Inspection on 01/10/09 for Allington Court

This inspection was carried out on 1st October 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Allington Court 21/01/09

Allington Court 04/10/07

Allington Court 16/10/06

Allington Court 05/10/05

Allington Court 03/02/05

Allington Court 31/08/04

Allington Court 11/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Allington Court Lye Lane Bricket Wood St. Albans Hertfordshire AL2 3TN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia House     Date: 0 1 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 27 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 27 Information about the care home Name of care home: Address: Allington Court Lye Lane Bricket Wood St. Albans Hertfordshire AL2 3TN 01923894542 01923894544 sylvestj@bupa.com www.bupa.com BUPA Care Homes (BNH) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home Allington Court is registered to provide accommodation and nursing care to 44 older people with dementia, 10 of whom may be below 65 years of age. It is owned and operated by BUPA Care Homes Limited and is situated in extensive grounds, adjacent to another BUPA care home, in a semi-rural location in the village of Bricket Wood, within easy access of the M25 and M1 motorways. There is ample parking space provided at the front of the building. The home was purpose built for this service user group and is in the form of a hexagon with two internal courtyards, which, together with the attractive and secure grounds provide ample additional communal space where service users can walk and exercise, or simply sit and enjoy the gardens and views. Care Homes for Older People Page 4 of 27 Over 65 44 10 2 1 0 1 2 0 0 9 Brief description of the care home All service users are accommodated in single rooms and there are four lounges, an activity room and dining room. There is an information folder/Service Users Guide in the reception area of the home, which includes contact details of the Care Quality Commission, (CQC), and information about charges for the home. The last CQC inspection report and the homes Statement of Purpose are displayed in the homes reception area and copies are also available on request. Current weekly fees start at £995 and are calculated according to need. Additional charges apply for hairdressing, personal toiletries and newspapers and for any chiropody, dentistry and optician services where these are subject to charge. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was completed on 21st January 2009. The information in this report is based on an unannounced inspection of the home, which took place over one day with three regulation inspectors carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as we. The registered manager has now left the home and an acting manager has been appointed and was on duty throughout the day and we spoke with staff and residents. We visited all parts of the home and checked a variety of records. There is an on-going investigation in progress, co-ordinated by Hertfordshire County Council under the joint agency safeguarding vulnerable adults procedures. Care Homes for Older People Page 6 of 27 We have also reviewed any other information we have received about this service Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? Since the acting manager has been appointed, improvements have been made in all areas of the home. There have been significant changes to the staff team and far fewer agency staff now work at the home. The current staff team clearly feel positive and motivated to provide the best possible care for the residents and all those we spoke with during the inspection said how much the home has improved. One said that all areas were now 100 better. Another told us there are far more choices of food provided and that meals were getting better and better. We felt that the attitude of staff was very different to what we noted during the last inspection and much improved. Those staff members we spoke with said that the manager expected high standards of work from them and in return supported them and dealt with any issues that arose right away. All staff have had updates of training in safeguarding, whistle blowing and dementia care, and those we asked said they felt confident with their knowledge in these areas. This has resulted in improved staff interaction with the more confused residents and an Care Homes for Older People Page 8 of 27 increased staff awareness of the need to maintain peoples dignity at all times. All areas of the home were very clean and bathrooms especially are now clutter free and accessible to residents. Signage has been provided on bathroom and toilet doors to enable residents to find these rooms and remain as independent as possible. 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 27 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 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents of the home are provided with detailed information, which enables them to be sure the home is right for them. Comprehensive assessments are documented to ensure that all individual needs are met and improvements in the home are continuing so that specialist dementia needs are met in the best possible way. Evidence: The homes Statement of Purpose and Service Users Guide have been recently updated and we saw these displayed in the entrance hall. The manager said that copies are provided for all prospective residents so that people can be clear about the services available. Copies were also provided for the inspectors. We checked a selection of residents care plans during the visit and saw that detailed assessments had been completed prior to admission to the home so that all parties could be sure the home could meet the individuals needs. Subsequent assessments of Care Homes for Older People Page 11 of 27 Evidence: needs had been completed by senior staff in the home from which initial care plans had been produced, showing staff how best to meet these needs. The home is registered with the Commission to provide services for people who have a dementia. In the report after the last CQC inspection we made requirements that specialist facilities for residents must be improved and that staff must receive appropriate