Inspection on 19/03/09 for Bath Lodge

This inspection was carried out on 19th March 2009.

CSCI found this care home to be providing an Good 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

Bath Lodge 18/05/06

Bath Lodge 28/06/05

Bath Lodge 05/04/05

Bath Lodge 28/07/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bath Lodge 8 Bath Road Reading Berkshire RG1 6NB     The quality rating for this care home is:   two star good 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: Mark Hemmings     Date: 1 9 0 3 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Bath Lodge 8 Bath Road Reading Berkshire RG1 6NB 01189589726 01189561933 relax@beechhousehotel.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Michael John Bissell care home 17 Number of places (if applicable): Under 65 Over 65 17 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Up to 17 older people can make their home in Bath Lodge (the Service). The property is a detached older house thats been adapted for its present use. The accommodation is on the ground floor and the first floor. There isnt a fixed lift between the floors. There is a motorised chair that can be used to climb up and down the stairs one at a time. There is a total of 12 bedrooms. When the Service is full, five of the bedrooms will need to be shard by two people each. In practice, only three are now used as doubles. All of the bedrooms have a private wash hand basin. None of them have a private bathroom. There are two bathrooms. There isnt a walk-in shower. There is a call bell system. This has call points in each of the, bedrooms, bathrooms and toilets. This means that people can ring for assistance should it be needed. Care Homes for Older People Page 4 of 33 Brief description of the care home The Service is set back a bit from a busy road. Its very close to the centre of Reading. At the back there is a large enclosed garden. The Service doesnt have its own vehicle. The Registered Provider is a private individual. If you want to find out more about the Service and about the fees charged, you can phone the Service and speak with the Manager. Care Homes for Older People Page 5 of 33 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 quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was an unannounced Key Inspection. We arrived at the Service at about half past eight and we were there for about seven hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in his self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with five of the people who live in the Service. We also spoke with the Manager, Care Homes for Older People Page 6 of 33 a senior care worker, two care workers, the cook and with the maintenance man. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we visited the Service, we asked 10 of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Bath Lodge. Everyone kindly completed them and sent them back to us. Later on in our report, well tell you what people are saying in these questionnaires. The Registered Provider has also asked the people who live in the Service to say what they think about their home. As we go through our report well tell you some of the things that people are saying in their replies. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 33 Care Homes for Older People Page 9 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. Evidence: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving in to Bath Lodge is the right thing for them. She also talks with family members and with people like care managers (social workers). All of this information is collected so that the Manager can build up a really good picture of how the person can best be supported. After shes got all of this information, she can then decide if Bath Lodge can meet the persons needs for help. We looked at the information that has been collected for one person who has recently Care Homes for Older People Page 11 of 33 Evidence: moved into the Service. We wanted to see what sorts of things are being considered. There is lots of useful information. Theres information about practical things such as the help needed in the bathroom and about health care. But there is also other information about quality of life things. Such as the sorts of social activities the person likes to do. The Manager says that when she gets the information she shares it with care workers. This is done so that care workers know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Manager recognises that moving into a residential care setting is a big step. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the introduction process, people are invited whenever possible to visit Bath Lodge. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. The Assessment says that she also makes sure that people know about our Inspection Reports and that shes happy to show them the most recent one of these. One of the care workers says, we know it can be a stressful thing to have to move somewhere new, especially if you havent been well and know that you need extra help. We always make a fuss of the person so that they know that theyre welcome which of course they are genuinely. In our questionnaire we ask people who live in the Service, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Everyone says that yes they did. Nearly all of the people who move into the Service do so with the intention of making it their longer term home. However, there is the chance that someone will only want to stay for a shorter period. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because they been in hospital and arent quite ready to go home yet. When someone moves into a residential care setting theres always the risk that their stay might become longer than is necessary. The Manager is aware of this. She says that people are helped to make any arrangements that are necessary for them to go home as planned. Care Homes for Older People Page 12 of 33 Care Homes for Older People Page 13 of 33 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 are provided with the personal and health care they need. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of support for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to staff so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one person needs to be encouraged to walk about so they dont get too stiff. Another person needs encouragement to make sure that they eat enough. We asked two care workers about some of these things. We wanted to know what all Care Homes for Older People Page 14 of 33 Evidence: of this written information means in practice. They know all about it. In our questionnaire for people who live in the Service we ask, do you receive the care and support you need? Nine people say that they always do and one person answers usually. The latter person doesnt say any more about their reply. The care plans are kept up to date so that they are accurate. This involves care workers making daily notes about how things are going. There are then monthly reviews. This is when the Manager checks out with the care workers how things are going and what might need to be changed. One person has a special medical need. Although there is some information about the matter in the plan of care, its not that detailed. Theres some uncertainty among care workers about parts of the support that they may need to provide. The Manager is going to strengthen the written information. Also, shes going to make sure that all of the care workers know about it. Shes going to do this by 1 May 2009. As weve already said, the care plans are very detailed. While this is useful for members of staff it can make it difficult for the people their written about to fully appreciate whats being written in their name. The Manager recognises this to be an issue. Shes going to look into what can be done to make the whole process more straight-forward and more user friendly. