Inspection on 24/03/10 for Northleach Court Care Centre

This is the latest available inspection report for this service, carried out on 24th March 2010.

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

Northleach Court Care Centre 13/10/08

Northleach Court Care Centre 31/03/08

Northleach Court Care Centre 30/10/07

Northleach Court Care Centre 12/06/07

Northleach Court Care Centre 22/06/06

Northleach Court Care Centre 12/12/05

Northleach Court Care Centre 16/12/04

Northleach Court Care Centre 12/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for older people Name: Address: Northleach Court Care Centre High Street Northleach Cheltenham Glos GL54 3PQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Kirby     Date: 2 4 0 3 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Northleach Court Care Centre High Street Northleach Cheltenham Glos GL54 3PQ 08453455746 01451861179 gillian.hughes@blanchworth.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Sally Anne Manby Roberts,Mr Jeremy Walsh Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Temporary variation to client categories OP (Old Age) for 1 (one) named service user. The Home will revert to the original client categories when this service user no longer resides at the home. To accommodate one named service user under 65 years of age with Dementia Date of last inspection Brief description of the care home Northleach Court is situated close to the centre of Northleach, which is about 12 miles from Cheltenham and 10 miles from Cirencester. The Home is a registered Care Home with nursing and has 60 beds with a category of dementia care for predominately older people. Accommodation is on two floors, on the ground floor there are a number of communal Care Homes for Older People Page 4 of 32 Over 65 60 0 0 9 0 3 2 0 0 9 Brief description of the care home rooms including a conservatory, dining areas and lounges. The home has grounds comprising of a number of enclosed courtyard areas and small lawns. Care Homes for Older People Page 5 of 32 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 was an unannounced Key Inspection which included a visit to the home. The visit was completed by two Regulation Inspectors and one Local Area Manager over one day. Prior to the inspection we, the Quality Care Commission (CQC) looked at various pieces of information to gather evidence in preparation for our visit, which included the following The previous inspection report where the home was rated a one star adequate service. The homes inspection record, which gives us an account of any information we have received about the home since the last inspection. The Annual Quality Assurance Assessment, known as an AQAA. The home is requested Care Homes for Older People Page 6 of 32 annually to complete and return this assessment to us by a specified time. We received the AQAA on time, which contained information about what the home considers it does well and what plans they have for further improvements in the coming year. We looked at six individual care files, which included, pre admission assessments, care plans and risk assessments. We also looked at a number of records and files relating to the day to day running and management of the home. At this inspection we did a Short Observational Framework (SOFI), this is a methodology we use to understand the quality of the experiences of people who use services who are unable to provide feedback due to their cognitive or communication impairments. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. At this visit we used SOFI in the home and observations were completed in the main lounge and the dining room. We spent time in all communal areas of the home and some of the bedrooms and spoke with people living in the home, visitors and staff. We finished the inspection with a feedback meeting with the Manager and Director of Nursing. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: All of the National Minimum Standards assessed at this inspection were met. No statutory requirements have been made as a result of this inspection. We would like to thank everyone who took part in the inspection, their enthusiasm and support was greatly appreciated. Care Homes for Older People Page 8 of 32 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 32 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 32 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. Peoples needs are assessed prior to admission to determine the suitability of placement. They can be confident that staff will have the resources and skills to meet their assessed needs. Evidence: We looked at the pre admission assessments, which were fairly comprehensive covering all activities of daily living, a full health screen and personal history background. The information gathered pre admission should provide a sound benchmark of the persons ability, state of health prior to admission and subsequent needs when they move into the home. People wishing to live in the home, family and carers are involved in the pre admission assessment wherever possible and all information is used to determine the suitability of the placement. Where possible the manager also obtains comprehensive assessments and care plans from other health and social care professionals involved, Care Homes for Older People Page 11 of 32 Evidence: for example, social workers and hospital staff. We spoke with the manager who was able to clearly demonstrate the importance of pre admission assessments in order to ensure that the home can meet individuals identified needs. Since the last inspection the AQAA tells us that pre admission assessments have improved, Significant