Inspection on 26/10/09 for St Peter`s House

This is the latest available inspection report for this service, carried out on 26th October 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

St Peter`s House 06/02/07

St Peter`s House 01/03/06

St Peter`s House 05/09/05

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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: St Peter`s House 29 Out Risbygate Bury St Edmunds Suffolk IP33 3RJ     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: Ann Wiseman     Date: 2 6 1 0 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: St Peter`s House 29 Out Risbygate Bury St Edmunds Suffolk IP33 3RJ 01284706603 01284706811 gnm@countycarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): County Care Homes Limited Name of registered manager (if applicable) Mrs Moira Elizabeth Clare Manager post vacant Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 36 The registered person may provide the following categories of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia - Code DE, Mental Disorder, excluding learning disability or dementia - Code MD, Old age, not falling within any other category - Code OP Date of last inspection 1 8 1 2 2 0 0 8 36 36 0 Over 65 0 0 36 Care Homes for Older People Page 4 of 30 Brief description of the care home St Peters House is close to the centre of Bury St Edmunds, opposite the West Suffolk College and is within a residential area close to local facilities, such as shops and churches. It has recently been extended to accommodate up to 36 older people and now specialises in caring for people who have dementia. The building, which is set in its own grounds, has ample car parking spaces and an enclosed garden and patio area. The accommodation was originally in a converted domestic dwelling but now the majority of it is in a purpose built extension. Since the recent building work the whole home has been refurbished and decorated to a high standard. The cost of living in the home ranges between £650.00 and £850 per week and depends on the size and location of the accommodation. 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: Since we have last inspected St Peters it has been closed for many months to allow the home to be almost completely rebuilt. What was a small fifteen bedded nursing home now has 36 beds and is a specialist home for people with dementia. The building work has been carried out to a high specification and the new furniture is contemporary and of a high standard. The home reopened in June 2009 and the manager and the workforce were all newly appointed when it reopened. This was an unannounced inspection; we arrived at 9.00am in the morning and stayed for seven hours. The manager and the providers were at the home when we arrived and they all facilitated the inspection, which they did in an open and helpful manner. Whatever files and documents we asked to see were produced quickly. During the day we had a look around the home and because the majority of the residents have Care Homes for Older People Page 6 of 30 dementia which affects their ability to communicate fully, we made time during the inspection to sit in the main lounge and closely observe the interaction between the staff and people living there so that we were able to judge their wellbeing. We also had opportunities to talk with the residents, their visitors and the staff to get their opinions. We looked at information belonging to four people and some of the of the staff files. We also assessed some of the homes policies and procedures and sampled a random selection of the health and safety files and records. The manager had sent us the Annual Quality Assurance Assessment (AQAA) she had completed prior to the inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. The detail given to us in the AQAA was detailed and informative and the manager gave us some good examples to underpin what she had told us. Care Homes for Older People Page 7 of 30 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 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 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 9 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. Using the information in their literature, people are able to make an informed decision about moving into St Peters. Evidence: St Peters House has recently been extended and refurbished and the number of beds have been increased form 15 to 36. During the building work the home was closed and it reopened in June 2009, the service is no longer registered as a nursing home and is specialising in offering dementia care. The statement of purpose is well written and fully reflects the service offered to people, an extract from it says, The manager or deputy will carry out an assessment of needs, usually in the persons home environment to ensure St Peters can meet the individual needs of the resident. This also enables management to present to the appointed key worker a holistic picture of the new resident to make the transition to St Peters as smooth as possible. During the inspection we examined the files of three people who have lived in the Care Homes for Older People Page 10 of 30 Evidence: home since it reopened and the assessment of someone who is in the process of moving in. We saw that they each contained detailed pre-admission assessments completed by the home, they contained a lot of good information and covered a wide range of the persons needs including their diet, continence, skin integrity, mental state and any known allergies. Details of their preferred leisure and social activities were also recorded and notes were made of their home situation and some of their life history. All of this information enables detailed care plans to be developed. We also saw copies of peoples contracts which had been signed by the manager and the new resident or their representative. The manager has many qualifications in caring for people with dementia and has put this training into action when developing the homes pre-admissions assessment forms and the outcome is that the assessments are detailed and gathered a great deal of valuable information to enable the manager to make a realistic decision about whether the home will be able to meet that persons needs She told us that she uses a model of holistic dementia care as developed by David Sheard who is a director of Dementia Care Matters, which is, An independent team specialising in