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Inspection on 05/02/09 for Alverstoke House Nursing Home

Also see our care home review for Alverstoke House Nursing Home for more information

This inspection was carried out on 5th February 2009.

CSCI 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alverstoke House Nursing Home Somervell Close Alverstoke Gosport Hampshire PO12 2BX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 0 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Alverstoke House Nursing Home Somervell Close Alverstoke Gosport Hampshire PO12 2BX 02392510254 02392503054 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Janet Hudson,Mr Andrew John Hudson Name of registered manager (if applicable) Mrs Rosemary Patricia Cook Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 30 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category(OP) Physical disability (PD) Date of last inspection Brief description of the care home Alverstoke House is a privately owned care home located in a residential area of Alverstoke, Gosport. The manager, Mrs Rose Cook, has been in post since the home opened. The home offers nursing care for up to 30 clients from the age of 60 years. Nursing and care staff are on duty 24 hours a day. The home is situated within easy Care Homes for Older People Page 4 of 31 care home 30 Over 65 30 0 0 30 Brief description of the care home access of local amenities as well as being in easy access to the coastal area of Stokes Bay. The home is furnished and decorated in a homely fashion enhancing the comfort of the clients at the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site inspection visit to Alverstoke House Nursing Home, which was unannounced, took place over a one day period on the 5th February 2009. The manager, MrsR Cook assisted the commission throughout the visit. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The manager had returned the Annual Quality Assurance Assessment (AQAA), which was completed comprehensivley, to the CSCI and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI since the last fieldwork visit, which was a key inspection in 26th February 2007. Documents and records were examined and staff working practices were observed Care Homes for Older People Page 6 of 31 where possible. The inspector looked around the home and spoke to most of the residents, staff and visitors in order to obtain their perceptions of the service the home provides. Those spoken to were very happy and complimentary about the care and services that the home provides. Surveys had been distributed to service users, care managers, GP and other visiting professionals. Seventeen service user surveys, fifteen staff surveys and three GPs surveys were returned to the CSCI. The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally residents and relatives are pleased with the environment and the care the home provides. At the time of the inspection the home was accommodating 26 residents, one being in hosptial at the time of this visit. There was one residents from an ethnic background. What the care home does well: What has improved since the last inspection? The home now undertakes a nutritional assessment for all service users to identify any risks of poor nutrition. The home has purchased more televisions for the benefit of the service users. The entertainment manager has attended an age concern training day for activities to ensure resdients have a varied programme. The home has converted one of the bathrooms to a shower room, which was an improvment that came up at one of the staff monthly meetings. A new call bell system has been installed which is proving to be more efficient and call bells respond times can be monitored. More staff have achieved the NVQ level 2 qualification bringing this to 80 of staff with that qualification. The home is striving to increase these numbers and offer other development opportunities to staff who have achieved this qualification. Care Homes for Older People Page 8 of 31 All fire doors are fitted with automatic closures which allows bedroom doors to stay open if that is the wish of the service user. Risk assessments and documented agreements have been put in place for those service users who use bedrails. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides information about the facilities of the home and carries out a full assessment of the potential service users needs before they are admitted to the home to ensure the home can meet their needs Evidence: The home has a Statement of Purpose and Service User Guide in place and when speaking with service users they confirmed that they or their relatives had received this information prior to their making a decision about going to the home to live. The AQAA stated that a full and comprehensive pre admission assessment is carried out by the manager or senior member of staff to ensure the home is able to meet the potential clients need fully, taking into account the dependancy level of the service user and those of existing service users. It is at this time information about the Care Homes for Older People Page 11 of 31 Evidence: facilities of the home is provided to the potential service user and family. Survey questionnaires returned from service users confirmed that they or their family had been given the sufficient information about the home to help them made a decision about being admitted to the home to live. The AQAA states that the homes policy is to welcome any race, gender identity, disability, sexual orientation, age, religion of both service users and staff. This was demonstrated in both the service users and staff being of mixed gender and culture. A sample of three care plans was viewed. These contained the assessment details prior to the person coming to live at the home and demonstrated a comprehensive assessment that covered all aspects of the persons care needs and also their nursing needs. Social services liaise with the home with regards to needs assessments if they are involved with the admission to the home. The manager told us that she encourages the person being assessed and their family to visit the home prior to a decision being made. Surveys returned from a service users said My family investigated the home before I came to have a look around.My daughter came to visit the home with me and we were shown around with staff.Daughter gave me information