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a care worker so that they dont lose their balance. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, people have seen their doctors as and when necessary. There have also been visits by other professionals such as district nurses. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. In our questionnaire we ask, do you receive the medical support you need? Everyone says that they always do. People can manage their own medication if they want to and if its safe for them to do it. At the moment, everyone who lives in the Service prefers to have members of staff sorting out their medication for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. The Assessment says that all members of staff who give out medication have been trained so that they know what theyre doing. There is a procedure for administering medicines. This is designed to double check that the right medicines are Care Homes for Older People Page 15 of 33 Evidence: given to the right people at the right time. Theres a record that is completed on each occasion that a medicine is given. We examined three sets of these records for a period of four recent days. They are correctly completed. We looked at three medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. People say that the care workers are courteous and attentive. In our questionnaire we ask, do the staff listen and act on what you say? Everyone says yes. When we were in the Service we talked with people a lot about this. They are very positive about the care workers. One person summarises the general mood in their comments to us. They say, the staff are quite wonderful here, nothing is too much trouble for them and you can ask them for whatever you want and theyll try to help. Theyre all so kind that I cant think of a single thing to complain about, really I cant. The Registered Providers questionnaire asks, (are you) satisfied with the care (you) receive from the care staff? Seven people say that its very good and 2 people say that its good. The questionnaire also asks, (are you) satisfied with the respectful attitude of staff? Everyone says that its very good. When people want to use the bathroom, they are helped to leave the lounge without drawing attention to themselves. Then they are helped in the bathroom with the door closed so that they can have privacy. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Care Homes for Older People Page 16 of 33 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. There are some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The Manager says that the plan is that several times a week there is a social thing that people can do. These events involve various things. Some of them are when outside entertainers come in to play music or to lead gentle exercises. At other times, care workers do things such as games and quizzes. Theres a record kept of the social things that take place. We had a look at it to see what sorts of things people have had the chance to do over the course of a recent month. They include things like musical exercise, playing bingo and doing various quizzes. In our questionnaire we ask, are there activities arranged by the Service that you can take part in? Three people say that there always are things for them to do, four people say usually and three people say that there sometimes are. The Registered Providers questionnaire deals with this subject too. It asks, (are you) satisfied with the social and recreational activities offered? Two people say that theyre very good and seven people say that theyre good. When we were in the Care Homes for Older People Page 17 of 33 Evidence: Service we chatted with people about this subject and in general we got positive comments. One person says, we have things to do like someone who comes in to play music and we all like that. I dont get bored here because I do what I want to during the day and theres always something to watch and people to talk to. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. The Registered Providers questionnaire asks, (are you) satisfied with the way (your) family or friends are kept informed? Seven people reply that the arrangements are very good and two people say that theyre good. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Instead, most people get help from members of their family. The Assessment says that people are encouraged to make their bedrooms their own private space. They are asked to bring in things for their own homes so that they can have personal items around them. We saw lots of examples of this. People have their own photographs and ornaments so that their bedrooms feel more like being home. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. The Assessment says that when people first move into the Service they are asked about any allergies they may have. This is done so that the meals they are offered are appropriate for them. One of the questions we ask in our questionnaire for people who live in the Service is, do you like the meals? Eight people say that they always do and two people reply that they usually do. The latter people dont say anymore about their answers. The Registered Providers questionnaire also asks about this subject. It says, (are you) satisfied with the menu? In answer, five people say that its very good and four people say that its good. There is a choice of dish at each meal time. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is a reasonable balance. The dishes include things like shepherds pie and roast pork. We chatted with people about the catering when we were in the Service. One person sums up the general tone when they say, if you dont like something you can say when staff tell you whats for lunch that day and have something different that you do like. Its not often because the menu is what we like Care Homes for Older People Page 18 of 33 Evidence: and so its not a problem. Care workers say that people can have drinks and snacks throughout the night. This is important. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. Care Homes for Older People Page 19 of 33 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. There is a complaints procedure. There are arrangements to make sure that complaints are dealt with properly. There are arrangements in place that are designed to safeguard people. Evidence: We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. In our questionnaire we ask, do you know how to make a complaint? Everyone says that yes they do. The Registered Providers questionnaire asks, (are you) satisfied with the way staff respond to (your) concerns? Of the eight people who reply, five say that the response they get is very good and four people say that its good. There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. Its the Registered Providers responsibility to sort out complaints. However, people can also tell us about things that are concerning them. Its very important that people are confident that theyre safe from being mistreated in some way. The Assessment commits the Registered Provider to ensuring that people who live in the Service are indeed kept safe. In our questionnaire for people who live in the Service we ask, do you know who to speak to if you are not happy? Nine people say that they always do and one person answers usually. Care Homes for Older People Page 20 of 33 Evidence: Care Homes for Older People Page 21 of 33 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 accommodation is comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. Evidence: The building is well maintained on the outside. At the back there is a large and well kept garden. There is a large patio area immediately outside the back door. On the inside, the accommodation is well decorated and furnished. Although its quite a large building, the place has a homely, lived-in feeling to it. The Registered Providers questionnaire asks, how do you rate the cleanliness of the home? Most people say that its good or excellent. At the moment, there are various training certificates, no-smoking signs and health and safety posters put up on some of the walls. Some people find it reassuring to know that these things are in place. However, we think that they take away from the homely feeling of these areas. The Manager says that shes going to take this into account when some of these areas are re-decorated. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the Care Homes for Older People Page 22 of 33 Evidence: system largely meets the national standard. They did ask for a limited number of improvements to be made. These have since been done. The Registered Provider does a regular fire safety risk assessment. This is where someone goes around the place to check out that everything is still working in the right way. We looked at the record of the most recent one. It says that the fire safety system remains well organised and safe. In March 2008, the kitchen and the larder were completely refurbished with new units and appliances. Soon after this, the people from the local Department of Environmental Health called to look at the kitchen. We looked at their report. It says that the kitchen has got five stars out of possible five. This is an excellent rating. It looks at things such as the cleanliness of the kitchen and the way that food is handled and prepared. The report does recommend a number of relatively minor improvements. The Manager says that theyve all been done. We looked in the kitchen too. Its well equipped, clean and well organised. We checked several of the things recommended for improvement. We found that they have indeed been done. At the moment, the Service has a motorised chair for people who cant manage the stairs. This is free standing device and it works by climbing up and down the stairs one at a time. The arrangement is that two care workers guide the chair whenever its being used to make sure that the person sitting on it is safe and secure. The use of this sort of chair is now a very unusual arrangement. Most residential services for older people have replaced them with passenger lifts or with stair lifts. We dont think that this chair is a good idea. Its slow and cumbersome. We think that its inherently less safe than a stair lift. This is because its less stable. People who need it are helped to get about. Both of the baths have got hoists. This means that there is a seat that goes up and down. There are three mobile hoists that can be used in the bedrooms. They might be needed if someone cant manage at all to get out of bed. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are banister rails along corridors. Also, there are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. When someone moves into the Service, the Manager makes a note of what assistance they need to get about. She looks at things such as the help someone needs in the Care Homes for Older People Page 23 of 33 Evidence: bedroom and in the bathroom. We asked care workers about this. They know what theyre doing. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has two large washing machines. These dont have an extra cycle for items that need an especially hot wash. The Manager recognises that this facility would be useful. She says that when one of the machines wears out its replacement will have this function. There is a tumble dryer. We looked in the laundry. Its well organised and clean. New rules have been introduced to help make sure that used water doesnt leak back from things like washing machines into the drinking water supply. It looks like the Service already meets these rules. However, just to be on the safe side the Manager is going to contact the local water supply company to find out. Shes going to do this by 1 May 2009. The Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough care workers around. Care workers know what theyre doing. Security checks are completed on new members of staff. Evidence: There is a minimum of three care workers on duty from early in the morning until around tea time when the number reduces to two care workers. There is a waking staff presence at night. Also, there are special security arrangements at night. Each day there is a cook on duty and each weekday there is also a housekeeper. In our questionnaire we ask people who live in the Service, are the staff available when you need them? Eight people say that they always are and two people answer usually. In our questionnaire for staff we ask, are there enough staff to meet the individual needs of all the people who use the Service? Eight people say that there always are and two people say that there usually are. One of the former people adds, there is always enough staff to cater to the needs of each individual service user during any given shift. Another person says, there is, we always try our level best!. When we were in the Service we kept a look out for things that might give us a clue about how well the place is being staffed. We noticed that two people who asked to be helped to use the toilet were assisted straight away. Its very important that only Care Homes for Older People Page 25 of 33 Evidence: honest and trustworthy people are employed as care workers. With this in mind, the Registered Provider completes a number of security checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for one recently appointed care worker. The checks have been done. The Manager says that new care workers have introductory training before they work on their own. In our questionnaire we ask about this. We say to members of staff, did your introductory training cover everything you needed to know to do the job when you started? Of the eight people who answered this question seven say that the training met their needs very well and one says mostly. One of the former people adds, I was able to complete an in depth induction as well as having continued support from both my manager and senior care staff particularly during my first few weeks and months of working here. There is a checklist of the subjects that