Inspection on 30/10/08 for Fieldgate Nursing Home

This inspection was carried out on 30th October 2008.

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

Fieldgate Nursing Home 09/01/07

Fieldgate Nursing Home 14/11/05

Fieldgate Nursing Home 08/06/05

Fieldgate Nursing Home 07/02/05

Fieldgate Nursing Home 09/09/04

Fieldgate Nursing Home 10/07/03

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fieldgate Nursing Home 153 Portsmouth Road Horndean Hampshire PO8 9LG     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: Christine Walsh     Date: 3 0 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 36 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 36 Information about the care home Name of care home: Address: Fieldgate Nursing Home 153 Portsmouth Road Horndean Hampshire PO8 9LG (023)92593352 Telephone number: Fax number: Email address: Provider web address: fieldgate@btconnect.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Muriel Joy Emery Type of registration: Number of places registered: Extraservices Limited care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: All service users must be at least 50 years of age Date of last inspection Brief description of the care home Fieldgate nursing home is a registered care home providing nursing and personal care to 39 clients in the older person category. The home is situated in a residential area close to local amenities. The clients accommodation comprises of seven single rooms and sixteen shared rooms and there is a passenger lift that allows access to both floors. There are a variety of aids and assisted baths to meet the needs of the clients. The service also benefits from a large and well-maintained garden with access for wheelchair users. 0 4 4 Over 65 39 39 39 Care Homes for Older People Page 4 of 36 Care Homes for Older People Page 5 of 36 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: This site visit formed part of the key inspection process and was carried out over one day by Mrs C Walsh, regulatory inspector. The registered manager Mrs Emery supported the Mrs Walsh with the inspection. Since the last visit to the home in January 2007 Extraservices Limited has new owners and directors, Mr and Mrs C W Legg. The Annual Quality Assurance Assessment (AQAA) document was returned to the Commission for Social Care Inspection prior to the visit to the home. The AQAA tells us that the service has identified areas where it does well and areas of improvement. These are referred to in the body of this report. Care Homes for Older People Page 6 of 36 The AQAA informed us that the home ensures the diverse needs of the clients are respected and told us that the home ensures staff are trained to meet those needs. The AQAA goes onto tell us that personal plans detail the clients diverse needs and there is a private sitting room where clients can entertain family and friends to meet cultural, spiritual and social needs. It was noted as part of the visit that the home also considers the learning and cultural needs of the staff. The information obtained to inform this report was based on viewing the records of the people who live and work in the home, of which four clients records were looked at. The day-to-day management of the home was observed, and discussions with clients and staff took place. When asked the manager informed us that the people who use this service are referred to as clients. The fees range from 560.00 pound sterling for a shared room to 770.63 pounds sterling for a single room. The home admits private clients and clients referred from social services. A top up fee is required for clients placed by social services. Additional fees include: Hairdressing. Papers. Chiropody. Personal Requisites. What the care home does well: Fieldgate Nursing Home does well to ensure it provides prospective clients and their representatives with information about the home, it assesses if it can meet their needs and supports them to become familiar with their new surroundings and others living in the home by supporting visits to the home prior to moving in. The home ensures its staff are familiar with the needs of the clients by developing care plans and risk assessment. The care plans tell the reader what they need to do to provide a consistency of care. In addition to care plans, risk assessments are undertaken for other areas of need such as mobility, diet, independence and prevention of bedsores. The staff do well to ensure the physical and psychological needs of the clients are being met, providing the clients with support to access health care professionals such as GPs, dentists and other specialist health care professionals if required. The home supports clients with their medication but where possible promotes independence in this area. The home listens to the clients needs, wishes and concerns and acts promptly to deal with any concerns or complaints the clients or their representatives may have. Staff are trained to protect the clients and to inform someone immediately if they are concerned that they are at risk of harm. Comments received from clients, relatives and staff in respect of what the home does well includes. Relative. The staff are very good here, they are very kind and make sure my ........ is well cared for. Client. The staff are wonderful, I am very grateful of the help and support they give me, I dont know what I would do without them. Client. I know how to make a complaint but I dont need to because I am happy with the care I receive here. Staff. I havent worked in the area of care before, but I have found the support of the care staff, the manager and the training I have received really helpful in moving into this area of work. Fieldgate Nursing Home offers a homely, safe and welcoming environment, which is spacious, tastefully decorated and furnished and offers individual bedrooms that are personalised and decorated to the clients liking. The registered manager and her staff are skilled and competent to meet the needs of the clients, the staff go through a thorough interview and induction process. The home has exceeded the standard in the area of staff training and induction, the unique delivery of training and the mentoring skills of the manager have supported this outcome. Care Homes for Older People Page 8 of 36 The registered manager and her staff go about their day-to-day responsibilities in a calm and relaxed manner and show kindness and respect to the clients and their visitors. The home does not manage personal financial affairs of clients but provides a safe place for clients to hold their money if they wish and has an audited system for billing clients or their representatives for purchases such as hairdressing and toiletries. The home does not hold client or care staff meetings but the manager will meet with clients, their relatives and staff informally or formally to provide open communication to listen to their views and deal with any concerns they may have. In addition the home regularly monitors the quality of care to establish if it is meeting the needs for the clients. The home carries out regular health and safety checks on the environment and all staff receive regular mandatory training such as fire safety, moving and handling, infection control, first aid and food hygiene to support them to identify, minimise and deal with emergencies. What has improved since the last inspection? What they could do better: The home has been issued with four recommendations, these are good practice points and, which the home can decide if they will use to improve their practice. It has been recommended that home develop the clients personal plans using a person centered approach, this means ensuring the care that is provided is individual to that person and staff carry out their care and support needs in the way that they want. Despite having good outcomes for clients with regards to activities, it is recommended that the home consider how they can meet the complex needs and requests of some of their clients. The home has good procedures in place for dealing with concerns and complaints, however it is recommended that the home change the address of the Commission for Social Care Inspection as the current address is incorrect. The manager currently does not hold meetings with non trained care staff. It is recommended that this occur in order that staff have a forum to discuss general caring Care Homes for Older People Page 9 of 36 and employment issues. 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 10 of 36 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 11 of 36 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. To ensure the home can meet the needs of the people wishing to move into the service it assesses their needs first. The home ensures people who are admitted to the home for intermediate or shortterm care receive the required support to return home. Evidence: The Annual Quality Assurance Assessment (AQAA) told us that they continue to ensure prospective clients have the information they need to make an informed choice about where to live. The AQAA told us that no client moves into the home without having their needs assessed first and went onto tell us that clients referred solely for intermediate care are helped to maximise their independence and return home. The service user guide and statement of purpose told us that all admissions to the Care Homes for Older People Page 12 of 36 Evidence: home are subject to a full assessment of needs, which are carried out by a senior member of nursing staff This was tested by viewing the statement of purpose, service user guide and viewing the assessment documents for four clients, including a client accessing the service for rehabilitation, we also spoke the manager. The manager informed us and provided evidence that the home is currently developing a website as an alternative source of information for people seeking a place for a relative, friend or client to move into. Assessment documents were viewed for four clients one of whom had recently moved in for intermediate care. The assessment is comprehensive and details information about the persons health, strengths and needs and other information relating the clients wellbeing, social interests, likes and dislikes and cultural and religious beliefs. The manager said that she meets with and obtains information from the prospective clients and family members. Social services assessments and assessments undertaken by health care professionals will also be obtained if applicable. If the prospective client is able they are invited to visit the home prior to moving in, where they are shown the room they will occupy, meet informally with other clients and meet with the staff. This process is to assist the prospective client to familiarise with the surroundings and make arrangements to move in if appropriate. Seven surveys were completed and returned to the Commission by clients. Five of the seven confirmed that they felt that they were provided with sufficient information about the home prior to moving in. The outcome of the last report told us that the home does not provide intermediate care, however the AQAA tells us that clients assessed and referred solely for intermediate care are helped to maximise their independence and return home. During the course of the visit the inspector met with a client who had been admitted for intermediate care and who confirmed that the home was providing support to enable them to get better and return home. Care Homes for Older People Page 13 of 36 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. The home ensures the people who use the service have their health, personal and social care needs set out in individual plans, this enables staff to monitor and maintain continuity of care. The plans do not provide information that will help the staff to have better understanding of their needs and how the person may wish to have those needs met. The home ensures the people who use the service receive their medication as prescribed by their general practitioner. The home ensures the people who