time and effort is taken to ensure that an admission to the home is person centered and well managed. The prospective resident and family are treated with dignity, understanding, respect and we appreciate the circumstances in which they find themselves. Care Homes for Older People Page 12 of 32 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. Because they are consulted about their health and personal care needs people can be sure their views and expectations will be considered. The health and personal care that people receive is based on individual needs. There are safe systems of practice in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. People can be confident that staff have a good awareness of their needs and that they will be treated with dignity and respect. Evidence: From the pre admission assessments the staff are able to develop a set of care plans based on identified needs During the first four weeks the plans are reviewed and developed accordingly. Care plans were completed with regards to health and social needs including, Care Homes for Older People Page 13 of 32 Evidence: psychological, emotional, and cultural needs which demonstrates that the home takes an holistic approach to the provision of care. The plans that we looked at were fairly detailed and person centered, including personal preferences and like and dislikes. Plans told us that people had specific requests and routines, this is very good practice and helps demonstrate that people are involved in deciding how they wish to receive care. The plans showed consistency in assessing, planning and evaluating care as required. The manager conducts random monthly audits on the care files and written feedback is given to staff including any further action required. Regular care reviews take place for people living in the home, which can include family members and care staff wherever possible. This allows the opportunity to discuss and evaluate care and any issues or concerns people might have. Staff agreed that they had up to date information about individuals needs and confirmed that care plans were reviewed at least monthly unless there were any other significant changes. The AQAA tells us, All care staff are encouraged to familiarise themselves with the care plans and to use the care plan to ensure that they are fully aware of the residents needs and wishes. Health care needs are monitored and documented in peoples care files. Nutritional assessments are completed on admission and reviewed monthly, people are weighed monthly as part of this review. Care plans are written for people who are nutritionally at risk and how this is to be managed. Specialist health care support is often sought and referrals are made to community dieticians and speech and language therapists. The daily progress records contained entries of what, when and how care was provided. Information recorded on care documentation corresponded with information given from relatives of people who live at the home and staff about the level and individualised levels of support that people received. Care plans identified the potential risks for people who may become socially isolated and in peoples records we saw how the home has developed strategies for individuals in order to overcome this, such as ensuring verbal and non verbal stimulation, providing one to one support and engaging with people in topics that are of interest to them. At this visit we found that the manager and staff knew individuals who live at the home well and they have recorded the preferred communication style of the individual. We saw that the home has incorporated detailed information within individual care plans in respect of their communication requirements, they have Care Homes for Older People Page 14 of 32 Evidence: ensured that essential information has been recorded in order to best facilitate effective communication for the individual concerned. This included the use of body language, facial expressions and the use of appropriate touch in order that communication is meaningful and tailored to the needs of the individual. For example, during our observations we saw one person who does not use verbal language in which to communicate, within minutes of our observation we noted that this person appeared to be uncomfortable, staff noticed this without any prompting from us and assisted this person in a timely manner in order to ensure they were comfortable, safe and pain free. We noted during the staff interactions with this person that they touched this persons hand when they were talking to them. In the care plan we saw this use of touch was recorded as an effective method of communication in order to support and reassure this person. The care documentation included risks assessments which are also regularly reviewed. The home also does all it can to promote empowerment for people that live in the home. The AQAA tells us, Any limitations to make choices are recorded, taking into account the policy of choice, capacity and best interests. When a resident appears to lack capacity for a specific decision , a capacity assessment is completed. If this evidences that a lack of capacity exists and that a decision must be made for a resident , a best interests form will be completed in conjunction with relatives and significant community professionals. At all times best interest decisions are made, choosing the least restrictive option for the resident, whist endeavoring to maintain choices that the individual would have made when they had capacity. Policies and procedures for receiving, storing, administering and disposing of medications were examined and discussed. All systems in place are very effective, well managed and audited. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by a local pharmacist. Six monthly medication reviews for people living in the home are completed by GPs. Fridge temperatures are recorded daily, the administration charts were legible and continuity of administration was shown with a signature from the people dispensing. The home promotes privacy and dignity to all people who use the home. Staff attend training on induction, which covers aspects such as closing doors and pulling curtains when delivering personal care and knocking on doors and waiting for an invitation to enter before going in to their bedrooms. We saw staff knocking on peoples doors before entering, members of staff spoke respectfully about individuals needs and referred to them in the term of address that they preferred, this information was also Care Homes for Older People Page 15 of 32 Evidence: recorded in the care files. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to make choices about their life style, and supported to engage with social and recreational activities which meet individuals expectations. People maintain family contact and staff encourage family and friends to join in with activities and any outings. People receive a varied and wholesome diet that they are able to influence. Evidence: There is one designated activities coordinator who arranges activities for people. It should be noted that this person is employed to work eighteen hours per week, although the homes statement of purpose records that a designated person is at the home thirty hours per week. The coordinator has been absent from the home for some time and serious consideration must be given to ensure that those hours are redeployed on a temporary basis. It is imperative that care staff do not cover the shortfall in the interim as this will compromise their roles and responsibilities. In addition to this consideration must be Care Homes for Older People Page 17 of 32 Evidence: given by the service as to whether eighteen hours per week is sufficient, particularly when we see that some people living in the home have been assessed as needing one to one support and that they would not benefit from group sessions. We saw that the home maintains a log of activities that have taken place in order to provide an overview of what has been provided. Within this we saw that within the previous two weeks people had participated in a cheese and wine tasting event, beetle drives, arm chair aerobics, pampering sessions, gardening and skittles. We also saw craft work and photographs on the notice board of recent Mothers day and St Patricks day celebrations. The home maintains a record for each person of the activities they have been involved with. Every person, regardless of their communication, ability and motivation are offered a choice as to whether to participate or note, individual choices are respected. We particularly noted that one person who would have limited ability to participate due to their frailty had been actively encouraged and involved with recent card making for Easter, the person was involved through discussion, was asked their opinion and shown what was happening, this is evidence of good practice and should be nurtured and encouraged. Other recorded activities for people included making a collage, painting, quizzes, planting seeds and tracing individuals family trees and heritage. People we asked told us, I dont like too much fuss, but I like what I do and I enjoy the singsongs. A relative we spoke with felt that people could be supported to do more. They felt that although care staff worked hard to maintain activities, things were not as well organised as before due to the absence of the activities coordinator. The relative we spoke with was aware of a forthcoming relatives support group meeting and they were going to put some ideas and suggestions for improvements forward to the manager at the meeting. There was a good reference within care plans, pre admission assessments and pen profiles about peoples previous hobbies and interests so that staff would know their preferences for activities and what they may not like. These included religious beliefs. The home have worked closely with the people living in the home and where possible, those close to them and have developed detailed person centered information in order to support people, to live the life of their choice. These documents recorded things that are important to them and have an affect on them. Also recorded was information such as things I have been proud of, previous hobbies and routines and a section entitled any other comments which would help me in my Care Homes for Older People Page 18 of 32 Evidence: home. For one person we saw recorded, hold my hand when you talk to me. We also saw that this information had been incorporated within the individuals care plan and observed that this is normal practice for staff when supporting and communicating with this individual, evidencing that areas of importance were adhered to and respected by staff. Incorporated within individuals care plans we saw that the home had consulted with people and had recorded both planned and ad hoc activities that people are involved with, such as baking and music activities. Whilst we were at the home during the morning a sing a long took place, although this appeared to be impromptu those who participated enjoyed the music and the engagement with staff. We observed that even those who were not actively involved in the singing appeared to benefit either by tapping their toes, clapping their hands, looking around and