after looking around at home. Alverstoke House does not provide intermediate care. Care Homes for Older People Page 12 of 31 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. Health, personal and social care needs are identified and met ensuring that the service users welfare is maintained. Service users dignity and privacy is assured through the ethos of the home and staff training. Evidence: A sample of three care plans were tracked. These evidenced very detailed assessments and information and from these, care plans have been devised to inform the staff how the service users needs were to be met. The plans contained life histories, personal care routines,likes and dislikes, healthcare needs and risk assessments for moving and handling, nutrition and falls with dependency levels being reviewed monthly. It was also observed that the care plans had been reviewed and updated at appropriate intervals with the inclusion of the service user or their family, which had been signed by them. Care Homes for Older People Page 13 of 31 Evidence: The care plans are kept in each service users room and therefore staff on duty have access to the information contained in the care plans and can refer to them to inform their practise. Daily notes are kept and these were observed to have been documented by the care staff to describe what care had been given that day. Any changes in the care plans are discussed between staff at handover meetings. It was observed that bed rails with bumpers are used on some service users beds. There was evidence in two of the plans viewed, of a risk assessment for the use of the bed rails and a signed agreement from the service user for their use. Comments from the surveys returned by service users and from service users during the visit indicated that they feel they are well cared for. Staff are very kind and I am happy at Alverstoke House. Cheerful and friendly staff who are always helpful. Most of the staff listen to what I say. I am happy enough and have no complaints.I am very happy here thank you. The AQAA stated that the home has a network of healthcare professionals who visit the home and also the support of social workers. Care plans evidenced that people have regular access to a chiropodist, dentist and optician and several GP practises in the area service the home. Other healthcare professionals such as a speech and language therapist (SALT) visit the home. It was observed when visiting service users in their rooms that one service user had a communication book created by the SALT to enable people to communicate with the person effectively. The records also demonstrate that a basic healthcare check is undertaken monthly and recorded for each persons file in order to see if care needs to be reviewed and the care plan needs changing. The home also has access to the community psychiatric team who will visit the home to review and assess service users if this is requested either by the GP or psychiatrist. Whist talking with the people living in the home they were very complimentary about the care they received and also the comments received in the survey questionnaires returned by the service users to CSCI, indicated that the service users receive the medical support they need. Some of the comments were. The doctor is called when needed.The staff are medically trained and doctor is called if I am feeling unwell.I see a doctor is I feel funny. Care Homes for Older People Page 14 of 31 Evidence: Visiting GPs surveys returned were very complimentary about the home and said. Appropriate requests for a home call and sensible discussion with well informed staff about the service user. The home is friendly, caring and pleasant and provides sensitive terminal care. It is one of the best places which provides excellent nursing skills.I have patients from a wide variety of backgrounds and ethnicity cared for at Alverstoke House and everyone is treated as an individual and appropriately. Help is always sought when needed and patients are always respected. Staff are consistently cheerful and are aware of nursing needs which they provide to a high standard. All visits from health professionals are recorded in the care plans. The home has reviewed and updated the medication policies and procedures for the storing, receiving, administration and disposal of medication which the registered manager coordinates every month. The home has taken delivery of a new monitored dosage system for the management of medication and this is supplied by the community pharmacist. The medication administration sheets (MAR) are now printed for each individual but if medication is written for a on off dose, this is hand written with instructions and signed by two staff. Medication is stored in a clean, well organised locked environment and is administered only by registered nurses who have undertaken medication training. Controlled medications were securely stored and a controlled register was in use to monitor administration and safe keeping. Two controlled medications were checked and found to be correct. The AQAA states that home has a policy that clients are treated with respect and their right to privacy is upheld and this is reinforced with staff training. Observations of how staff interacted and addressed service users throughout this visit, would suggest that the privacy of the service users is upheld. Staff questionnaires returned to CSCI told us that staff do respect service users choices and rights to privacy and respect. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provided to service users matches their expectations and recreational needs. Families and visitors are made welcome at any time and the home provides a range of nutritious home cooked meals. Service users are supported to exercise control and choice within their daily routines. Evidence: The AQAA states that families and visitors are welcome to the home at any time and are encouraged to take part in any of the activities that take place in the home. The AQAA says that as many of the clients are frail and some very ill in bed, they are conscious that the home should meet their social, cultural, religious and recreational interests and needs and plan activities around these needs. Although the home does not display an activities programme about forthcoming events, these are advertised on posters around the home and in the news letter to residents, which advertises what is on, along with birthdays and general news of the home. The manager said that in the coming months she intends to put the activities programme on a notice board, which she is awaiting to be put on the wall. Care Homes for Older People Page 16 of 31 Evidence: Many of the people currently living in the home are quite frail and are being nursed in their rooms. For those who stay in their room and are able, a library visits to leave books of their choice and there is a television in every bedroom. For people who wish to access them, activities are provided including gentle exercise, visiting musicians and speakers, quizzes, bingo and Karaoke if the clients wish to participate. The registered provider is a talented pianist and provides the service users with a weekly piano recital in the lounge, which they told us, they enjoy immensely. Records of what activities take place and who attends are maintained in the activities records, which were viewed. The home has a visiting library and there are books, games and magazines placed throughout the home and some residents were reading the newspapers, knitting or watching television. One person was very proud of the range of knitted toys and bags she had made and although confined mainly to her bed, insisted on continuing with her knitting, which has been a life long recreational activity. For another person who had difficulty in communicating verbally, a communication book using pictures and photographs, was in use, to enable them to communicate with staff and visitors. Another person said that they attended a day centre in the community, for which transport is provided by the organisation. The home has two pleasant conservatories in which servicce users enjoy sitting and people also said that they liked sitting in the gardens in better weather. Staff take service users out in their wheelchairs to the nearby beach in the better weather. The home has an open visiting policy and the visitors book evidenced that the home has visitors most days. Three visitors were spoken to and they reported to be very satisfied with the home and the services of the home and considered the activities provided were good. The home is visited monthly by the local Church of England vicar to provide communion to those who which to take it and the evangelical church visits to sing hymns and say prayers. The Roman Catholic father will visit the home if there are any practising catholic clients. The home will arrange visits to the community dentists and hairdresser. A hairdresser does visit the home weekly who told us that she has quite a number of service users who like to have a weekly hairdo. Service users are encouraged to exercise choice and autonomy over how they spend their days and staff are trained to encourage this. Service users plans indicate the Care Homes for Older People Page 17 of 31 Evidence: level of assistance people need with their care and how they like this care given and to what extent. Service users spoken to told us that they spend their days how they wish and they do not always wish to attend the activities and prefer to stay in their rooms and this is respected. Surveys returned to CSCI from service users told us that residents have choices about how they undertake their daily routines. A staff member told us that we go to great lengths to treat all our residents as individuals and to give them choices from meals to bed times and they have a good quality of life. The kitchen was visited and was clean and well organised. Menus showed that a wide variety of fresh, home cooked food, which is planned to be seasonal, is provided. The menu planning is undertaken by a senior sister, who has a particular interest in nutrition, and the cook.There is always an alternative choice available at mealtimes and special diets including, vegetarian, diabetic, soft and pureed meals are catered for. The lunchtime meal, which is the main meal of the day, was observed. The food was well presented and looked nutritious with fresh vegetables. The service users told us that they enjoyed the meal and that the food served at the home is very good. Comments from residents during the visit and survey questionnaires received by CSCI said, The food is good, very tasty. I like the food, it is very good food. If you dont want it at the last minute, they will get you something else. The food is very good, you get a good variety and as much as you want. I like certain meals but I am fussy about food. I like the meals very much and am always satisfied with what is put in front of me. The meals are nice and we have a good variety.They do baked potatoes for me as that is my favourite. The meals are very nice. The home caters for my needs when I fancy something that is not on the list the staff try to get it for me. Two of the seventeen surveys returned reported they did not like the meals. The AQAA reported that the home has undertaken a full nutritional risk assessment screening of all service users and this is being undertaken with the involvement of Southampton University who is researching the value and use of nutritional supplements for people identified as at risk. A number of service users are involved with the trial and are taking the nutritional supplement drinks to ascertain the benefits and if their general welfare is improved. Care Homes for Older People Page 18 of 31 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. Residents and their families can be confident that their concerns and complaints will be addressed and the homes policies, procedures and staff training are designed to protect people from the risk of abuse. Evidence: The AQAA says that all clients are informed of the complaints procedure and are supported by staff to make a complaint. There is a complaints procedure in place a copy of which is included in the Statement of Purpose. The AQAA reports that four complaints have been recorded since the last visit. The log was viewed and demonstrated that the manager, Mrs Cook, had addressed them and responded to the complainants in a timely manner. The people living in the home told us when spoken to and survey questionnaires received by CSCI said they were confident that any concerns they might have would be taken seriously and acted upon and they would know who to complain to. Comments made were If I have a problem I inform my family. I would complain to matron. No complaints but I would tell daughter.I can shout loudly but I feel I could sort the situation out myself at the time it is needed. The home has updated its Adult Protection policy, the staff team receive adult protection awareness as part of their induction process and also attend formal training, Care Homes for Older People Page 19 of 31 Evidence: which is provided at regular intervals. The staff on duty showed an awareness of protection issues and said they would report any suspected abuse to the manager or owner. Survey questionnaires returned to CSCI indicated that they would know what to do if they suspected or witnessed any form of abuse. Comments made my them on questionnaires said I would inform the person to speak to matron or the owner who will deal with any concerns All staff have been made aware of the procedures for Whistlblowing. I would refer them to the sister in charge of the shift or the manager. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a homely, clean and comfortable environment for the people who live there and has an ongoing maintenance programme. Evidence: The AQAA states that Alverstoke House provides a warm, homely, well maintained and attractive environment for the people who use the service. The home has a programme of redecoration and refurbishment in place, which is ongoing as bedrooms are redecorated and refurbished when they are vacated. The plan for the coming year is to replace all wooden windows that are rotting, replace doors and mirrors in the lift and generally maintain the building to a high standard. The home has specialist equipment such as pressure relieving beds, hoists and assisted baths and records showed that they are well maintained. Over the last twelve months one bathroom has been changed to a shower room and the upstairs corridors and hallways have been redecorated. The nurse call bell system has been replaced by a more efficient and reliable system. Four flat screened TVs have also been purchased along with some new profiling beds, pressure relieving equipment and appropriate moving and handling aids. Care Homes for Older People Page 21 of 31 Evidence: We looked around all areas of the home. The home is very clean and well presented. Generally the whole of the building is light and airy. The main lounge is comfortably furnished and has a pleasant outlook. In addition to the main lounge there are sitting areas and two conservatories with books and games, situated around the house. The garden courtyard area in front of the house has an attractive fountain and pond with fish and is pleasant to look out on. Private bedrooms are very attractive and have been personalised with furniture and belongings brought to the home by the current residents. Many people also have their own telephones in place. All bedroom doors have automatic closures fitted in case of fire, so that residents can keep their doors open in the day should they wish to do so. The requirement from the previous report when one door was identified as not having an automatic closure and was being wedged open. This door has now been fitted with the closure. There were three cleaners working at the time of the visit and the home was clean and hygienic throughout. The staff on duty wore gloves and aprons when providing personal care and hand washes and antiseptic gels were in place to assist with infection control. One resident said she especially like the home because it was always spotlessly clean. Other comments made were The cleaners are in every day and clean my room. My room is cleaned daily to my satisfaction and I like to see the cleaners they are always cheerful and helpful. It is lovely and clean always. There were no negative comments returned on the surveys. Cleaning staff spoken with had a good understanding of the COSHH guidance on how to use the cleaning materials that are chemicals hazardous to health and how they must be stored. The home provides infection control training for staff to make them aware of how to reduce the risk of cross infection. The AQAA reports that 20 staff have received training in prevention and control of infection. Care Homes for Older People Page 22 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported by sufficient numbers of committed and caring staff that have undertaken appropriate training. Service users are protected by the home having robust recruitment procedures in place. Evidence: The AQAA states that the home strives to have three registered nurses on in the morning with two in the afternoon and one at night. On the day of this visit there were three registered nurses and four carers on duty. The manager told us that at week ends there are two trained staff on duty with four or five care staff depending on the dependency of the clients. She reports there is a minimum of six staff on duty throughout the daytime with a total of three at night. At the time of this visit it was observed that there were sufficient staff on duty to care for the twenty six service users in residence. Staff surveys returned to CSCI indicate that there is nearly always sufficient staff on duty to meet the service users needs and that it is only short notice sickness that leaves the home short of staff which is infrequent, as agency staff will be requested if sufficient time given. In addition to care staff there were three cleansers on duty, a cook, kitchen assistant and a handyman, that, although off sick at the time of this visit, normally visits the Care Homes for Older People Page 23 of 31 Evidence: home daily to undertake any repair jobs etc. Many of the staff have worked at the home for some considerable years and have built up good relationships with the people they support and other staff members. Service users, visitors spoken with and surveys returned to CSCI from service users say that the service users are happy with their care and consider the staff to be kind and caring. Comments say When I buzz they come as quick as they can and say they do not mind as that is what they are there for. I get all the support I need and do not know what I would have done without being cared for here. Care staff are pretty good. All new staff have an induction training.The induction programme is based on the common induction standards for Skills for Care. The manager told us that the most of the newest recruits have already achieved their NVQ level 2 or 3 and therefore they undertake