Inspection on 02/04/09 for Oaklands House Residential Home

This is the latest available inspection report for this service, carried out on 2nd April 2009.

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

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

Other inspections for this house

Oaklands House Residential Home 30/01/06

Oaklands House Residential Home 08/08/05

Oaklands House Residential Home 05/01/05

Oaklands House Residential Home 02/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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: Oaklands House Residential Home Blackwater Covert Reydon Southwold Suffolk IP18 6RD     The quality rating for this care home is:   three star excellent 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: Julie Small     Date: 0 2 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 32 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 32 Information about the care home Name of care home: Address: Oaklands House Residential Home Blackwater Covert Reydon Southwold Suffolk IP18 6RD 01502724955 F/P01502724955 admin@oaklandshouse.healthcarehomes.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) : Pri-Med Group Ltd. care home 29 Number of places (if applicable): Under 65 Over 65 29 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Oaklands is a large detached property, and stands in wooded grounds within the Suffolk village of Reydon. The home has been adapted to meet the needs of older people in a hotel style setting and is registered to provide care and support for up to 29 service users. Oaklands is part of the Pri-Med Group of care and nursing homes, which was founded in 1976. Healthcare Homes Ltd purchased the company in March 2006 and the home continues to operate under the Pri-Med registration. Oaklands has a choice of attractive ground floor communal lounges, large conservatory and a spacious dining room. Good views are available of the landscaped grounds. The accommodation is on three floors with 6 bedrooms on the ground floor, 13 bedrooms on the first floor and 10 bedrooms on the second floor. All rooms are single occupancy and spacious, with en suite facilities. In all bar three of the en suite rooms this includes a bath or shower as well as the standard toilet and hand washbasin. The home has its own minibus transport enabling service users access to local shops, arranged entertainment events or day trips out. The minibus also provides access to Care Homes for Older People Page 4 of 32 Brief description of the care home Southwold and Lowestoft, for shopping. The homes manager stated that fees for the home range from £467 to £800 per week, items not covered by the fees include the use of services such as hairdresser, newspapers, chiropodist, manicurist and aroma therapist. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place Thursday 2nd April 2009 from 08:55 to 14:45. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The manager was present for the inspection and provided the information that was requested promptly and in an open manner. During the inspection three staff recruitment records, staff training records and the care plans, medication records and needs assessments of three people that live at the home were viewed. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and seven staff members, two visitors Care Homes for Older People Page 6 of 32 and four people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA), staff, relative and service user surveys were sent to the home. The AQAA, one staff, two service user and four relative surveys were returned to us. What the care home does well: 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 8 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 9 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. People who use this service can expect to be provided with the opportunity to visit the home to help them to make decisions about if they wish to move in, to be provided with a needs assessment prior to them moving into the home and to have their assessed needs met. Evidence: The records of three people that lived at the home were viewed and each held a detailed needs assessment which had been undertaken prior to them moving in. The needs assessments showed the support that people required in areas such as mobility, continence, medication and personal care. The AQAA stated a pre-admission assessment is always carried out to make sure that the home is appropriate for the prospective resident. A person who recently moved into the home told us that they had been provided with Care Homes for Older People Page 10 of 32 Evidence: a needs assessment and they were assured that their needs could be met in the home. Each of the records that were viewed held a care plan which detailed how their assessed needs were to be met. Two people that were spoken with told us that they had visited the home before they had made the decision that they wished to move in. One person told us that they knew that the home was the right place for them when they arrived for their visit. They said that they were provided with the opportunity of having a meal and meeting the other people that lived at the home and the staff. The manager told us that recently a person had an interest in the home, that they had stayed at the home for a short while and they were in the process of making a decision about if they wanted to move in. The AQAA stated we offer short term respite care to give the resident a trial period before any decision is made re: a permanent move. Prospective residents are invited for a meal. The relative survey asked if they had been provided with enough information about