humming along. Also in the afternoon representatives from the local church came and provided a religious service with hymns and prayers for those who wished to participate. This appeared to have been well received for those who attended the in house service. Within the homes AQAA they told us of their plans to re create a room within the home which would be a memory room. This room would be themed around a 1940s lounge, incorporating artifacts and memorabilia of that era. We have seen this introduced within another of the organisatins care homes. It has been well received and residents and visitors alike had benefited by using the area to have a meal with their relatives, to reminisce and to use the area as a quiet lounge, we look forward to reviewing progress in this area when we next visit the home. We saw from the visitors book that people receive visitors at the home. staff confirmed to us that people are welcome at any time. People we spoke with told us, The staff here are wonderful and We are always made to feel very welcome. During our observations we spent time in the lounge and dining areas and saw that staff engaged with those who live at the home in a meaningful way. People were spoken to politely and respectfully. People were asked what they wanted to do and what assistance they would like. We also the staff observed making general conversation with people about their day, rather than just being task orientated. Staff, on the whole, were attentive and supported people in an appropriate manner. We looked to see how people were being supported at lunchtime. The dining room was pleasant with the tables appropriately laid with flowers and condiments and fresh Care Homes for Older People Page 19 of 32 Evidence: drinks on the table. We noted that the vegetables were put on the table in serving dishes in order for people to serve themselves and retain some independence. We saw that roast turkey, roast potatoes and an assortment of vegetables were offered to people, with an alternative of salad being provided if people did not like what was being offered to them. During out visit we saw that there were sufficient numbers of staff present to assist people, some people were encouraged through verbal prompting and encouragement, some people were given minimum assistance, others were supported on a one to one basis to eat their meal. Staff were polite and patient at all times. We saw that staff used diversion and distraction techniques in order to encourage people to finish their meal and to encourage conversation and interaction. Feedback from visitors included, The food here is wonderful and Plenty of choice and a cooked breakfast is available everyday. At various times during the day stocks of fresh fruit, snacks and chocolate were replenished throughout the home. Blended fresh fruit drinks were also being served during the afternoon and people told us that they enjoyed them. The home told us that the results of its quality assurance survey show an increase in satisfaction with meals. The kitchen and food storage areas were inspected and found to be clean and orderly with the home recently having been awarded four stars by the local Environmental Health Officer. Care Homes for Older People Page 20 of 32 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. Those who live at Northleach Court Care Centre can be assured that complaints will be taken seriously and acted upon. The home also has systems in place, practices and procedures to help protect those who live at the home from abuse. Evidence: The homes complaints procedure is included in the statement of purpose and the residents guide and information on how to make a complaint is contained within individual contracts relating to the terms and conditions of their placement. A copy of how people can raise concerns or complaints about the service was on display within the entrance hall to the home. We saw evidence that complaints and concerns have reduced and that all concerns are dealt with effectively under the homes policies and procedures. We receive details from the home about any internal complaints investigations and safeguarding referrals, the outcomes we saw at the inspection show us that these have been dealt with openly and effectively. The manager is committed to encourage an open culture within the home so that people feel comfortable and able to make a complaint or a suggestion without fear of reprisals. He makes every effort to see people living in the home Monday to Friday Care Homes for Older People Page 21 of 32 Evidence: and his office is accessible which means that visitors can see and talk to him on a regular basis. Being available has meant that people can discuss any concerns or issues with the manager before they potentially escalate into complaints. Holding meetings for people living in the home, relatives and staff will mean that communication and sharing information will improve. This further promotes people becoming less frustrated, thus relieving anxieties and any potential complaint referrals. People told us that they knew how to make a complaint and that they could speak with someone in the home if they were not happy. We spoke to one relative, who said that their relative had lived at the home for a number of years and that they knew how to raise a complaint. Comments made by this relative included, I have no issues or concerns, I feel my relative is well cared for. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and the understanding of their role in protecting vulnerable adults who live at the home. We were told that the home actively promotes staff training and education in the protection of vulnerable adults on induction and on an annual basis the staff receive an update. Policies and procedures given to staff include, Whistle blowing, How to make a grievance and Harassment in the workplace. A number of staff have either completed or are enrolled on the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of protecting vulnerable adults from abuse. Care Homes for Older People Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general the home is comfortable, well decorated and furnished. It provides a safe, peaceful and well maintained environment for everyone. The bedrooms, communal rooms and facilities are suitable and well presented for their purpose and meet the needs of people living in the home. Evidence: The home has a number of aids and adaptations throughout the premises to enable physically disabled people to maximise their independence. This includes wide corridors and pathways, passenger lifts, specialised bathing facilities, grab rails, and assisted toilet facilities. We walked around the inside of the home and viewed most of the bedrooms and the communal areas including the dining rooms lounges and bathrooms. There is ongoing refurbishment of the home that includes the replacement of some carpets. At the time of the inspection several rooms were in the process of being decorated. There is a hole in the door of the main lounge that has been prepared for the installation of an air vent. The vent cover has yet to be fixed leaving a draught coming into the lounge from the area. The sluice beside the lift was in need of refurbishment. Care Homes for Older People Page 23 of 32 Evidence: The tour of the premises took place towards the end of the morning and most areas were clean and tidy. There were designated staff with responsibility for the cleanliness of the home. There was discussion about the staining of toilets that is attributed to hard water lime scale. The organistion continues to try to find cleaning products to help remedy the situation to make them more pleasant for people to use. It was however noted that standards of cleanliness and hygiene had been compromised. Within the home we noted odours in peoples rooms and within some communal areas. We also noted that one toilet did not have toilet roll or hand towels available, although this was later rectified when a delivery arrived to the home in the afternoon. There are several vacant rooms and these had been made to look welcoming with beds made, clean towels and soap in place. The regional director advised that when a new person is admitted to the home a welcome pack of toiletries is placed in the room to be occupied. People had been supported to personalise their bedrooms with pictures and ornaments and they are able to bring items of furniture should they wish. Rooms are lockable so that they can maintain their privacy and keep their personal possessions secure. Most rooms had profiling beds and good quality matching bedroom suites lounge chairs and a small table. Most rooms have en suite facilities and people have individual commodes when required. Communal bathing areas, showers and toilet facilities are located throughout the home. One relative commented on the poor television reception in the home and this was checked in some bedrooms. The reception was variable indicating that whilst there could be a problem with the aeriel signal it could also be related to the tuning of channels. The Regional Manager indicated a commitment to resolving this issue to ensure that all residents would have improved viewing. Care Homes for Older People Page 24 of 32 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 relationships between staff and people living in the home are good and create a warm positive environment to live in. People are supported and protected by the homes recruitment policy. The people are cared for by skilled staff that are trained, supported and supervised by management. Evidence: The manager told us that staffing levels are indicative of needs and the level of care required and confirmed that levels of staff would rise should dependency levels increase. We know that the home also increases the levels of staff at certain busy times of the day to ensure that needs are met. People living in the home and staff agreed that there were enough staff to meet their needs. When there have been staff vacancies regular agency or bank staff have been used to provide continuity and the permanent staff will often cover extra shifts. A sample of staff recruitment records were looked at and showed us that the home follows a good recruitment procedure. This will help ensure that the right people are employed to work at the home, and people living in the home will be further protected. Records contained completed application forms with a full employment Care Homes for Older People Page 25 of 32 Evidence: history, two written references and Criminal Records Bureau (CRB) disclosures. Qualified nurses, are required by law to register annually with the Nursing and Midwifery Council (NMC) to be able to practice, these registrations are checked annually by the manager to ensure that the staff have done this. Staff confirmed that these checks had been completed before starting work at the home. There is an induction programme which covers all mandatory training. The home has a mentor system where all new staff are linked with and shadow a senior staff member during shifts to help with continued training throughout the induction process. Staff told us that the induction was good and covered everything they needed to know in order for them to do their job. The home provides the staff at the home with training