a basic induction of the environment and policies and how the home works. The induction programme was seen by us and was signed by the carer and supervisor. The AQAA reports that 80 of the staff have achieved NOV level 2 or 3. The home has a training and development plan in place and in addition to mandatory training, records show that the staff team have attended courses such as wound care, palliative care, diabetes, adult protection, the mental capacity act and nutrition in the elderly. The home encourages and supports staff to undertake training to enhance their knowledge of the client base. Training needs are identified during the yearly appraisal and supervision sessions that each staff have six times during the year. Records of the supervision and appraisals were evidenced. Surveys returned to CSCI from staff indicated that staff are receiving appropriate induction training and further training. Comments say.I have been sent on many courses to enhance my knowledge as I am NVQ assessor and am now relating my qualification to achieve the A1 award in assessing.Plenty of opportunities to attend in house training and study days.We are given ample opportunities to join any educational sessions as and when they occur.I have yearly appraisals where we discuss our learning needs and make plans for our training for the coming year. We have supervision six times a year and a yearly appraisal. We have staff meetings once a month were we discuss different ailments or diseases that refer to the residents in the home.We all have a yearly appraisal and should we need advice the matrons door is always open. One support staff member said, I have worked here for 16 years. I stay here because the care for residents is so good and I receive regular supervision and have been Care Homes for Older People Page 24 of 31 Evidence: supported to develop and progress to become and NVQ assessor. There is a robust recruitment process in place three staff files were seen and all contained the required documentation including current Criminal Bureau Checks (CRB) and Protection of Vulnerable Adults (POVA) check and two written references received. Care Homes for Older People Page 25 of 31 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. The homes manager provides effective leadership There are systems and procedures in place for monitoring and maintaining the quality of the service provided and promoting the safety and welfare of everyone living and working in the home. Evidence: The home is run by an experienced, competent and committed manager who is a registered nurse and has been in post for a number of years. She has maintained her professional portfolio by attending further training in order to update her skills and knowledge. The home has clear lines of accountability with regards to the management structure and the home has a deputy manager in post to support the manager and a senior registered nurse who has been employed at the home for some years. Care Homes for Older People Page 26 of 31 Evidence: Residents, families and the staff team spoke highly of Mrs. Cooks management style and said that she manages the home in a well-organised and inclusive manner. Comments from service users and observing the manager interacting with service users suggests that Mrs. Cook is well informed about each client and has good relationships with them. Surveys returned from staff indicate that they feel they always receive the support they need from the manager to enable them to meet the diverse needs of service users. Comments say I feel I can to to a more senior member of staff if I need support or any help I need with a client.The manager works with us on a daily basis so has a lot of input and I find her very approachable if I have a problem.I am well supported by the management and attend training.The manager is always available.I am able to discuss any concerns at any time. A comment from a visiting health professional said Matron is very well informed and an excellent colleague to work with. Observations throughout the day evidenced that Mrs. Cook has good relationships with her staff. The AQAA states that the home follow the Registered Nursing Homes Association Blue Cross Mark of Excellence Quality Assurance System. A quality assurance process has been started by an internal audit being carried out annually. Questionnaires are sent to residents, their families, friends as well as visiting professionals. The outcomes are detailed in compliance sheets.The outcome of the surveys distributed was very positive with comments from visiting health professionals about the home and staff which were very complimentary saying the home provides excellent person centred care to all the people using the service. There were no actions documented to address any suggestions that came from the surveys, which could be seen as part of an improvement plan. Registered Provider visits are carried out monthly and the records are kept on file which were viewed by us. The manager does not act as appointee for any of the people living in the home and financial matters are usually managed by families or legal advisors. Where monies are held for residents, they are safely locked away and a records book showed that all transactions are recorded and receipts gained. Records for the running of the business were seen including the fire book, staff fire training, incident and accident forms, maintenance records and a sample of servicing certificates for systems and equipment and all were current and in good order. A fire risk assessment for the home was seen along with individual service user fire risk assessments. The fire log evidenced that the fire system is tested regularly and at appropriate intervals. Care Homes for Older People Page 27 of 31 Evidence: The training matrix for staff mandatory training was seen and this evidenced that staff received appropriate health and safety training. Training certificates were also evidenced in personnel training files. The Environmental Health Officer visited the home in recent months and the outcome was the home was awarded an excellent status with no recommendations made. Care Homes for Older People Page 28 of 31 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 29 of 31 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 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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