the home to help them to make decisions. Two answered always and two answered usually. Care Homes for Older People Page 11 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 excellent 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 can expect to be treated with respect, to be provided with a care plan which identifies how their assessed needs are to be met, to have their health care needs met and to be protected by the homes medication procedures. Evidence: The care plans of three people that lived at the home were viewed and each detailed the support that they were provided with to meet their assessed needs. The care plans included information of the support that people required in areas such as their personal care, what areas of their care that they could attend to independently, their preferred form of address, mobility, communication, the specific support that they required with sensory loss, dietary requirements, manual handling and continence. The care plans were regularly updated as peoples needs and preferences changed, for example where their independence with their mobility had deteriorated. Regular reviews of care plans had been undertaken and the person had signed the documents to show that they had been consulted with about the support that they were provided with. Care Homes for Older People Page 12 of 32 Evidence: The regional manager was spoken with and told us that the quality director had formulated a new care plan, which would be in place the following month. They explained how the care plans would increase the views and preferences of the people that lived at the home. People that were spoken with said that they felt that their needs were met at the home. The service user survey asked if they received the care and support that they needed. One answered always and one answered usually. The relative survey asked if their relative was provided with the support that they expected and agreed. Three answered always and one answered usually. Care staff that were spoken with told us that the care plans provided them with the information that they needed to meet peoples needs. Two care staff were observed to update the daily records during the inspection. The daily records were viewed and they detailed the support that people had been provided with, staff observations, peoples well being and the choices that people had made during the day. Each care plan that was viewed clearly detailed the persons wishes for end of life care. Information included their wishes for burial or cremation, if arrangements had been made and if they wished to be resuscitated. The AQAA stated end of life wishes and advanced directives are respected and documented so all members of the team are aware. The organisation has a working party which is planning how to implement the new End of Life Quality Markers identified in the 2010 National Strategy. Several cards and letters were viewed, which had been sent to the home by relatives thanking them for the support and care that they had provided to their dying relative. Peoples health care needs were met and the care plans that were viewed clearly showed the support that people had been provided with and the outcomes from health care appointments that they had attended, such as with the doctor, optician and chiropodist. The care plans clearly documented peoples weight, if they had issues with falls and pressure areas. All included risk assessments in these areas which identified the methods of minimising the risks. Three people that were spoken with said that they were provided with the opportunity to see a doctor if they wished and all three provided examples of when the staff had called in a doctor in a timely manner when they had complained of being unwell. The service user survey asked if they were provided with the medical support that they needed. One answered always and one answered usually. The relative survey asked if they were kept up to date with important issues that affected their relative. Three Care Homes for Older People Page 13 of 32 Evidence: answered always, one answered usually and comments included very good at keeping me informed on all aspects of my (relatives) medical changes and Ive been told every time something has happened, details of doctor visits etc.. Part of the lunch time medication was observed and it was noted that people were supported with their medication safely. The medication was administered from a trolley, which was secured each time the staff member left it, and the trolley held medication in its original packaging or MDS (monitored dosage system) blister packs. The MAR (medication administration records) were completed when people had taken their medication or appropriate codes were used when people had refused their medication, for example with PRN (as required) pain relief medication. The staff member clearly explained the procedures for the safe handling and administration of medication. They said that they had been provided with medication training, which was confirmed by the staff training records that were viewed. The staff member was observed to knock on peoples bedroom doors and wait to be invited in before entering. The interaction between the staff member and people was observed to be professional and respectful. The MAR charts of three people were viewed and it was noted that they were completed appropriately and all medication was accounted for. Two people that were spoken with told us that the staff helped them with their medication and that they were happy with the support that they were provided with. One person told us that they administered their own medication. Their care plan clearly identified