working with organisations and their staff in developing Dementia Care Services and Mental Health Services for Older People. The home offers staff training through the organisation and displays training material written by David Sheard in the home for staff and visitors to read. In the AQAA the manager told us, We are becoming very skilled at meeting the needs of people who have dementia whose needs have not been met elsewhere. This, I believe, stems from our philosophy of offering a true person centred approach in which peoples psychological and emotional needs are paramount and meaningful occupation is recognised as a way forward in helping to increase peoples sense of identity, purpose and sense of self. Work like activity is promoted throughout the home. St Peters House doesnt offer an intermediate care service. Care Homes for Older People Page 11 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. Care plans are person centred and people are allowed to make decisions about their lives. Evidence: We examined three care plans during our visit to the home, they reflected the needs of the person involved and we saw notes on them that shows they have been reviewed by the key worker since they were written four months earlier, when the home reopened. They contained risk assessments that are developed to minimise the risk of harm in peoples every day activities, which enable them to live a full and active life without being restricted unreasonably. Risk assessments were also carried out in respect of peoples mobility, continence and moving and handling. Waterlow checks were done when they moved in and had been reviewed monthly, these assessments help to identify people that may need extra support to maintain they body weight. The care plan of one person recorded that they were underweight and instructed care staff to weigh them weekly, to encourage them to eat and to give them a fortified drink to help them maintain their weight. Weight Care Homes for Older People Page 12 of 30 Evidence: charts in the file showed that these instructions had been followed. The manager told us that none of the residents had pressure sores at the time of the inspection. The care plans are written in a way that is person centred and reflect the person as a whole, their personality and listed their personal preferences. This will help staff to get to know the person quickly and will enable them to support them as an individual. In the AQAA the manager told us that, We have produced new care plans, which encompass the whole person with the life story in the front so that we see the person and their achievements before we see the person with dementia which is in line with our philosophy. We have forged links with other professionals especially the primary care team and the local Alzheimers Society. We saw memory boxes attached to the door of nearly all of the bedrooms, some people prefer not to have one. The boxes are made of wood and look like a small bathroom cabinet, with a shelf and a fixed Perspex front. When people first move in families are invited to fill the boxes with knick-knacks and memorabilia that reflect the persons life. Some were very simple and contained family photos and small ornaments, others were beautifully and skilfully put together. One contained the occupants RAF wings, pictures of them in front of their war time plane, a wedding photo, a business card, award certificates and other small objects that gave a picture story of their life. Another persons, who loved travelling, was full of postcards and souvenirs bought back from the places they had visited. It was impressive to see just how many memories could be put into one small box. They serve two purposes; to act to remind carers of the real person masked by the dementia and to give the occupant a point of reference to their room and their past life. We saw evidence that peoples health care needs are met, residents are encouraged to keep their own GP and the manager told us that rather than always getting the doctor in they will support people to visit the doctors surgery. The home offers a free chiropody service or people can continue to use their own private practitioner. The AQAA says, We work closely with other professionals particularly the primary care team and mental health team to ensure the health and personal care needs are met. Psychological, occupational and emotional needs are catered for and are evident in the care planning approach and underpin everything we do. We saw copies of specialist reports on file such as speech and language and psychology. Doctors visits are recorded along with any treatment given. We examined Care Homes for Older People Page 13 of 30 Evidence: the medication and the way it was managed, we found that there were no omissions in the records and that the medication is stored as required, in a locked cabinet, which is securely attached to the wall. There was a separate controlled medication cabinet and controlled medication was seen to be recorded and dispensed within Royal Pharmaceutical Society of Great Britain guidelines. We noticed that, despite it being late October, the room the medication was stored in was very warm, a thermometer showed that the temperature was at 26 degrees centigrade which is one degree over the recommended temperature that medication should be stored at. Arrangements should be made to monitor and record the temperature in the room and steps should be taken to keep it within the recommended levels. House meetings are held where everyone gets a chance to make suggestions about the running of the home and comment on the quality of care, the dates of the meetings are advertised on the notice board so that family and friends are able to make arrangements to attend. Induction training includes keeping confidences and we observed that interaction between the staff and people living in the home was easy and relaxed, staff listened to what people had to say and responded in a way that showed respect and consideration to their feelings. One resident became distressed and seemed to have lost their direction, a carer approached and put her are around their shoulders, she talked quietly and reassuringly as she walked with them to the place they wanted to be. The person responded well and was quickly relaxed and chatting to the carer about dinner. When not in use private information is stored in a locked cupboard in the office and is not left