training in dementia care so that the specialist needs of all the residents can be met. The written Statement of Purpose states that the home aims to provide a high standard of dementia care for all residents. Since the last inspection a new acting manager has been appointed and she has recently produced a written Dementia Care Framework setting out, in detail, how staff at the home will achieve this aim. During this inspection we spent time talking with residents and staff and also spent time observing their interaction. One inspector spent two hours conducting a short period of intense observation, where the experience of residents in one lounge was assessed. We concluded that considerable improvements had been made to dementia care provision and that this was still a work in progress. We saw that care staff generally interacted well with the confused residents and took pains to offer people choices when offering services. We saw care staff offering people the choice of hot or cold drinks throughout the day and saw tea and coffee served using tea pots and jugs with milk and sugar offered and served separately. Hot drinks were served in cups and saucers in most cases and if biscuits were chosen, plates were provided. This showed that the residents were treated with respect despite some being very confused. The staff we spoke with all said they had received dementia care training and demonstrated an awareness of how to promote peoples independence and how to maintain residents dignity and gave examples of how they did this. We also noted that this awareness extended to the ancillary staff in the home. We saw a domestic worker and the maintenance person provide meaningful interaction with residents and they were able to understand a need and provide the items people were looking for when it was not clear what these were. We saw that breakfast time extended over a considerable period as residents chose different times to want this meal. Residents were assisted to choose what they wanted to eat and we saw some residents having toast, some having cereal and several enjoying a cooked breakfast, all at varying times. We saw care staff supporting residents with patience and good humour. On the day the activity co-ordinator was not on duty but staff said that a range of activities were usually provided for residents. However, we noted that, although some care staff initiated a ball throwing game during the day, very little stimulation was provided on this occasion. We saw records completed of the activities each person took part in each day in care plans, and these records did show that daily activities were provided although it appeared that some residents never took part in these activities. It is acknowledged that some residents will never enjoy organised events, and we did see Care Homes for Older People Page 12 of 27 Evidence: that one to one interaction was also recorded and took place for residents. However where a home is totally aimed at providing services for confused people, daily stimulation comes from everyday things, not just organised activities, and needs to be supported by all staff in the home, not just the activity co-ordinator. We noted that the television in one lounge is situated high on a wall and was left on all day, although most of the time the sound was not high enough for people to hear and some peoples seating did not enable them to see the picture clearly. There was no music system in this room although there were times when some appropriate music could have been beneficial. People generally were sitting in chairs around the rooms but there were no interesting objects for them to see or reach although having a variety of objects to touch and examine is recognised as having on going interest for some confused people. Similarly there were few pictures on the walls in lounges and corridors to provide interest for residents. We noted that staff provided meaningful interaction to some residents, mostly those who were able to respond to some degree. It was clearly more difficult for staff to interact with people who could not respond but having a variety of objects around for staff to use is known to aid communication and such items should be made available at all times. One resident was assisted to the dining room by a member of staff and initially sat at the table for breakfast. However, when the worker went to get the food, the resident left the table ,and the room. We felt that, if there had been something of interest on the table, the resident may well have stayed to examine this while their food was prepared. Signage to aid confused residents to find different rooms has been provided since the last inspection. Bathrooms have appropriate pictures on the doors and care staff are working with residents and families to complete memory boxes which will be positioned near bedrooms so that people can identify their own rooms. The manager said that pictures or photographs, relevant to the individual are also being produced and will be placed on bedroom doors to aid room identification. The doors in the home are currently all painted the same colour and an imaginative use of colours for doors and signage is also known to aid finding your way, and should be considered. One corridor does have an inside garden displayed which is very imaginative and provides real interest, but most corridors currently lack visual or tactile areas of stimulation. We are aware that the manager has ordered more equipment from the suppliers of equipment aimed to assist dementia care. We also acknowledge that great improvements have already been made in all areas and that, as stated, the area of stimulation for those with dementia is still a work in progress. Currently there are residents in the home whose first language is Italian and Spanish and it was good to see that some of the care staff also spoke these languages and could encourage conversation between all the staff and these people. Care Homes for Older People Page 13 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their health needs documented and met appropriately. The procedures followed in the home for administering medication ensures that people are safeguarded from the risk of harm and have their good