Inspection on 04/08/09 for Patcham Nursing Home

This is the latest available inspection report for this service, carried out on 4th August 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

Patcham Nursing Home 10/01/06

Patcham Nursing Home 17/08/05

Patcham Nursing Home 23/11/04

Patcham Nursing Home 15/06/04

Similar services:

Old Hastings House

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Patcham Nursing Home Eastwick Barn Eastwick Close Brighton East Sussex BN1 8SF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Dudley     Date: 0 4 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Patcham Nursing Home Eastwick Barn Eastwick Close Brighton East Sussex BN1 8SF 01273-501358 01273-542028 pat@patchamnursinghome.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Eastwick Barn Ltd care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 30 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category : Physical disability(PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Patcham Nursing Home is situated in a pleasant residential area on the outskirts of Brighton, close to a bus service and all main routes to the city centre. It provides nursing care for thirty service users over 65 within the categories of elderly care, physically disabled and terminally ill. Care is provided in exceptionally well-maintained and comfortable surroundings with access to a well-maintained and interesting garden. A high standard of catering is provided. The home was extended from a converted barn and has exposed beams in some areas. Accommodation is provided in either Care Homes for Older People Page 4 of 30 0 30 Over 65 30 0 Brief description of the care home single or double rooms, most of which have views of down land or the garden. There are two lounge areas, one large and one relatively small, both of which give access to the gardens. Garden access is also available from some ground floor rooms. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on the 4th August 2009 from over a period of seven and a half hours from 10:00 to 17:30. It was facilitated by the registered manager, Mrs S Kidd and the registered providers, Mr and Mrs C Dauncey. Prior to the inspection the Annual Quality Assessment (AQAA) was requested by the Care Quality Commission and this was received when we asked for it. This is a document required by regulation which tells us what has been happening in the home in the past twelve months and how the home has improved outcomes for the residents. It tells us what the manager and owner have planned for the next twelve months. This document was well written and comprehensive and gave us clear and comprehensive information. It also gave us some numerical data which is used to inform the inspection. Care Homes for Older People Page 6 of 30 The Care Quality Commission also sent surveys for ten residents,eight staff and three stakeholders and asked the home to distribute them to relevant people. All of these surveys were completed and returned and thanks are extended to the residents, staff and health care professionals. Comments made on these surveys were used in the inspection and in the formation of this report. Other methods used to form the judgments made in this inspection included the examination of documentation such as care plans, medication charts, health and safety and catering documentation and personnel files. All areas of the home were visited including residents accommodation and whilst all residents were seen, eight residents were involved in the inspection and gave their views on life in the home. There are twenty eight residents currently living at the home. During the day discussions were held with nine members of staff; and two visitors and three health care professionals were met with and contributed to the inspection process by giving their points of view on how the residents needs were being met. The last inspection on this service was completed on the 17th October 2006. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? A requirement was made at the last inspection relating to staff personnel files, this has been complied with. During the past two years the home has been changing its double rooms to single rooms, they are in the process of converting the last room and building another room to use as a single room. The total number of residents will remain unchanged. Care Homes for Older People Page 8 of 30 Since the last inspection the home has continued to explore ways of improving the services offered to residents. Ongoing investment in staff training has resulted in the staff becoming accredited with commendation by the Gold Standards Framework; which ensures that residents reaching the end of their lives receive a nationally recognised high standard of care and ensures that they are kept free from pain. Staff are now skilled at this type of care. The home perceived a lack in its own expertise at providing a diet which appeals to the varying tastes and needs of the older person, it therefore joined the National Association of Care Catering which has enabled staff to attend courses in nutrition and given the home fresh ideas, particularly in adding taste and texture to the pureed foods necessary for some residents. The home has been proactive in ensuring that it was ready for the implementation of the recent Mental Capacity Act which includes Deprivation of Liberty Safeguarding by preparing the staff by sending them on the relevant training and ensuring the relevant paperwork is ready in the home if required. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a good range of information for prospective residents to enable them to make a decision about whether the home is the right place for them. Thorough and personalised preadmission assessments are undertaken by the manager to ensure the home is confident that they can meet the individuals assessed needs. Evidence: The home has produced an innovative range of information for prospective residents. The brochure, which is initially sent out following an enquiry, contains useful fact sheets which address the different problems an individual faces on making the decision to come into a care home, the relevance of the different fact sheets sent with the brochure is determined by the information given at the initial enquiry. The Service User Guide is similarly produced and also includes questions new residents may wish to ask and the answers to these questions, such as How do I get my laundry done. All residents receive a copy of the Service User Guide on admission Care Homes for Older People Page 11 of 30 Evidence: to the home, although the manager also takes one with her when she assesses prospective residents. All prospective residents are fully assessed by the manager; and following this, receive written confirmation about whether the home can meet their needs. Three preadmission assessments belonging to recently admitted residents were examined, these were very comprehensive and contained a substantial amount of information relevant to the social and health and personal care needs of the residents. This formed the basis of the care planning. The manager said that she endeavours to find out as much information as possible from the individual, their family and health or social care professionals, as its such an important life change for anybody. Two residents said that their experience of the home on admission had been good with one of them saying When I got here I was met by this very nice person who explained she would be my key worker and brought me a welcome cup of tea, she helped me settle in and explained everything I needed to know. Prospective residents are encouraged to visit or spend time in the home prior to deciding whether they wish to live there. Every resident, irrespective of their funding arrangements, receives a contract and terms and conditions of residence following their admission the home. The home admits people for permanent, respite and continuing care but not for intermediate care. Care Homes for Older People Page 12 of 30 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. Staff deliver a good standard of care which meets the residents needs and expectations and upholds their dignity. The standard of medication administration safeguards the residents in the home. The home has gained accreditation in the implementation of the Gold Standards Framework therefore enabling the home to ensure that staff are aware of, and residents expect and receive, a nationally recognised standard of care at the end of their lives. Evidence: There are twenty eight residents currently living in the home, with a diverse range of nursing needs. The care planning for these residents is sufficiently personalised to meet these needs and ensure that the care is given in a way that takes into account individual preferences regarding the way that the care is given. Examples of this included prefers to have personal care before breakfast, does not wish to have wound care until later in the day. Care Homes for Older People Page 13 of 30 Evidence: Six care plans were examined and the standard of care planning was generally good. All of the care plans included nutritional care plans (using a malnutrition universal screening tool, to ensure that the resident meets the recognised nutritional screening tool), tools for assessing mental capacity and for deciding whether the resident has any needs for deprivation of liberty under the new safeguarding requirements, risk assessments for pressure damage and skin integrity and wound and continence care plans as required. Evidence of doctors visits and required treatments were present in all plans and daily records generally identified the care that had been given that day. Recommendations were made to the manager regarding the need for more clarity in the instructions for care staff, ie in showing how many staff would be needed to assist an individual with bathing, and also for more detail in the daily records. Information regarding details such as required pressures on pressure relief mattresses, food and fluid and turning charts are kept in residents rooms. It was recommended that information regarding mattress pressures and continence aid sizes are also included in the care plans. Social care plans need to be more in depth, although again more information is generally kept in the folder used by the activities co-ordinator, this should form part of the main care plan, and the use of night care plans is recommended. The manager and provider said that they are considering in purchasing a commercial care planning system which will facilitate the care planning process. The home was in the process of updating the format of risk assessments for bed rails to include recent information from the Medical Devices Agency and other risk assessments are being similarly reviewed to ensure that they meet current legislation. Whilst all residents were seen during the day, eight residents were visited in their rooms and residents that required to be nursed in bed were also seen, they appeared comfortable with appropriate equipment in place and evidence of frequent nursing interventions taking place. Any care taking place was upholding both dignity and privacy of the resident. Charts recording nursing and care interventions were up to date and detailed, providing a clear picture of how much fluid the resident was offered and the care given. Care Homes for Older People Page 14 of 30 Evidence: Residents spoken with all made very positive comments about the care given: Wonderful care here, the staff are excellent and very friendly and polite. Everything, the care, the staff, the manager, are excellent. You are a person, an individual here, the staff listen to your wishes and act upon them. Residents said that their call bells were answered promptly and If they cannot attend to your needs straight away when they are busy elsewhere, they say they will be back in a few minutes and they are. There were no call bells noted sounding for more than a few minutes on the day of the visit. Subsequent to the inspection,a survey received expressed some concern that in the evenings there were sometimes no staff readily available in the lounge and therefore immobile residents would have difficulty in reaching the call bell should they be in difficulty. Two General Practitioners were spoken with, they said that The care is very good here, very high standard. They call us