lying around in communal areas. Care Homes for Older People Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Peters House offers an excellent range of activities and have shown that they have taken the needs of the people they are caring for into account when developing them. Evidence: The home has several areas were people can sit, which range from busy areas with lots going on to quiet areas where they can sit alone. In one quiet area we saw a box decorated with seaside paper, it was left slightly open so people could see inside to invite them to look at the contents, which were things you would find at the seaside including a childs plastic spade, a stick of rock, some shells and some seaside post cards. Similar boxes are left about the home covering other topics. The home has an activities coordinator working five days a week and one of the rooms is full of activities and objects of interest. We were told that the coordinator will lead on activities but all staff see it as their role to offer opportunities to people. For example the handyman will invite residents to help him do gardening and has helped one resident make bird boxes, which have been put in the garden. While we were at the home there was lots going on and people were seen to be engaged and happy to join in. Only one person was sleeping in their chair and when Care Homes for Older People Page 15 of 30 Evidence: they didnt wake up to participate, staff were concerned and began looking for a reason why they werent as active as usual. This is evidence that staff expect the residents to be busy and active rather than being content that they are quite and no bother. It also shows that staff respond to changes in peoples behaviour and demeanour and look for reasons why. The manager told us that they aim to offer meaningful occupation and give lots of opportunity for people to carry out normal work like activity. One person likes to put the washing out on the rotary line in the garden and another has been given a bucket and window washing equipment, which they keep in their room, so that they can wash the windows. Others do light housework with the feather dusters and brooms that are left in a housework corner. The AQAA says that, Gardening items are usually popular also a basket containing sandpaper and blocks of wood is popular with a resident whose life story indicated that he has always been good with his hands. The garden is planted with soft fruit and vegetables. People are invited to tend the plants and pick the produce to take to the kitchen so that they can feel included in the working life of the home. Residents are encouraged to help set the tables and clear away in the dining room. Regular entertainment is arranged in the home and people are asked to choose different outings. Trips are arranged every Friday to attend an activity held at the local library and the mobile library visits the home. Recent outings have included trips to West Stow and Felixstowe, social events have been held throughout the year including a strawberry tea, with brass band. We were assured that people are supported to follow their faith and people can continue to attend their own place of worship or they can attend the services that are held in the home, the pastoral visits are advertised on the notice board. Residents can have a birthday tea with their families and the home makes this a special occasion by taking photos and presenting the resident with a small photo album of the day. The AQAA tells us that, Free therapies in the pamper room such as reflexology, reilki and aromatherapy are popular and the therapist gives feedback to staff. We have social gatherings in the evenings and afternoons where Pimms or a favourite tipple is served. Families are welcome and can book our front lounge for parties or a family get together. Care Homes for Older People Page 16 of 30 Evidence: We were told that in the future the home plans to develop a therapeutic garden, a life skills area and a project with a reminiscence trainer to create a collage depicting peoples lives based on old photos. They also hope to open a workshop to offer male residents the opportunity to work with the maintenance man on woodwork projects. Mealtimes at St Peters reflect in the homes ethos of allowing people to make choices for themselves. The dining room has large windows that overlook the gardens. It has a climate control unit that keeps the temperature within a comfortable range throughout the year and is attractively decorated. The room is furnished to a high standard and when we arrived it was coming to the end of breakfast. We saw that a long table had been set out by the door with a selection of breakfast cereals and fruit drinks so that people could choose what they wanted to eat on their way into the dining room. The toaster and a selection of bread was on another table close to the kitchen door so that it could be supervised. The toast was made fresh as needed and people were able to prepare it themselves if able. Pictorial menus are displayed in the dining room and people are given the choice of two main meals, the statement of purpose says that, The Chef is a national award winning Care Homes Chef and specialises in promoting catering for the needs of those suffering with dementia. We provide home cooked meals using local produce, ensuring a balanced, varied and nutritional diet. it also said, Understanding the problems of physical and mental illness and the effect it has on an individuals diet, shows that a flexible approach to meal times is required and if a resident decides to eat later, a meal will saved for them and served when they wish. We observed lunch and saw that the tables had been laid with good quality table linen, with a snow white under cloth and a dark green cover, each setting had a fresh clean linen napkin and the tables had flower arrangements and condiments. The overall effect was that of walking into a good quality restaurant. The experience for the residents must have been similar, they were escorted or welcomed into the room, staff made sure people were comfortable and they were offered drinks including a choice of several juices as well as red or white wine. Several people chose wine and drank it with their dinner. Staff asked people individually which meal they wanted and helped them make a choice by showing the two different meals served on a plate. The food smelt and looked appetising and