the methods for the administration of their medication and how the staff made regular checks, which ensured that they were safeguarded and that they were taking their medication as prescribed. The AQAA stated that they had improved in the last twelve months we have worked hard in the internal audit process with regard to the administration and storage of medicines, allowing staff ownership and self regulation of the process. We have recently had a metal controlled drug cabinet fitted in line with changes in legislation. People that lived at the home were treated with respect and their privacy was respected. The interaction between staff and people that lived at the home was observed to be respectful and professional. All staff were observed to greet and smile at people as they moved around the home. People that lived at the home and visitors that were spoken with said that the staff were always respectful, polite, caring and attentive to their needs. One person said very much so and I have not met one nasty girl here. A person told us about how Care Homes for Older People Page 14 of 32 Evidence: they had been supported, which ensured that their needs and preferences were met. The support that they had been provided with included that the manager had ensured that their laundry was washed in non biological powder and their bed linen was laundered at the home (when others were sent out to an external laundry) to ensure that their needs regarding a skin condition were met. They told us that they had mentioned that their mattress was a little hard and that they had been provided with a new mattress the same day and they had said that the sun was bright in their bedroom and a window blind had been fitted that afternoon. People told us that they were happy with the laundering of their clothing and that they always received their own clothing after it had been washed. A person was observed to ask the manager if the mail had arrived. The person told us that the mail was delivered at different times throughout the day and they confirmed that they were always provided with their unopened mail. We observed a person that was on their way to their bedroom from the bathroom. A staff member was walking with them and it was noted that the staff member was very attentive, patient and they offered the person encouragement as they were moving along the corridor. Another staff member was heard to be supporting a person in their bedroom and it was noted that they were provided with the same respect and care as the previous person. Staff were observed to knock on bedroom and bathroom doors before entering them, which ensured that peoples privacy was respected. We were talking to a person in their bedroom and a staff member knocked their bedroom door to deliver a cup of tea and a biscuit. They apologised for interrupting us and offered that they could return when we had finished. The dignity of people that lived at the home was respected. It was noted that all people in the home were smart and clean. A visitor that was spoken with told us that the staff at always ensured that people were as independent as possible. Comments made in the relative surveys included promoting independence where possible and balancing privacy and support. Knowing when residents ability/judgement needs guidance. Knowing when to tactfully encourage mobility despite being easier/quicker for carer to use wheelchair... Care Homes for Older People Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be provided with an activities programme which is of interest to them, to be supported to maintain their chosen contacts, to be supported to make choices in their lives and to be provided with a balanced diet. Evidence: People were provided with the opportunities to participate in activities which were of interest to them. The activities coordinator was spoken with and they worked at the home Tuesday to Thursday 10:00 to 16:00. They had a large amount of materials that they used for activities, which included larger print bingo cards and arts and craft materials. During the inspection they were observed to take a person shopping to buy new shoes and they provided a prize bingo activity in the conservatory for those who chose to participate. On arrival to the home we noted that there was a number a newspapers that had been delivered to the home. There were several areas in the home which provided a large selection of books and video films for people to use. A local library service visited the home during the inspection and we noted that people were waiting for the visit to exchange their books. One person was observed to be provided with a selection of Care Homes for Older People Page 16 of 32 Evidence: talking books, which they said that they needed due to their deteriorating eye sight. There were several Easter bonnets in the conservatory, which had been made by people that lived at the home. The monthly activity programme was displayed on the notice board in the entrance hall to the home and it was noted that the people that were visited in their bedrooms had a copy of the programme. The activities programme included a visiting hairdresser, hand massage, manicure, Easter bonnet making and competition, Holly Communion, coffee and hot cross buns, a visiting violin and piano duet, Southwold shopping trip, reminiscence tea, ladies clothing sale, chiropodist, exercise and tea outings. The AQAA stated the activities programme is planned well in advance and is well publicised on the noticeboards and individual diaries and residents take advantage of the regular trips into Southwold and Lowestoft for shopping and social meetings. The AQAA said that they had