when they need us and the care here is very good. Three surveys returned from General practitioners who visit the home made only positive comments about the home Very good personal and nursing care, very professional. A medication round was observed and medication charts, storage and recording examined. The standard of medication administration, recording and storage of all medication, including controlled drugs, safeguarded the residents in the home. It is recommended that medication given on an as required basis, has information in the medicine charts which states when that medication will be used for the specific individual. Whilst residents are enabled to administer their own medication if they so wish, the home must ensure that risk assessments are in place. Currently only one person is self medicating, and this does not include oral medication but creams and inhalers. The manager gave assurances that a risk assessment would be put in place. The home has recently received its accreditation, with commendation, for the implementation of the Gold Standards Framework within the home (a recognised nursing framework used alongside the Liverpool Care Pathway, which ensures that people reaching the end of their lives receive a nationally recognised high standard of care and pain relief). Care Homes for Older People Page 15 of 30 Evidence: Care plans contain advance care planning for residents for when they reach the end of their lives including their preferred place for this and whether they wish for any interventions to take place. All members of nursing staff have the skills to implement syringe drivers if required. Letters from relatives of deceased residents were seen, complimenting the home on the care that was given during the residents stay in the home. Care Homes for Older People Page 16 of 30 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. The home provides a good range of leisure activities which enables people to pursue past interests and engage in new ones. The standard of catering is very good but residents were not aware of choices at all the meals and may benefit from more attention to attractively set up tables and trays. Evidence: The home provides a range of activities varying from art and craft, cake making and icing to Tai Chi and a Scrabble club. It produces a newsletter at interim periods throughout the year and encourages residents to take part in this and also encourages residents to follow previous interests, one resident is being encouraged to maintain his interest in model making and painting, both of which take place to a professional standard. They employ an activities co-ordinator for thirty hours a week and she has set up a full programme of activities and engages residents in these. One to one sessions and hand massage is provided to residents who are too ill to take part in activities. A pianist comes in monthly to entertain residents and in July farm animals including Care Homes for Older People Page 17 of 30 Evidence: piglets, ducklings and an owl were brought into the garden for residents to pet and enjoy. The home provides wireless internet access throughout the home, and although only one resident currently uses the computer they are encouraging other residents to get involved with this. The home also provides Sky television in residents rooms for those residents who wish for this. All residents that wish for it are provided with suitable phones in their rooms and the home does not charge for any phone calls made. Residents said that there is a good variety of activities, I loved the owl, you have a good choice of what to do and (the activities coordinator) is very innovative. She ( Activities coordinator) taught me to ice cakes which I have never been able to do. I enjoy the Tai Chi, we do it in the garden. One survey from a resident said that It would be nice to have people come into talk about art, travel, music etc and It would be nice to have a shopping service as those who do not have relatives cannot get shopping and its not good to always ask the staff. The manager was made aware of these comments and will look into arranging this. Records are kept of residents participation in activities and their interests. Residents said that they have choices around their activities of daily living, including rising and retiring, and this was evident on the day. A resident said Goodness, yes, we do whatever we want, when we want. Visitors are able to visit at any time and visitors were seen arriving from early morning. Two visitors were spoken with and they expressed satisfaction with the home: Very good and very caring here. They are able to join residents for meals if they wish to do so. A Church of England service is held at intervals and ministers of other denominations visit the home as required. Menus were varied and the all diets can be catered for. The residents currently are only offered one choice at lunch and supper, which only became apparent on talking to residents. They are offered a second choice if they do not like the main menu. Previously the home was offering two main choices at each meal and also extra choices such as omelettes and baked potatoes. Care Homes for Older People Page 18 of 30 Evidence: Although the cook said that they can have whatever they wish, not all residents were aware of this. There has been a change of catering staff and the provider and manager were not aware that choices were not being offered as a general rule. They have said that this will be addressed. Residents have a full choice at breakfast including a cooked breakfast every day if they wish. Snacks and beverages are available throughout the day and the night. All residents spoken with and all surveys received stated that the food provided was of a very high standard and that they enjoyed the meals. Excellent food. Very good food, always freshly cooked and using good ingredients. The provider has recently changed his sources of buying food to local farms and companies, and said the quality of the food has improved. The home has joined the National Association of Care Catering, primarily to get more advice on serving pureed food, which is often required, but say that this has helped with the menu in