use the service are treated with respect and their rights to dignity and privacy are upheld, this includes arrangements made in the time of a clients death. Evidence: The AQAA told us that the home continues to ensure that clients health, personal and social care needs are set out in an individual plan of care and care needs are fully met. Care Homes for Older People Page 14 of 36 Evidence: It also told us that it makes sure the clients feel they are treated with respect and their dignity is upheld. Where appropriate clients are responsible for their own medication and are protected by the homes safe policies and procedures. The above was tested by viewing the personal plans, daily notes and medication records of four clients. Speaking with clients, a relative, staff and the manager and observing day-to-day care practices in the home. Each client has a personal plan of their own which provides information on their daily personal, physical and mental health care needs, social support and areas of where the client maybe at risk. The plans identify the area of need and what action is required to ensure the clients needs are met. It was noted that the plans have been clinically written, and in some circumstances did not refer to the clients by their name and did not provide enough detail to describe how the clients wish to have their individual care needs carried out. A long discussion took place with the manager regarding the need for the personal plans to describe a person-centered approach based on the clients individual needs, history and wishes. All care plans followed the same format and description of care and only three of the four plans viewed used the name of the client in the text. The manager explained that the plans are written in a specific way to ensure all staff carry out safe caring and nursing practices. Following the discussion the manager agreed that improvements could be made to the plans and would consider how the plans could describe a more person-centered approach. When asked a member of staff said she found the care plans informative and helped her to support the clients with their everyday needs. Care staff told us that they are not involved in the development of clients personal plans but are required to read, follow them and record outcomes of daily care once they have provided the care. The care staff informed us that they receive regular informative handovers from trained staff and are made aware of any immediate changes to the needs of the clients. A client said they are aware they have a personal file and can look at it if they wish. Care plans are linked to risk assessments and provide detail of the risk and action required by staff to minimise them. The information was written in plain English and easy to follow. There was evidence that the home regularly reviews clients weight, skin condition and mobility to minimise the risk of them developing pressure sores. Those clients identified as at risk are provided with pressure relieving equipment such as specialist mattresses and cushions. Care Homes for Older People Page 15 of 36 Evidence: Clients and relatives who were spoken with at the time of the visit were very complimentary of the care and support the staff and manager provide. A client said: The staff are wonderful, I am very grateful of the help and support they give me, I dont know what I would do without them. A relative said: The staff are very good here, they are very kind and make sure my ...... is well cared for. Each client is registered with a GP and information in clients personal plans tell us that a record is kept of clients personal health care needs and the support they require to get better. In addition clients have access to other health care professionals such as dentists, opticians, chiropodists and specialist health care teams such as occupational therapists, physiotherapists, community psychiatric nurses (CPNS) and psychiatrists. A client said: If I am feeling unwell the staff will make sure I am seen by a doctor as soon as possible. There was evidence that specific aspects of nursing care such as using feeding devises and administration of medications have care plans in place and clinical staff are provided with training and up to date policies and procedures to ensure these procedures are carried out safely. The home has systems in place for the administration of medication. The trained staff administer from named bottles and packages, which is supplied by a local pharmacy. Clients who are assessed as able to administer their own medication are encouraged to do so and a safe place is provided for them to store their medication. A registered nurse demonstrated the procedure and processes used to administer, record and audit the receipt and disposal of medications, which appeared to be in line with the Royal Pharmaceutical Guidelines. Throughout the course of the visit it was noted that staff showed respect and kindness to the clients, taking time to listen to them, knock on their doors before entering and Care Homes for Older People Page 16 of 36 Evidence: ensuring the clients dignity and privacy is carried out in a respectful way. In the four personal plans seen there was information relating to their end of life arrangements and wishes. The home has adopted the Care of the Dying Pathway. This is a specific continuous assessment of the changing needs of the client. It provides information on actions required by staff to ensure the client receives a comfortable and dignified end to their life. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures it supports the people who use the service to participate and engage in activities of their choice, maintain contact with family and friends and provide them with meals that meets their dietary requirements. Evidence: The AQAA tells us that the home continues to ensure the lifestyles experienced in the home matches the experiences and expectations the clients had before moving into the home and that social, recreational and individual interests meet the clients needs. The AQAA goes onto to tell us that they ensure clients maintain contact with family and friends and that they receive a wholesome and appealing balanced meals. This was tested through observation on the day of the visit, viewing a weeks menu and activity notices/timetable, observing the lunchtime meal, and speaking with clients and staff. Each client has within their assessment documentation and personal plan an area where their interests, social and spiritual needs can be recorded, however for two of clients this information had not been fully completed. The manager stated that it is not Care Homes for Older People Page 18 of 36 Evidence: always possible to obtain this information either because the client wishes not to provide it or the client is unable to say what they are. The manager went onto say for the clients referred to in this report do get involved in activities of their choice. The home has designated three members of care staff to undertake activities on specific days with clients. Their responsibilities include working with individual clients and working with groups of clients in planned activities, these include in house and external events. The home arranges seasonal activities and at the time of the visit it was making preparation for a fireworks party, which the manager said will be well attended by clients and their family and friends. Other activities include attending the theatre, charity walks in the summer, arts and crafts and attending clothes parties. The manager said: If they want it they can have it (referring to activities) We were informed by a client that some activities that had been requested had not happened because of associated risks. There was no evidence in the clients plan to indicate the home had assessed the level of risk. Where the home considers there are risks associated with specific activities requested by clients they must be able to demonstrate why the activity cannot take place. The manager must consider how risks can be minimised to either compromise with or meet clients individual requests. Comments received from clients varied in their opinion of the activities that they could take part in from there are always activities that I can take part in Sometimes there are activities that I can take part in. It is recognised that activities are down to the clients individuals personal choice. Whilst visiting clients in their own rooms and walking around the home is was observed that clients have access to radios, televisions and other forms of entertainment such as jigsaws and knitting. A relative who was met with at the time of the visit was very complimentary of how he has been made to feel welcome and the support the home has given his relative and him at a difficult time. The relative went onto say: The staff are always very welcoming and will always make time to listen to any concerns I may have. A visitors notice is displayed and all visitors are asked to sign in and out of the home. Care Homes for Older People Page 19 of 36 Evidence: Clients have access to a phone, but can have a phone of their own installed if they wish. The manager told us that visitors are very welcome to stay for meals at no extra cost and the clients can meet with their family and friends in the privacy of their own room or the comfortable communal areas. The manager also informed us that clients are supported by care staff to write letters and make cards. This was confirmed by a client who told us that the home often helps her to maintain contact with family and friends. A member of staff who was spoken with said she was aware of the importance of supporting clients to maintain contact with family and friends and to ensure visitors are made welcome. The same member of staff was observed making a tray of tea for visitors later in the day. Care plans tell us what time clients wish to get up and go to bed, although all four care plans seen provided the same information. Further discussion took place on the importance of providing a person-centered approach to the individual needs and wishes of the clients. It was also discussed how valuable obtaining a life history or pen picture would be to establish why clients may wish to do certain things at certain times of the day. As stated in the AQAA the home currently cannot fully evidence that it will ensure life experiences for the clients prior to moving into the home will be met. The home has a full time chef and several assistance to support him to meet the daily dietary requirements of the clients. The manager said that the cook has worked in the home for a long period of time and is fully aware of the importance of ensuring the clients receive a well balanced diet. Clients have an option of three cooked meals a day including a cooked breakfast. A light tea is provided with a hot and cold option and supper is later provided for clients who may still be feeling hungry. The weekly menu plans appeared well balanced. The menu is not displayed but clients are asked what they would like to eat at the beginning of each day, if they change their mind an alternative is provided. There were mixed views received in comment cards about the meals provided in the home. Some clients in their comment card said that they always like the meals to another indicating that they never like the meals. A monthly visit made by the provider seeks the views of the clients in respect of mealtimes. All reports provided evidence that clients are happy with the standard of meals they are receiving. Four personal plans seen had a completed nutritional assessment in them and there was evidence that a record of what each client is eating and drinking is kept. It was Care Homes for Older People Page 20 of 36 Evidence: observed that clients receive regular drinks and snacks throughout the day, and fresh water and juice is in easy reach of the client. The staff support clients with eating and drinking where required and the routine at mealtimes ensures that clients who require support with eating and drinking are supported before those who are able