carers assisted those that needed help in a way that was respectful. Once the residents had been served, staff took their meals to the table and ate with them. The manager explained that this helps social interaction and acts to stimulate people to eat and allows staff to support people to eat in an unobtrusive manner. Care Homes for Older People Page 17 of 30 Evidence: Throughout the day fresh fruit is available for people to help themselves to and there are sweets and biscuits located in the lounges and smaller sitting areas. This is considered good practise when caring for people with dementia as they often find it difficult to sit and eat a full meal, but will often snack on the treats as they walk from one room to another, this helps them maintain their calorie intake. The environmental health officer inspected the kitchen on 25th August 2009, he identified no infringements and commented that there was a very high standard of cleanliness in the kitchen. Care Homes for Older People Page 18 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. People living in the home can be assured that the home will listen to them if they are unhappy and take action to investigate any complaints they make. Evidence: The manager feels that she has a hands on approach and an open door policy and told us that she speaks to residents every day and makes it her business to speak to family and friends when they visit. She finds this easy to do as her office is near the front door and she can see people as they come and go. We were told that they havent received any complaints since the home reopened and we havent received any sent directly to us either. We examined the homes complaints procedure and found that it provided the necessary information on how to raise any concerns or complaints about the service. We had a discussion with the manager about the possibility of them adopting a policy of recording all complaints and concerns no matter how minor, this is considered good practise as it gives people confidence that the home will take all matters raised with them seriously and that they will listen to everything that they have to say. The home gives the Say no to abuse leaflet to all the residents on admission, so that they know what action to take if they need to. People are further protected from abuse by staff training, we saw that the training files showed evidence that staff have undergone Safeguarding of Vulnerable Adults training (SOVA) and there are policies in Care Homes for Older People Page 19 of 30 Evidence: place around recognising and reporting abuse. We talked to four staff members while we were in the home and all of them showed a good understanding of the homes safeguarding policy, when we asked one carer what would they do if it was the manager they witnessed abusing a resident they answered, It doesnt matter who they are, if I saw anyone hurting these people I would report it. I would call the police if there was no one else to go to. The home has worked within the local authorities safeguarding guidelines, making alerts when necessary and they have worked with the safeguarding team to investigate them. On one occasion a staff member locked the door to a residents bedroom while they were in their resting after lunch, thinking they were protecting them from another resident who was displaying challenging behaviour. The manager investigated the incident and advised the staff member that, although she thought she was acting in the persons best interest, what she had done would be considered restraint, which is against the homes policy and must not be done again. The staff member was given direction about managing a similar situation and apologies were given to the resident and their family, who were happy with the outcome. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home offers a safe and comfortable environment, which is designed to maintain peoples independence. Evidence: During a tour of the building we saw that the home was clean, furnished comfortably and safe. The whole building has been decorated and refurbished to a high standard, it is obvious that the manager has used her expertise in decorating and furnishing the home so that people with dementia will find it easier to orientate themselves and find their way about. The corridors are painted in different colours and each has a different theme such as film stars, the seaside and transport. The lounges, bathrooms, hairdressing room etc. are clearly signed with pictures and words. Peoples bedrooms are marked with memory boxes that are filled with bits and pieces and photographs etc. from the occupants past which helps them recognise their room. People have free access to an interesting and safe garden where they can sit and enjoy the garden or they can help to tend the vegetable beds. The exit doors and stairwell doors are alarmed so that staff know when people leave the building or are moving into another area of the house so that they can monitor their whereabouts without restricting their movements about the home. The bedrooms we saw are all newly furnished and some people have bought their Care Homes for Older People Page 21 of 30 Evidence: personal furniture and possessions in with them, this helps to make the rooms individual to the occupant. Some of the bedrooms are big enough for couples to share, if they want to stay together. The statement of purpose tells us that all of the bedrooms have television and phone points and there is a secure internet access available in all of the rooms. The bathrooms and toilets are sufficient in number and were clean. There were lots of examples of specialist equipment and adaptations in the home that will prolong peoples independence, we saw a combined wheelchair and shower seat that was designed to go under the shower allowing the resident to shower completely independently and all of the beds had special pressure reliving mattresses. Personal protective equipment was available for staff use to enable them to maintain good infection control and we saw staff using it appropriately. Care Homes for Older People Page 22 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. People living in the home can be confident that they will be looked after by staff that are well trained and qualified. Evidence: Staff personnel files are kept at the home and we examined three of them in detail. They held all the information and documents that are required