improved in the last twelve months by the introduction of regular reminiscence sessions which has proved very popular, are often themed i.e. cream tea. Peoples records that were viewed included the details of activities that they had participated in, which included visiting entertainers and making stained glass windows. Three people that were spoken with said that there was plenty to keep them occupied in the home. One person told us that there were regular shopping trips to Southwold and Lowestoft, where they could buy the things that they needed and that the home had a small shop where they could purchase toiletries. They said that they often walked to the local shop if they needed to. They said that there were regular card schools held in the bar and conservatory areas that were organised by people that lived at the home. A person told us that they had recently been to the theatre and that if they told the staff at the home that they wished to see a show it was arranged. A person told us that they liked music and that they often played the piano in the home. Another person told us that they were supported to participate in their religious worship and that a friend visited the home who talked with them about their faith. The service user survey asked if there were activities provided that they could participate in. One answered always and one answered usually. The records of three people that lived at the home were viewed and each detailed the contacts that they chose to maintain with their friends and family and the methods of maintaining the contacts. People that were spoken with told us that their friends and family were always made welcome in the home when they visited. Two visitors to the home were spoken with said that they were always welcomed in to the home and that they were offered drinks and meals. A relative survey commented incoming calls to my (relative) are allowed - the staff bring to cordless phone to (the persons) room, Care Homes for Older People Page 17 of 32 Evidence: this enables distant family to keep in touch. A notice for the attention of visitors was displayed in the entrance hall to the home, which asked that visitors notified staff if they had brought in medication to ensure that it was recorded and electrical items into the home to ensure that they were tested, which ensured that people were safeguarded. People that were spoken with said that their choices were listened to by the staff at the home. Peoples records that were viewed showed how they had been consulted with about the support that they were provided with. The minutes of a recent residents meeting was viewed, which was displayed in the entrance hall to the home. The minutes showed that people were consulted with about issues in the home such as food, housekeeping, infection control, activities and outings. It was noted that there was a suggestion box in the entrance hall to the home. The AQAA stated choice of activities and menus are always on the residents meeting agenda and is also in the in house quality questionnaire. The AQAA stated that they had improved in the last twelve months with a bi-monthly newsletter is now in regular production, informing residents and relatives of events and news within the home. Two service user surveys said that the staff listened and acted upon what they said. People were provided with a well balanced diet. The menu was displayed on a notice board in the entrance hall to the home and people were provided with a copy. It was noted that there were two choices of each meal, for example trout with peppercorn sauce or lamb curry with rice for the Monday before the inspection and the day of the inspection lunch was roast beef and Yorkshire pudding or omelette and dessert was a selection from a trolley. Supper was smoked fish kedgeree or tongue sandwiches and black forest gateau or strawberry mousse. People that were spoken with reported that the food was excellent. They were particularly complimentary about the fish dishes that were provided. A person told us that they had asked the chef to include red cabbage and beetroot on the menu and they said that they were provided immediately. A person told us that there was always a potato dish and at least two fresh vegetables with each meal, and that they could have as much vegetables as they liked. We asked if their meals were provided on service plates on the table to help themselves to and they replied oh no its silver service dear. This was confirmed when we observed lunch time, the staff served each person individually at the table and they were provided with their choices of meal and accompaniments. The meal looked and smelled appetising and it was noted that the dining room was attractively decorated and furnished. Tables were laid with napkins, table cloths and condiments. Care Homes for Older People Page 18 of 32 Evidence: The AQAA stated meal times are a valuable social part of the residents day, taken in the comfortable dining room or spacious conservatory. We provide a hotel style menu and mostly use local seasonal produce. Visitors and relatives are welcome to eat with their resident whenever they wish. Two visitors were spoken with and they said that the meals at the home were very good and they were also complimentary about the fish dishes. They also told us about how good the Christmas buffet had been. Comments in the relative surveys included excellent well balanced food, plenty of choice and excellent food. The service user survey asked if they liked the meals at the home. One answered always and one answered usually. The chef was spoken with told us that they were kept informed of peoples specific dietary requirements