to manage for themselves. The home encourages mealtimes to be a social event but respects clients wishes to eat in their own rooms. Care Homes for Older People Page 21 of 36 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. The home ensures that the people who use the service are listened to and concerns raised by them are acted upon. The home ensures that the people who use the service are safeguarded from the potential risk of harm. Evidence: The AQAA tells us that the home continues to ensure that clients, relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. The AQAA also told us that the home ensures clients legal rights are protected and they are protected from abuse. This was tested by viewing the complaints procedures and logbook, testing if the home has procedures for safeguarding the clients and speaking with the clients and staff. The homes Statement of Purpose informs the clients and their representatives how they can make a complaint if they have concerns about any aspects of their care. The manager was informed of the new contact details for the Commission for Social Care Inspection and requested to amend the policy to reflect the change. The manager provided evidence that the home keeps a record of all complaints, which Care Homes for Older People Page 22 of 36 Evidence: includes the nature of the complaint, who the complaint was made by, what action was taken and the outcome. The manager keeps the records secure for the purpose of confidentiality. The managers records told us that the home has not received any complaints or concerns since January 2008. When speaking with clients the feedback on the care and support they receive from the staff was complimentary and they do not have any concerns about the way they receive their care. A client told us: Ive no need to complain the staff are wonderful here, I couldnt ask for anymore Another said: I know how to make a complaint but I dont need to because I am happy with the care I receive here. The homes training records and training matrix tell us that staff receive regular training in safeguarding vulnerable adults. Both the manager and staff told us that the home will designate a month to training specific mandatory areas, which includes adult protection. Discussion took place with five care staff who were able to clearly describe different types of abuse, how to whistle blow and steps they would take to ensure clients remain safe. They told us that they have access to policies and some staff spoke confidently of how they had brought specific concerns to the attention of the manager and wouldnt hesitate to do it again if they felt someone was being harmed in anyway. This demonstrated that the staff have a good understanding of their roles and responsibilities and the importance of ensuring people in their care are safe. Care Homes for Older People Page 23 of 36 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 ensures the people who use the service live in a welcoming, comfortable and clean environment. Evidence: The AQAA tells us that they continue to ensure the clients live in a safe, wellmaintained environment where they have access to safe and comfortable indoor and outdoor communal facilities. It also tells us the home is clean, pleasant and hygienic. This was tested by walking around the home, speaking with clients about their personal rooms and the homes environment and speaking the manager and care staff. The home is situated in a residential area of Horndean in Hampshire and there is a large car park to the front of the home with ample parking. An extensive tour of the home provided us with evidence that the home takes pride in its facilities and cleanliness. The physical environment is well maintained and appears to meet the needs of the current clients. The home has designated staff to ensure the areas of the home that need attention and repair are attended to promptly. The manager informed us that the home has a rolling repair and redecoration program Care Homes for Older People Page 24 of 36 Evidence: and plans are in process to make alterations to the homes environment to accommodate more single rooms and provide up to date aids to assist with clients mobility. The home has a large accessible garden, which is regularly maintained by maintenance staff. At the time of the visit the garden was being prepared for the winter months and preparation was being made to plant winter flowering shrubs. Photographs provided evidence that the garden is used, especially in the summer when fetes and tea parties are held. Clients who were spoken with at the time of visit told us that they are happy with the environment and their personal space. For some this is shared space, screens are in place to provide privacy and maintain their dignity. A client told us that she was able to bring in many of her personal effects and small items of furniture, which helped her to settle in. Another client took pride in her personal belongings and proudly showed pictures of her extended family. The home has designated staff for cleaning and laundering bedding and clients personal clothing. Laundry facilities provide equipment to manage the control of infection such as sluice action washing machines, which can work at very high high temperatures when required. Domestic staff provide a clean environment and all areas seen on the day of the visit were free from offensive odours. All staff receive training in infection control, this is a topic that is covered frequently throughout the year as one of the homes specific training sessions. The topic is covered using the staffs rest room notice board and providing other applicable information and training aids. Staff are equipped to guard against the spread of infection, equipment such as disposable aprons, gloves hand gels and disposable hand towels and liquid soaps are used throughout the home. Information regarding good hand washing techniques are discreetly posted around the home and visitors are politely asked to use hygiene gels on entering and exciting the home Staff