new care workers are told about. We looked at one of these checklists. It shows that important things are being covered. For example, new care workers are told about the individual care plans we spoke about earlier. They are also told about fire safety things. The Manager says that this initial training is just to get the care workers started. Theres a lot to learn after that. The Manager says that all care workers are expected to do regular training in important subjects. For example, in how to safely support people move about, in basic first aid, in keeping people safe and in infection control. She says that most of this training is done by care workers attending external courses. We looked at the records of who has done what courses and when. The records show that care workers are doing quite a lot of training in relevant subjects. In our questionnaire we ask staff, are you being given training that is relevant to your role and that keeps you up to date with new ways of working? Everyone answers yes to this question. Several people then comment some more. One person says, I am regularly given the opportunity to attend various courses which enable me to keep up to date as well as ensuring I am able to adequately meet the needs of all the service users. The Manager is going to assess the skills and knowledge that each care worker already has. This is so that she can be sure that each person does training in the future that will be of the most benefit to them. She is going to do this using a new national model that we think is very useful. Theres a total of nine care workers employed in the Service. Of this number, six of them have completed a National Vocational Qualification (NVQ) in health and personal Care Homes for Older People Page 26 of 33 Evidence: care. Two more are studying for the award. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. The Manager says that all new care workers will be encouraged to work towards the qualification. We spoke with three care workers to find out what they know about particular bits of the support they will need to give people. As we have said earlier in this Report, they know a lot about how each of the people who live in the Service likes to be supported. More generally, they know about helping older people to take care of their skin. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 27 of 33 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. Things are well managed. People are asked what they think. People are helped to buy what they want. There are sensible health and safety things. Evidence: The Manager has a good knowledge of how things are going. She has both of the formal qualifications that are recommended by the Standards. These qualifications are important. This is because theyre designed to help managers ensure that high quality support is reliably provided. The care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers can be kept up to date with developments. There are team meetings every couple of months or so. We looked at the records of the sorts of things that are being discussed. Theyre practical and relevant. For example, care workers have recently talked about the need to be careful in the laundry so that things dont get shrunk. Theyve also Care Homes for Older People Page 28 of 33 Evidence: discussed how important it is to be careful in general so that the accommodation stays well presented and homely. In our questionnaire for members of staff we ask staff, do the ways you pass information about people who use the Service between staff (including the manager) work well? Of the nine people who reply, seven say that the arrangements used always work well, one person says usually and one says sometimes. Its really important that the people who live in the Service have a direct say on how things are going. Theyre the experts because they live there. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. In addition to this informal thing, there are also house meetings. These are events when anyone can attend and can tell the Manager how they think things are going. We looked at the records of the most recent of these meetings. People raised a variety of interesting things. For example, people talked about the menu and they chatted about the social activities that are available. Weve already mentioned about the questionnaires that people who live in the Service are asked to complete. The Manager does a summary of what has been said. She also responds to any suggestions that have been made saying what improvements she plans to make. The Service doesnt hold any money for anyone. Instead, it helps some people by paying for things for them and then sending a bill to their families about once a month. Each of the people concerned and their relatives have agreed to this in advance. We looked at the records for one person. We wanted to see if the amounts claimed to have been spent are reasonable. We also wanted to see if the purchases are supported by a receipt to prove that the money in question has been spent. Things are in order. The Manager says that regular checks are completed to ensure that the Services fire safety equipment remains in good working order. This includes a weekly test of the fire alarm bells. More detailed checks of the fire safety equipment are completed every now and then by an engineer. There should be quite regular unannounced fire drills. These are a bit overdue now. The Manager is going to sort this out by 1 May 2009. Most but not all members of staff have recently received fire safety training. This training is very important. This is because the level of fire safety protection largely depends upon members of staff doing the right thing when there is a fire safety emergency. The Manager is now going to strengthen the training system to make sure that every member of staff has the required training frequently enough. Shes going to complete this development by 1 May 2009. There are up to date reports from engineers about the gas appliances and the mobile Care Homes for Older People Page 29 of 33 Evidence: hoists. They say that everything is in good working order. However, there has not been a thorough check of the electrical wiring installation in the last five years. This check now needs to be done to make sure that the installation remains safe to use. The Registered Provider is going to sort this out by 1 September 2009. We looked at the record of accidents that have occurred in the Service over the past several months. There hasnt been that many. Most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what has happened. This is done so that she can do something if there is a particular problem that is causing the accidents. The Manager says that she and the care workers regularly check the accommodation. They do this to make sure that nothing is broken. Also, they want to see that there are no hazards that might cause someone to have an accident. The Manager says that they havent noticed anything in particular that needs attention. We kept our eyes open when we were walking around. We didnt notice any particular hazards Care Homes for Older People Page 30 of 33 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 31 of 33 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 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!