and that they regularly attended residents meetings to ensure that people were happy with the menu. The minutes from a recent residents meeting were viewed and it was noted that people had thanked the chef for the recent inclusion of vegetarian options on the menu. The chef was observed to follow good infection control procedures and washed their hands often. They showed us the records of the regular fridge, freezer and food temperature checks that they made, which ensured that food was served and stored at appropriate temperatures. During the inspection people were observed to be provided with a regular choice of hot drinks and it was noted that people who were visited in their bedrooms were provided with a jug of cold drink and a glass that was within easy reach, which showed that they were provided with regular drinks to minimise dehydration. Care Homes for Older People Page 19 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. People who use the service can expect to be protected from abuse and to have their complaints listened to and acted upon. Evidence: Staff that were spoken with had a clear understanding of their roles and responsibilities regarding the protection of people that lived at the home. They said that they had been provided with safeguarding training, which included a house keeping staff member that was spoken with. The staff training records that were viewed confirmed that staff were provided with safeguarding training which was regularly updated. There was a copy of the local authority safeguarding guidelines November 2008 provided in the entrance hall to the home, which ensured that staff, visitors and people that lived at the home were provided with easy access should they wish to refer to them. The AQAA stated we ensure that our staff are trained in the safeguarding and protection of vulnerable adults and they understand how to make a referral to the adult protection team. The complaints procedure was displayed on a notice board in the entrance hall to the home, which provided people with information of what they could expect if they wished to make a complaint about the service that they were provided with. The AQAA Care Homes for Older People Page 20 of 32 Evidence: stated [staff] are aware of the the residents right to raise any concerns or complaints that they might have. Copies of the complaints procedure are available for residents use and it is also available in large print and an audio version. Three people that lived at the home and a visitor were spoken with and they said that they knew how to make a complaint if they were not happy with the service that they received. Two service user surveys and four relative surveys said that they knew how to make a complaint. The relative survey asked if their concerns had been acted upon appropriately. One answered always, one answered usually and comments included never needed to query the care, so can not answer but have no reason to believe they would not respond to my satisfaction, they are very responsive to my concerns and not applicable. A staff survey and staff that were spoken with said that they knew what actions to take if a person wished to make a complaint. The complaints book was viewed, which identified the nature of the complaint, actions taken and the correspondence that had been undertaken with the complainant. There had been one complaint received since 2007, which had been investigated and acted upon appropriately in a timely manner. Since the last inspection a grumbles book had been developed, which held details of informal concerns that had been received and the actions taken as a result of the concerns. It was noted that all concerns had been acted upon in a timely manner. Several compliments had been received at the home from relatives of people, which were letters and cards thanking the staff at the home for the support that they had provided to their relatives. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can expect to be provided with a clean, comfortable and well maintained environment to live in. Evidence: A tour of the building was undertaken during the inspection and it was noted that the home was clean and furnished and decorated to a high standard. There were no unpleasant odours. The home was accessible to the people who lived there and it was noted that there were grab rails provided. All radiators were covered, which ensured that people were safeguarded from the risk of burns. Two service user surveys said that the home was fresh and clean. People who lived at the home and visitors that were spoken with were complimentary about the environment. One person said that they felt that the decor of the home was very tasteful. The communal areas to the home included two lounges, a dining room and conservatory, which were all clean and attractively furnished and decorated. The grounds were well maintained and people could walk around the grounds if they chose to. The AQAA stated the home is well maintained to ensure resident comfort, the residents rooms regularly refurbished to maintain the high standard of Care Homes for Older People Page 22 of 32 Evidence: accommodation we offer. Three people were visited in their bedrooms and it was noted that they were warm, clean and attractively furnished and decorated. Each room held items of the persons personal memorabilia and the room reflected their individuality and choice. There were call bells provided in each room, which provided people with a system where they could call for help if they needed to. People spoken with said that they liked their bedrooms and that they had been provided with the opportunity to bring items of their own