and development opportunities tailored to individual needs. The manager and all staff are conscientious in attending training relevant to the care needs of the people they are caring for and those relevant to the roles they perform. Comments received about the staff included, They are caring and kind all the time, They treat us with dignity and respect, Staff have a very good caring attitude and Staff are always friendly and helpful. We spent some time throughout the day talking and observing staff carrying out their duties and assisting people. Staff were respectful, warm, good humoured and sensitive towards people within a relaxed calm environment. Care Homes for Older People Page 26 of 32 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. We are satisfied that the outcomes for people who use this service will improve and that peoples needs and best interests are central to the new management approach in the home. The home continues to improve its quality assurance by introducing continuous monitoring of polices, procedures and practices in order to ensure that the home is run in the best interests of the people who use the service. Good accounting methods are adopted and policies and procedures are followed correctly when handling peoples personal money so they can be sure their finances will be managed correctly. The health and safety checks within the home will help protect the people who use this service. Care Homes for Older People Page 27 of 32 Evidence: There have been several managers at the home in recent years and continuity of management has been compromised. We spoke at length with the newly appointed manager of the home who demonstrated effective leadership and management skills that relate to the aims and purposes of the home. He shared various new initiatives in order to further develop the care, standards and services that the home provides to the people living there. The manager is currently aplying to the Commission to be the registered manager. The staff are a stable team that supports a commitment to providing quality care for the benefit of the people living in the home. People we spoke with told us that they were happy in the home and with the services provided. Comments included Im very happy and made the right decision to move here and I am well looked after, everyone does the best they can for me. Comments in surveys included, I would like to say that the service has much improved and They create a happy, friendly atmosphere and take time to speak with visitors. The home continues to monitor and assess the quality of services provided, by giving people questionnaires to complete and holding meetings for people living in the home and their relatives , families and friends. Internal audits are also carried out in the home with regards to care documentation, medication and other procedures in the home. We received the AQAA on time and the service fully recognises the importance of the AQAA and has used the content to form their own quality assurance. The home demonstrates a good level of self awareness and recognises the areas that it still needs to improve, and has clearly detailed the ways in which they are planning to do this. There are policies and procedures for holding peoples personal money. Each person has a statement and receipts for sundries were available. The AQAA states, Peoples monies and valuables are audited by senior staff members. Any person wishing to have their finances managed by us have an individual bank account which provides bank statements and people can access their funds as required. During our SOFI observations we saw staff moving people in a safe manner. We saw staff assisting people with the hoist and also supported people to move into a more comfortable position and transferred people from chair into the wheelchair and vice versa. On all occasions staff explained to the resident what they were doing, they checked that the person understood what had been said to them and the move was Care Homes for Older People Page 28 of 32 Evidence: completed in a calm, reassuring and safe manner. The home have manual handling assessments in place and these outline information about the support needed by people who live at the home. These records gave an indication of the level of risk in this area for individuals, the assessments also contained information of staff action/support and equipment needed in order that people are moved safely. Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place and along with risk assessments are reviewed regularly and updated where necessary, to ensure they remain appropriate and reduce risks to people living and working at the home. The home has written policies and procedures in relation to the promotion of the health and safety for all people who use the service and associated training was provided for staff in all health and safety matters. Some of the Health and Safety records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms, equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services and the passenger lift. The fire log book was examined and all appropriate tests for fire safety are recorded as carried out appropriately. Fire drills, to assist staff in understanding their role in the event of fire, have been well attended. Care Homes for Older People Page 29 of 32 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 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 Re deployment of activity hours needs to be addressed and reviewed so that care staff are roles are not compromised Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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