health promoted. Evidence: During the visit we spoke with and observed residents and watched some of the staff provide people with services. We then tracked a selection of care plans relating to the people we had seen. In all cases the planning was thorough and provided clear details of individual needs and how best to meet them. Currently none of the residents in the home have pressure sores but we saw details of past pressure sore treatment and these records were detailed and gave clear information about the care given. In one care plan a need for the fluid intake of one resident to be monitored was documented and we had already noted that care staff were recording the amounts of liquid this person was taking. We saw evidence that appropriate referrals were being made to Health professionals and saw outcomes recorded. One resident had been referred to their G.P. because of weight loss and we saw that a food supplement had been Care Homes for Older People Page 14 of 27 Evidence: prescribed. We also noted on-going reviews of this residents progress and continuing involvement from a dietician. Where we has seen bed rails in use in bedrooms we found corresponding risk assessments and signed consent forms in care records. There were night care plans in place with evidence to show that this care had been provided. Care staff had been provided with written viability guidance for treating leg ulcers and copies were seen on appropriate care plans. One resident had also been assessed as needing a sensor pad beside their bed. This had been provided and reasons for this were documented in their management plan. A wide range of risk assessments were in place in all plans and these had been regularly reviewed. Because the care plans are so detailed, the manager and senior staff have been completing information sheets which summarise each residents daily care needs, and how to meet these needs. These summaries will be positioned discreetly in wardrobes in residents bedrooms so that all staff can be sure of how to meet all individual needs in the agreed way at all times. The residents we spoke with, who could give an opinion, confirmed that all members of staff treated them with respect and maintained their privacy. All the interaction we observed during the day supported this view. We noted that any member of staff we saw entering a bedroom or bathroom, first knocked and waited. We saw people offered a choice of where to sit when care staff assisted them to move about. We also noted a member of staff spend some time searching for a pair of spectacles for a resident as they felt the resident could not see properly without these glasses, although the resident could not voice this for them self. We checked the storage and administration of medication during the visit and the systems in use were sound and enabled residents to have their health needs supported in a safe way. We saw details of allergies recorded so this information could be clearly seen and saw details of prescribed food supplements recorded on care plans. Some medication had been reviewed and stopped in consultation with the relevant G.P. so that residents did not continue to be given medication they no longer needed. Where medication had been administered to treat a residents agitation, reasons for this had been noted and showed the situation was being monitored. Appropriate written protocols were in place for any homely or covert medication administration and written records showed that these guidelines were being followed. Senior staff at the home undertake weekly audits of all medication, and document these checks, to ensure all medication is safely stored and administered. We just recommended that levels of medication stocks are regularly brought forward and the manager confirmed this would be done. Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by staff to make choices about how they spend their days and have family contacts promoted so that residents still feel part of the community wherever possible. The food provided is of a high standard and helps to promote peoples good health and well being. Evidence: As already noted, the activities coordinator was not working on the day of the inspection. We saw some of the care staff provide a ball throwing activity during the visit, in one lounge and saw one resident provided with colouring pens and books when they requested these items. Later in the day we saw care staff sit in the activity room with residents and support some of the people there with a craft session. Care staff confirmed that when the activity coordinator was on duty there were regular activities taking place and we acknowledge that some of the residents prefer one to one contact with staff during the day and that staff support residents choices in what they want to do. We were also told that one resident had not been out side their previous home for four years but, since coming to Allington Court, now goes out to a weekly music therapy session. We saw a written management plan for this resident which staff were implementing to encourage more social interaction. Staff also told us about other ideas for stimulation which now take place and said that one resident likes Care Homes for Older People Page 16 of 27 Evidence: to help staff and folds tea towels each day. Details of the activities people take part in, or not , are recorded in their care records. However for much of the day many of the residents were seen asleep, both in the lounges and activity room. The actual layout of the lounges also makes it difficult to provide ways for residents to vary how they spend their days, as chairs in the communal rooms are all sited around the edges and close together. This prevents for example small tables being placed between chairs which might contain items of interest such as magazines or objects to hold. The position of the television in one lounge also makes it difficult for all residents to see and hear the programmes, even if they wanted to. We have already described these observations in an earlier section of the report and accept that this area is a work in progress which is being implemented in the home. Care staff confirmed that visitors are welcomed in the home at all times. There are facilities