furniture from home. One person said that they did not need to bring in items as there was sufficient good quality furniture that was already provided. The laundry was viewed and there were two washing machines and one dryer provided. The laundry was clean and tidy. Bathrooms, toilets, the kitchen and the laundry were provided with hand wash facilities, which included hand wash liquid and disposable towels which minimised the risks of cross infection. Throughout the inspection care staff, house keeping staff and kitchen staff were observed to use good infection control procedures, which included hand washing and wearing protective clothing and disposable gloves when working with food, medication and supporting people with their personal care needs. Staff spoken with had a good understanding of their roles and responsibilities regarding infection control. Staff training records that were viewed showed that staff were provided with infection control training. The AQAA stated that they had improved in the last twelve months we have nominated infection control liaison officer who attends regular meetings with the local health protection team and ensures we meet requirements as in the essential steps document. During the inspection we observed three domestic staff on duty, who undertook the house keeping duties in the home. A house keeping staff member was spoken with told us that there was usually three staff on duty to ensure that the home was kept clean and tidy. The AQAA stated the house keeping team maintain a high standard of cleanliness and work hard to maintain an odour free environment. Care Homes for Older People Page 23 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. People who use the service can expect to be supported by staff who are trained and qualified to do their jobs and to be protected by the homes recruitment procedures. Evidence: During the inspection staff were observed to be attentive to the needs of people that lived at the home. The interaction between all staff and people was observed to be respectful, friendly and professional. People that lived at the home who were spoken with were complimentary about the approach of the staff at the home, they told us that they were caring, supported them when they needed it and that the call bells were answered promptly. Two service user surveys said that the staff listened and acted upon what they said. The survey asked if the staff were available when they needed them and one answered always and one answered usually. A staff survey said that there was always enough staff to meet peoples needs. Three day care staff, one night staff, one house keeping staff and a member of the kitchen staff were spoken with and they all told us that they felt that there was sufficient staff on duty at all times to meet the needs of the people that lived at the home. The rota was viewed and confirmed the staffing levels which we had been told about. The AQAA stated we ensure that we have staff in adequate numbers and with Care Homes for Older People Page 24 of 32 Evidence: appropriate skills to meet the needs of residents and the duty rota is produced four weeks in advance to ensure a good skill balance per shift within budgetary requirements. The home had met the target of at least 50 staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2, as identified in the National Minimum Standards relating to older people. The AQAA stated that there were sixteen permanent care workers at the home and ten had achieved a minimum of NVQ level 2 in care. The NVQ was a qualification in which staff were assessed on their competence to perform their work roles. Staff training were viewed, which included training certificates that were displayed in frames on the wall of the main stairway in the home, training certificates filed in three staff members records and a training matrix. The training records showed that the staff were provided with the training that they needed which enabled them to meet the needs of people that lived at the home. Training included medication, safeguarding, Mental Capacity Act, health and safety, manual handling, infection control and an induction which incorporated the Skills for Care Common Induction Standards. Training certificates were displayed in the kitchen to show that kitchen staff had been provided with the training that they needed, which included food hygiene. The manager told us that the training was updated regularly which ensured that staff were kept up to date with the requirements of their roles. The AQAA stated new staff receive a welcome pack, a job description and full induction training and all staff are encouraged to take advantage of any additional training accessible and the attendance of mandatory training made as convenient for the staff as possible. The AQAA also stated the improvements that they had made in the last twelve months, which included we have achieved our training targets and offer all our staff the chance to develop their knowledge with distance learning courses and we have nominated a training coordinator to keep records up to date and help track gaps in staff knowledge. Three care staff that were spoken with told us that the training provision was very good and that their training was regularly updated. A house keeping staff member was spoken with and told us that they had been provided with training, which included safeguarding, infection control, manual handling and health and safety. During the inspection we observed staff participating in a morning or afternoon training session on health and safety, which confirmed that staff were provided with updated training. Care Homes for Older People Page 25 