general. Staff have undertaken training in nutrition and assisting residents with meals and this was seen taking place in an empathetic and caring manner with staff sitting down and talking to those residents whom they were assisting. Meals can be taken at the dining table in the lounge, at tables next to residents chairs or in the small lounge or their rooms. The majority of the residents take their meals in their rooms. Food and fluid charts are filled out for those residents at a risk of poor nutrition. Currently the home is not providing trays for residents food at lunchtime, this being served from the heated trolley on the first floor and taken into the residents rooms and put direct onto the individual tables, the resident is not provided with condiments. The provision of well set out trays and dining table would add to the residents enjoyment of the dining experience. This was discussed with the manager who said that they would commence this. The cook is suitably qualified and the home was awarded 5 stars by the Environmental Health Authority. Care Homes for Older People Page 19 of 30 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. Any complaints received are addressed in a thorough and transparent manner, with residents saying that they felt comfortable and confident about making a complaint should the need arise. Staff were aware their responsibilities regarding the safeguarding of those in their care. Evidence: All residents have a copy of the complaints procedure which is included in the Service User Guide and there is a copy displayed in the entrance foyer. Residents spoken with said that they were aware of how to make a complaint and were confident that this would be addressed in an open and transparent manner. The home has received two complaints in the past year which the commission was made aware of, neither of these were substantiated. The home has had six minor concerns which have been addressed by the manager. Records of concerns and complaints are kept in a confidential manner which includes details of how these have been addressed. Staff have received training in the Mental Capacity Act and its implications in their care of the residents, with the appropriate forms being in the care plans. Senior staff and the manager have also attended training in the Deprivation of Liberty Safeguarding and this will be cascaded to other staff. The manager has the correct forms in place should any be any resident about whom there is a query about the safety of them having freedom to do as they wish. There are no residents in the home Care Homes for Older People Page 20 of 30 Evidence: of this category at present. There have been no adult safeguarding issues in the home, staff have had the relevant training in the safeguarding of those in their care and were aware of their responsibilities towards those in their care. It was recommended that the provider and manager attend training with the local authority to update their knowledge of reporting protocols which have changed considerably during the past two years. This was accepted by the provider and the manager. All residents are enabled to participate in the civic process by postal votes and the majority of those who are able, do so. The manager also has links with an agency that provides advocacy services and will access advocates for those residents that require this. Some residents spoken with said that the manager had made them aware of this facility. Care Homes for Older People Page 21 of 30 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. The environment is attractive and clean and provides a pleasant home for residents. There is sufficient equipment in the home to maximise residents independence and to reduce the risk of pressure damage. Staff receive training in the control of infection Evidence: The home has had some of the double rooms made into single rooms in the past two years and is in the process of commencing more building work to convert the remaining double room into single and provide another single room and new office facilities. Communal space consists of two lounges, one of which is used as lounge/ dining room. There is a large attractive and well maintained garden which is accessible to all residents. Work has taken place in the garden to provide an extra water feature and additional paths and raised beds are planned. Some of the ground floor residents rooms have patio doors opening onto the garden and they are encouraged to keep their own pots of flowers. The home consists of two floors which are served by a shaft lift. Residents accommodation consists of single rooms with en suite facilities and the rooms are very light and pleasant, most giving views over the garden or looking out Care Homes for Older People Page 22 of 30 Evidence: onto adjacent wooded downland. All residents rooms have lockable door and drawer facilities with residents being given keys under the auspices of risk assessment. Assisted bathrooms are provided and there are adequate toilet facilities. Hot water temperatures to residents outlets are monitored and recorded and records showed that temperatures were within recommended parameters to prevent scalds or infections. Other equipment provided to encourage residents to retain their independence includes hoists, grab rails and raised seats. The home provides moving and handling equipment and pressure relieving mattresses and cushions. A member of staff said that: The owners are brilliant at providing any equipment we may need to help us in the care of the residents and to help residents keeping independent, the only problem being that we do not have sufficient storage facilities for these. All areas of the home are very clean and the housekeeping staff are to be commended on the efforts they have made to maintain the cleanliness of the home, particularly during the time when building work is going on, this was mentioned by a resident who said even when they were building there was no dust anywhere. All staff have received training in infection control and there is an infection control champion in the home (a member of staff who has received specific training in the control of infection and liaises between the home and the Health Protection