to be kept as set out in schedule 2 and 4 of the care home regulations. The staff members we spoke to confirmed that all the checks that safeguard people are carried out before people start working at the home and that they took part in induction training when they first joined the workforce. In the AQAA the manager said, We promote a person centred approach to staff recognising them as whole people whose emotional needs and feelings are nurtured, they have the ability to sense and act upon the fragile emotional wellbeing of the residents. We consider that Birthdays are important not only for the residents but to staff also. Every member is given a card and a little gift and a Christmas party for the staff is being arranged We noted from the staff files that there is evidence that people get supervision and that regular staff meetings are held and staff are encouraged to add items to the agenda. Care Homes for Older People Page 23 of 30 Evidence: The care staff we spoke with displayed a good knowledge of the people in the home and understood their needs. Information given to us in the AQAA completed by the manager, tells us that the home has exceeded the minimum requirement that 50 of its staff must have attained the NVQ 2 in care or its equivalent. The staff records show evidence that the home offers the mandatory training, and staff have access to specialist training suitable for the assessed needs of the people living in the home. Training that has taken place since the home reopened includes dementia awareness, understanding mental health needs, medication, diabetes awareness, dealing with challenging behaviour, protection of vulnerable adults, infection control and fire training. The manager has assessed the staffs training needs and has developed a training matrix. In the AQAA she says, We have a targeted staff team, who have skills in being spontaneous and who are able to connect on an emotional level. This starts at recruitment and continues by using reflective training and on the spot training using dementia knowledge sets. Care Homes for Older People Page 24 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. This home is well run and the ethos of its management is empowering to the people living in it. Evidence: The manager and the providers were at the home when we arrived. They all facilitated the inspection, which was done in an open and helpful way and everything we asked to see was quickly produced. The manager, who was on annual leave, had only gone into the home to welcome a new staff member and to ensure that their induction program was started, she stayed on until the end of the inspection for which we thank her. The manager has been running the home since it reopened in June this year, she has undertaken our registration process, which checks that she is a fit person to run a care home for vulnerable people. The building was extended and the number of beds has been increased. The service is Care Homes for Older People Page 25 of 30 Evidence: no longer a nursing home and specialises in dementia care. The manager has extensive qualifications and experience of caring for those with dementia and is an approved dementia trainer. Her qualifications include a diploma in dementia care, a post graduate diploma in management and has dementia care mapping at basic and advanced levels. She also has a BSc (Hons) in nursing and professional studies, a diploma in nursing, an ENB in coronary care and is a state registered nurse. We saw evidence in the way the home is run and the way she organises the paperwork that she is well organised and comments we received indicated that she is well liked by the people living in the home and the staff. The home, which was closed for over a year due to the building work, have already implemented their quality assurance policy and have sent surveys to staff, people in the home and their relatives, they intend that the information received will be collated and a report will be produced and a copy made available so that people can see what areas need attention and what steps are going to be taken. All of the comments received in their surveys were positive. One relative said, All the staff are excellent. another person commented, We can see a change in our relative and they seem so happy and settled. One persons solicitor who acts as their power of attorney said, My client is very well cared for and looks a lot cleaner and smarter than when they were a resident elsewhere. The manager told us that she will always make herself available if anyone living in the home or their relatives wanted to talk to her. She said that she likes to work with the residents and will often help support them with their personal needs, by doing this she feels that she leads by example and it gives her an opportunity to supervise the staff and offer direction. House meetings are held where people are encouraged to speak their mind about how the home is run and how it can be improved. Records are kept of these meetings and we noted that a copy of the last meeting had been posted on the notice board. The AQAA notes that, We have a comments book in the main entrance to encourage families and visitors to tell us how we are doing. The homes polices and procedures are comprehensive and were reviewed and updated before the home reopened, our registration team examined them as part of the process of re-evaluating the service since the change in size and designation as a home for people with dementia. Records are kept up to date and are stored Care Homes for Older People Page 26 of 30 Evidence: appropriately, personal details are stored away from public gaze and are kept confidential. Staff are asked to read and sign the organisations policy on confidentiality when taking up their post. A sample of health and safety records were inspected and were found to be in order. The fire officer carried out a fire safety audit in August 2009 and made a few minor requirements regarding the emergency plan, which have been implemented. 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 The temperature in the room where medication is stored was higher than the recommended temperature that it should be stored at, it is recommended that a system is put in place to monitor the temperature in the room and to keep it within an acceptable range. 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). 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