of 32 Evidence: A staff survey said that their induction covered everything that they needed to know to do the job when they started and that they were provided with training which was relevant to their role, helped them to understand the individual needs of people and that kept them up to date with new ways of working. The relative survey asked if the care staff had the right skills and experience to look after people properly. Two answered always and two answered always. The recruitment records of three staff members were viewed and they showed that the appropriate checks had been made which ensured that people that lived at the home were protected by the homes recruitment procedures. The checks that had been undertaken were CRB (Criminal Records Bureau) checks, POVAfirst (protection of vulnerable adults) checks, two written references, a history of their working careers and identification. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to live in a home which is well managed and run in their best interests. They can expect that they are supported by staff that are supervised in their job roles and to have their health, safety and welfare protected. Evidence: The manager had achieved the appropriate care and management qualifications that they needed to do their job and they had been successful in the CSCI (Commission for Social Care) registered manager application process, which showed that they had been assessed as fit to be in charge of the home. The manager was positive about the inspection process and provided the requested information promptly and in an open manner. They had a clear understanding of their roles, responsibilities and the needs of people that lived at the home. The manager had returned the AQAA to us when we asked for it and it was noted that the AQAA clearly showed what the home did well and the identified areas of continuous improvement to the service that was provided at the home. Care Homes for Older People Page 27 of 32 Evidence: Staff, people that lived at the home and visitors that were spoken with were complimentary about how the home was managed. They told us that the manager was approachable and acted quickly on concerns that they may have. A person that lived at the home told us about how the manager had acted on issues when they first moved into the home and these are discussed fully in the health and personal care section of this report. Staff that were spoken with said that they felt supported in their role and that they were provided with regular supervision meetings, this was confirmed by the three staff records that were viewed. The regional manager was spoken with during the inspection and they clearly identified their role in ensuring that quality assurance activities were regularly undertaken and that the home was run in the best interests of people that lived there. Their roles included undertaking regular audits and Regulation 26 visits, in which people were provided with the opportunity of telling the regional manager about their experiences of living in the home. The Regulation 26 visit reports were filed in the home and were available for inspection. Further quality assurance exercises where the views of the people who used the service were sought included regular residents meetings, consultation in their care planning and regular care reviews. Annual satisfaction questionnaires about the service that was provided were also undertaken to seek the views of the people who lived at the home, staff and external stakeholders, such as health care professionals. The quality assurance report was viewed, which was displayed on the notice board in the entrance hall to the home for the attention of people in the home. The report included the results from the satisfaction questionnaires which had been completed 2008. The document included the areas for improvement that had been identified in the questionnaires and the actions that had been to address the issues. Peoples health, safety and welfare was safeguarded. We observed the finance records of two people that lived at the home and they clearly showed all transactions that had been made. The fire safety records were viewed and showed that regular fire safety checks were regularly undertaken which ensured that people were protected in case of a fire. The fire procedure was displayed around the home for the attention of staff, residents and visitors. A health and safety audit was viewed, which detailed the checks that had been undertaken to ensure that the environment was safe. The audit included checks that the fire safety checks had been undertaken, that there was a COSHH (control of Care Homes for Older People Page 28 of 32 Evidence: substances hazardous to health) risk assessment, that the employers liability insurance certificate was displayed and up to date, that water temperatures were regularly undertaken and that all staff had been provided with food hygiene training. The records of regular water temperature checks were viewed, which were kept in the bathrooms, which ensured that people were protected from scalds. Checks which showed that food was stored and served at appropriate temperatures were made and the records were viewed in the kitchen. The training records of staff were viewed and they showed that they had been provided with training which showed that they were made aware of working in a safe manner, which included health and safety, food hygiene, infection control and manual handling. 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 Care Homes for Older People Page 31 of 32 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. 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