Agency to ensure that the appropriate controls and policies are in place). There are sufficient disposable gloves, aprons and hand gel in place and staff were seen to be using these appropriately . Residents praised the standard of the laundry service provided by the home. Again, the laundry room was clean and organised, with red bags being used for soiled linen and a relatively new range of up to date equipment in place. Care Homes for Older People Page 23 of 30 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. There are sufficient staff with suitable training to ensure that the residents in the home receive care which meets their needs. The home is proactive in ensuring that all grades of staff have the opportunity to participate in further training relevant to the work they have to do, and encourages the registered nurses to attend specialist courses to further their knowledge and skills and ensure a good quality of care for the residents in the home. Evidence: Staff appeared to be working in an unhurried, efficient and confident manner. The duty rota, and staff spoken with, showed that there were sufficient staff on duty at all times in the home and surveys received from staff and residents verified this. Staff were polite and helpful and there was evidence that they treated residents with respect and dignity. There was evidence of sufficient training taking place. All new members of staff commence by having the homes own brief induction which includes moving and handling training and fire training by staff members who have the relevant qualification to do this. Care Staff are then commenced on the Skills for Care, a nationally recognised induction course. Other training is supplied by the Nursing Home Support Team and staff are Care Homes for Older People Page 24 of 30 Evidence: encouraged to participate in other relevant training. Registered nurses attend updating of their skills and learn specialist skills with the Nursing Home Support Team or attend training at the local university or hospital. Nineteen out of the twenty two care staff have attained the National Vocational Qualification in Care at level 2, with the other three members of staff about to study for this. The Laundry assistant also stated that she wished to attain a National Vocational Qualification in an appropriate subject. The cook has had further training on catering for the older person, and the activities co-ordinator has attended an accredited course the provision of activities for the older person. Robust recruitment procedures are in place with the five personnel files examined all containing the appropriate references and checks as required by legislation. The manager checks the PIN of registered nurses prior to employment and on an annual basis and keeps records of these. Care Homes for Older People Page 25 of 30 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. Management systems in place ensure that residents are safe and that the quality of life offered meets their needs and expectations. The ethos in the home ensures that staff retention is good and contributes to the happiness of the residents. Evidence: The manager has been in post for six years and is a registered general nurse with a midwifery qualification. She has attained the Registered Managers Award and is registered with the commission. Under her guidance the home has continued to be innovative in improving the quality of life for the residents in the home and maintain high standards of care. Staff and residents spoke of the good atmosphere in the home; Its a friendly homely place. The manager and the owner are always available and we see them very regularly. Excellent home. Lovely place to work. Staff turnover is low enabling Care Homes for Older People Page 26 of 30 Evidence: residents to have a continuity of care from staff that they are familiar with. the AQAA was received when we asked for it and was very well written and comprehensive giving full and accurate information on what was taking place in the home. The manager holds regular staff meetings and minutes seen show that staff are encouraged to give their views on life in the home as well as being updated on training matters in the home. Residents and relatives meetings are not held as the manager says she sees people individually as they come into the home, and goes and talks with all residents most days. The home sends out questionnaires to residents, relatives and stakeholders, inviting them to give their views on the various services offered by the home and there was evidence that the home listens and acts on these views; ie menus have been reviewed in accordance with residents wishes. All staff are receiving regular supervision and records were seen of these. Regulation 26 reports (monthly visits to the home by the provider and reports thus generated, which are required by regulation) were seen, and had been undertaken within the required timescales and included evidence of interviews with residents and staff. The home manages the money of one resident. The resident has their own bank account and records of money spent and appropriate receipts were in place. All policies and procedures were in place and the manager is in the process of the forming a policy on the Mental Capacity Act and Deprivation of Liberty Safeguarding to guide staff in their use. Other records seen in the home were up to date and secure. Staff have received mandatory health and safety training and records showed this was up to date. The AQAA stated that all servicing of utilities and equipment was in date, and there are risk assessments in place for all areas of the home. All windows have restrictors and these were patent. Care Homes for Older People Page 27 of 30 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 28 of 30 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 9 That medication folders include information regarding the individuals symptoms which will require as required medication to be administered. In the event of any service user self administering medication either external or oral, a risk assessment must be in place. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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