for visitors to make drinks, in the entrance hall and for resident safety the manager has introduced a residents log, which is also kept in the entrance hall. Visitors who take their relatives and friends out for trips now sign the resident out and then in, so that staff can be sure the resident is safe and not missing and can make contact if they need to. We saw residents eating at breakfast and lunch time during the day and saw that these meals were provided in a very flexible way and that people were offered choices of what they wanted to eat. We saw a wide variety of breakfasts being eaten, including full cooked meals, cereal, toast, fruit and yoghurts. When one resident asked for a cup of tea during the morning they were provided with a pot of tea served with separate milk and sugar. Tables for the lunch time meal were attractively laid and we saw care staff providing appropriate assistance to residents where this was required. Some residents had chosen to have whisky, beer or wine with their meal and all residents were provided with water or juice and encouraged to drink the fluid. We visited the kitchen and the chef confirmed that lots of pureed and soft foods were provided and we saw that special diets were prepared for those with diabetes, a lactose sensitivity and for residents with a Jewish faith. There are good systems in place to ensure residents receive the correct diet. There is a laminated list which staff take round with the drinks trolley which also shows peoples special dietary needs such as those with allergies or who should not be given cranberry juice. This system also ensures residents are provided with the appropriate food and drink to maintain their good health. The current menu was on display so that people could see what the days meal would be and we saw that snacks were made available at all times as well as nite bites which could be provided in the evening or during the night. We were told by staff that the chef regularly talks with residents to be sure of their preferences and attends relatives meetings to hear their views about the food provided. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that any concerns they might have will be listened to and acted on and that procedures followed at the home will help to protect them from abuse. Evidence: The manager has recently produced a new Managing Customers Expectations Policy for the home which is more pro-active than the previous complaints procedures and incorporates grumbles as well as formal complaints. There had been two complaints made since the last inspection. We checked the recorded details of these and saw that they had been really well investigated and handled, using the new policy. The home has written policies on Safeguarding Adults and Whistle Blowing. We spoke with a variety of care staff, nurses and ancillary staff during the inspection and they all confirmed they had received recent training in these topics. More importantly they were all able to demonstrate a clear understanding of these policies and their implications. There is an ongoing investigation taking place under the Local Authority safeguarding procedures. The manager has fully taken part in this and has implemented changes to procedures at the home as a result. The manager has also initiated an investigation about safeguarding and has demonstrated a clear understanding and committment to this process for the protection of the residents. Care Homes for Older People Page 18 of 27 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. People who use the service benefit from living in a home which is well maintained and homely and where procedures followed by staff ensure the home is kept clean and hygienic and promotes their well being. Evidence: The inspectors visited all areas of the home during the inspection. We found all areas were very clean and well decorated and well maintained. The bathrooms were free from clutter and were all unlocked and accessible to residents, with signage on the doors for ease of identification. One bathroom has a lovely seaside mural on the wall for the benefit of the residents. One resident showed us their room and how their door opened onto the garden. The gardens all looked very attractive and the resident concerned said they enjoyed going out there when they chose. There were seats for the residents positioned by the garden doors, both inside the home and outside.Care staff confirmed that these outside doors were alarmed once it became dark for safety. The home was pleasantly heated and the residents we asked said the home was always warm enough. All communal bathrooms and toilets contained liquid soap and paper towels, as recommended for good infection control. We visited the laundry and this was well appointed and hygienic. The laundry assistant confirmed that red bags were used to transport and wash soiled laundry, as recommended for infection control. The Care Homes for Older People Page 19 of 27 Evidence: assistant said that they were aware of health and safety standards and infection control and that they had all the facilities they needed in order to run the laundry smoothly. They were also pleased that there was a washing line outside so that clothing could be dried and aired naturally whenever possible, for the residents benefit. Currently, most bedding is laundered by an external company. We just noticed that the sink unit in the laundry is old and worn and should be replaced as soon as possible for hygienic reasons. The laundry assistant said that this unit was due to be replaced soon. The home has established links with the local Health Protection Agency and the deputy manager is the appointed person maintaining this contact. This ensures that the home has easy access to any advice about, and receives the latest guidance on, good infection control. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by a staff team who are well trained and able to meet their specialist needs. Procedures for staff recruitment in the home are thorough and help to protect residents from the risk of abuse. Evidence: On the day of the inspection we felt that there were sufficient care staff on duty to meet residents health needs. However, if plans for increased social stimulation are implemented, more staff may be needed when there are no activity coordinators on duty to ensure activities take place. The staff we asked said the home currently needed more registered nurses and the manager confirmed that interviews and appointments for nursing posts were in progress. The manager said she is not hurrying this process as it was important to get the right people for the jobs. We found that the atmosphere amongst the staff team was excellent and all staff were very supportive of oneanother. It would therefore be really important to ensure the right staff were appointed so that this situation continues. We spoke with domestic staff who all confirmed that the home was now really well run. The Housekeeper said that their requests for more domestic staff had been listened to by the manager and that domestic appointments were also being processed. The manager has produced a staff training matrix and a copy was provided for the inspectors. This overview showed that staff had all received or were booked on all the Care Homes for Older People Page 21 of 27 Evidence: basic training courses seen as essential for social care staff. More specialist courses had also been provided or booked and all staff, including ancillary staff, have completed safeguarding and dementia training. We saw a nurse who had started work at the home on the day of the inspection and they were undertaking induction training with a senior staff member. The manager confirmed that care staff would all be encouraged to undertake NVQ training in due course. We did not check the numbers of NVQ qualified staff on this occasion. We checked a selection of staff recruitment records during the visit. In all cases appropriate recruitment checks had been in place before the person concerned started work at the home. We found no shortfalls in any of the staff files checked. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from living in a home which is well run and where their views are listened to. Procedures followed by staff ensure that residents safety and their well being are promoted at all times. Evidence: Since the last key inspection an acting manager had been appointed to the home. We had met this manager before the inspection during meetings with the Local Authority and been aware of the depth of her understanding of the issues at the home, highlighted at the last key inspection. We found, during the inspection that improvements had been made in every area inspected. Without exception the staff we spoke with praised the manager and said she had turned the home around and one felt the home was getting better and better. The staff we spoke with were all very positive about the care being provided and appeared keen to make even more improvements, especially in activity provision for residents. Staff told us that, if there was a problem in the home, the manager sorts it right away. We were also told that the manager runs the home for the benefit of the residents at all times. Some care Care Homes for Older People Page 23 of 27 Evidence: staff said they now felt confident about their role and could always ask for help if they were unsure of anything. The acting manager has made many changes to procedures in the home and has introduced new systems to improve general efficiency. The manager said she was setting up a resource library for staff so that they could easily find guidance for aspects of care they were unsure of. The manager has also introduced an hourly check list, which staff pass on to one another and where written details account for every resident in the home. The manager and qualified staff undertake a variety of regular audits of procedures in the home to ensure that standards are being met. These audits include checking care plan recording, wound care documentation and progress and health and safety checks. Regular external audits form the companys senior staff also take place and checks are made to ensure that any money held for residents is properly documented and appropriately managed. Small group meetings are regularly held to pass information and listen to any views. The staff we spoke with felt that their views were listened to and felt included in the running of the home. The manager is also continuing to provide a newsletter for relatives and to hold relatives meetings to ensure families are aware of any changes and can have their views heard. In addition, the BUPA quality assurance system is in operation and promotes quality assurance in the home. We checked the fire drill records and the homes accident records and these documents were all completed well and showed that appropriate fire training and drills took place. In the homes Fire Emergency Folder the mobility of every resident is assessed weekly and this information advises the fire safety plan. The home also has a comprehensive written emergency plan in place which shows how residents will be protected or evacuated should the need arise. We saw no hazardous substances left accessible to residents during the visit and noted that risk assessments had been completed for the use of recliner chairs in the home for the protection of people who use these chairs. During the inspection we saw care staff assist residents to transfer, using hoists. In all, cases the assistance was completed appropriately and residents were reassured throughout the procedures. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 4 12 Improvements must be made to the environment and appropriate equipment must be provided which will benefit people with a dementia. This requirement has been partially met. A new due date has been made. This is to benefit people with a dementia and to meet current guidelines for providing good dementia care. 01/01/2010 2 12 16 A suitable range of activities and stimulation must be provided for all residents in the home on a daily basis. This requirement has been partially met. A new due date has been made. This is to ensure that adequate stimulation is provided so that all residents are able to enjoy their lives as fully as possible. 01/01/2010 Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 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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