas. Doors between the units Care Homes for Older People Page 21 of 31 Evidence: are not locked thus enabling people to move freely between the two units. To ensure the safety of people using the service, the door to the reception area/main entrance is accessed by a key pad. On the first floor there are a further 13 beds on the Carolena unit for people with higher dementia nursing needs. Within this unit is a smaller unit with 3 beds for people who require more intense one to one care. The Serena unit is also located on the first floor. This unit has 11 beds for people who require general nursing care. The very large gardens are beautifully maintained and parking facilities are very good. All bedrooms are for single occupancy and are fitted with en-suite toilet facilities. All but three bedrooms also have a shower facility. Bedrooms and communal areas exceed the National Minimum Standards for size. Bedrooms are fitted with an appropriate lock which can be accessed by staff in the event of an emergency. Lockable space is provided in bedrooms so that people can store personal items. Fixtures and furnishings are of a high standard and all rooms have profiling beds. Bedrooms have internet access, telephone and television points. All bedrooms are provided with a flat screen television with freeview. Orientation aids are provided throughout the home to assist people with dementia. Hand rails are appropriately sited to assist people to mobilise. Ramps are sited at the main entrance. A large lift gives access to the first floor. Nurse call systems are installed throughout the home. Assisted toilet and bathing facilities are available on each floor. During this inspection we saw all communal areas and sampled some bedrooms. The standard of cleanliness was noted to be very good and there were no malodours. The home has appropriate procedures in place to reduce the risk of the spread of infection and the majority of staff have completed training in infection control. Staff hand washing and sluice facilities are appropriately sited throughout the home and staff have access to a good supply of protective clothing. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that staffing levels are sufficient to meet the needs of people using the service. The homes procedures for staff recruitment have improved and these now offer better protection for people using the service. Newly appointed staff receive a thorough induction programme and this, along with the ongoing training programme, ensure that staff have the skills needed to meet the needs of people living at the home. Evidence: At the time of this inspection 43 people were residing at the home. We were informed that current minimum staffing levels were as follows; Throughout the day/evening there are two registered nurses and 13 care staff. At night there is one registered nurse and seven care staff. At least two care staff are available on each of the units and staff are available to provide one to one support to six people currently using the service. The acting manager is a registered nurse and works in addition to the care hours shown above. The acting manager is supported by a deputy, also a registered nurse, Care Homes for Older People Page 23 of 31 Evidence: who provides a minimum of one day a week supernumerary hours. We spoke with the majority of the staff during this inspection and no concerns were raised regarding the current staffing levels. Staff told us that they were able to meet peoples needs and also had quality time with people. This was observed throughout the day. The atmosphere in each of the units was noted to be very relaxed. Staff interactions were kind and unhurried. People spoke of the kindness of staff and positive comments were also made by visitors spoken with. The home also employs a full time administrator, catering staff, domestics, laundry staff and a full time maintenance person. A full time and part time activity coordinator are also employed. We were informed that the home are not currently having to use agency staff. The home have taken steps to ensure that registered general nurses and registered mental health nurses along with care staff, are provided with forward thinking training in dementia care. Staff were very positive about recent training called Yesterday, today, tomorrow, which they stated gave them a much greater insight into people with dementia. The homes completed AQAA told us that of the 39 permanent care staff employed, 8 have achieved a minimum of an NVQ level 2 in care. This equates to 21 which falls below the recommended 50 of the National Minimum Standards. The homes AQAA identified this as an area for improvement. It also stated that all new staff are now being enrolled on an NVQ programme. We examined the homes procedures for staff recruitment and found this to be much improved. We looked at recruitment files for four staff who had been recently employed. Records were found to be very well organised and all required information was available. There was evidence that staff had not commenced employment until receipt of two satisfactory references and an enhanced criminal record check (CRB) and check against the protection of vulnerable adults register (POVA). All newly appointed staff follow a 12 week induction programme which meets with the recommendations of the Skills for Care Common Induction Standards. Staff spoken with during the inspection were positive about the induction programme and confirmed that they had received the training needed to enable them to care for the people living at the home. The registered provider employs a training manager who oversees training needs and requirements at the home. Clear training plans were in place for each member of staff. Care Homes for Older People Page 24 of 31 Care Homes for Older People Page 25 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. Appropriate steps have been taken to ensure that the home is effectively managed in the absence of a registered manager. The home have effective quality assurance procedures in place which seek the views of people using the service and other stakeholders. Safe systems are in place for the management of peoples money. The homes arrangements for ensuring staff are appropriately supervised have improved. The home follows appropriate procedures to ensure the health and safety of persons at the home. Care Homes for Older People Page 26 of 31 Evidence: The home has a new acting manager who has been in post since 6th October 2008. An application for registered manager is currently being processed by the Commission. In the absence of a registered manager, the registered provider has taken appropriate steps to ensure the effective running of the home in the interim. The provider employs an operations manager who has been providing additional support to the home. Staff spoken to at this inspection told us that they felt the acting manager was very approachable and that positive changes had taken place and were on-going. The home have effective quality assurance programmes in place which seek the views of people using the service and other stakeholders. We were able to view the results of a recent survey and comments were noted to be very positive. Regular meetings are held for staff, people using the service and their representatives. On behalf of the registered provider, the operations manager conducts the homes regulation 26 visits on a monthly basis. Reports have been forwarded to the Commission and these demonstrate that the quality of the service provided in all areas, is audited and reviewed. At the request of people using the service or their representatives, the home manage small amounts of pocket money for people. Monies are held in individual accounts and a record of all transactions is maintained on individual computerised statements. Receipts are also maintained. A float of money is held at the home to ensure that people have easy access to funds as required. This is managed by the homes administrator and overseen by the company. Since the last inspection the home have taken steps to ensure that all staff receive formal supervision sessions at least six times a year. Appropriate records were in place and staff spoken with told us that they felt very well supported and confirmed that they received formal supervision. We examined the homes procedures for ensuring the health and safety of persons at the home and found all records to be up to date. FIRE SAFETY - Up to date in-house checks and external servicing were up to date. Training records indicated that staff had received training in fire safety. EQUIPMENT SERVICING - Up to date servicing records were available for the homes hoists and passenger lift. ELECTRICAL SAFETY - The home has an electrical hardwiring certificate and there was evidence that appropriate checks had been made on portable appliances. ACCIDENTS - Appropriate records are maintained for all accidents in the home and the home have ensured that the Commission have been informed of all significant events. As recommended at the last inspection, steps have been taken to introduce systems for regularly auditing accidents so that any traits can be identified. Currently the home Care Homes for Older People Page 27 of 31 Evidence: are analysing falls only. Whilst this is positive, consideration should be given to analysing all accidents/incidents at the home. Training records indicated that 18 staff have a current certificate in first aid. MANDATORY TRAINING - This area has improved since the last inspection. A training manager oversees staff training needs and has taken steps to ensure that all staff receive up to date mandatory training. Staff spoken with confirmed that they had received the required training. HOT WATER/SURFACES All hot water outlets are fitted with thermostatic valves and the home conducts monthly checks to ensure that temperatures remain within safe upper limits. To ensure the safety of people using the service, windows above ground floor level have restricted openings, any free standing wardrobes have been secured to the wall and any wall mounted radiators have been fitted with a guard. 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 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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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