spoken with at the time of the visit confirmed that they had received infection control training and are aware of the importance of good hygiene procedures to guard against cross infection. Care Homes for Older People Page 25 of 36 Care Homes for Older People Page 26 of 36 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. The home ensures the people who use the service have their needs met by adequate numbers of skilled, competent and appropriately recruited staff. Evidence: The AQAA told us that the home continues to ensure clients needs are met by the numbers and skill mix of staff, ensure they are in safe hands at all times and are protected by the homes recruitment policies and procedures. It also tells us that it ensures that staff are trained and competent to do their jobs. This was tested by observing practice on the day of the visit, seeking the views of clients and visitors, viewing Have Your Say comment cards and viewing staff recruitment and training files. On entering the home midmorning it was soon established that the home was busy with staff supporting clients with their personal care needs, providing refreshments and greeting visitors. The duty rota confirmed that there are sufficient numbers of staff on duty in each area of the home. Each area has a named registered nurse on each shift and care staff who are allocated to clients (keyworker system). In addition the home has a manager, Care Homes for Older People Page 27 of 36 Evidence: deputy manager and domestic and catering staff. A member of staff said that clients are supported to get up at their leisure and no one is rushed or expected to do anything they dont want to. A relaxed and organised approach to the day-to-day needs of the clients was observed and call bells were answered promptly. The staff were observed to be happy, involved in cheerful banter with the clients and other staff. Staff spoken with at the time of the visit said they were happy working in the home and in particular working with the clients. Some went onto discuss specific aspects of the job they enjoy most, which on the whole was making sure the clients were well cared for and happy. The manager informed us that the home does not use agency staff as this can disrupt the continuity of care and that most of the staff are happy when necessary to cover shifts. Comments received from clients who were spoken with at the time of the visit were positive in respect of the care they receive and kindness and helpfulness of the staff. A client said: The staff are very attentive and helpful A relative said: The staff are very good here, they answer call bells quickly and do the best they can for my relative. Two newly recruited staffs personal records were viewed. Recruitment records indicated that appropriate checks are carried out on staff prior to them starting in the home, including two references, criminal record bureau (CRBs) and protection of vulnerable adult (POVA) checks. A member of staff recently employed was spoken with and confirmed that they had completed an application, attended an interview and hadnt started working in the home until all their checks were in place in the home. Following the last visit to the home it was identified as only have 37.5 percent of its staff trained in a national vocational qualification. The AQAA told us that in the last twelve months the home has reached the Care Homes National Minimum Standard of having 50 percent of its staff trained in a national vocational qualification (NVQ). Staff spoken with at the time of the visit confirmed that they had completed or were in Care Homes for Older People Page 28 of 36 Evidence: the process of completing a NVQ. The home ensures all new staff receive a comprehensive induction based on the governments Skills for Care programme. The manager provided evidence of the program she has developed in line with Skills for Care, and provided evidence that the programme is used as a mentoring tool that is completed and signed off by the member of staff and the mentor. The induction is broken down into days and weeks, outlining what the new member of staff should be doing and learning at that particular point of their employment. A member of staff confirmed that she had received the support of the manager and senior staff to complete her induction and said she felt well supported. The manager provided evidence that she ensures all staff receive mandatory training using various materials and sources of information to assist in the learning process. It was established by speaking staff, viewing training records and viewing the homes training matrix that staff receive regular up to date mandatory training. The manager provided evidence that she has the appropriate qualifications to teach staff in areas of care and has gained the appropriate qualifications to mentor and micro teach students on placement from general hospital. The manager told us she is mentored to ensure her practices are up to date. The manager has adopted a unique way of ensuring staff receive the knowledge they need to carry out their day-to-day responsibilities. At the time of the visit the training topic of the month was moving and handling. A wall in the staff room is dedicated to the topic, which on this occasion provided information on safe positioning, appropriate moves, information on the physical make up of the body and questions to staff to on what to do and not what to do. The staff agreed that the information provided in this way was beneficial as it was visual everyday to prompt them to carry out moving and handling procedures correctly. The manager commented that she is very keen to continue to promote the skills of the staff and ensures all staff, including trained staff receive regular training to ensure they can meet the diverse needs of the clients. Staff spoken with at the time of the visit said they had recently received dementia care training and had found this very helpful in understanding the needs of the people they support who have dementia. Care Homes for Older People Page 29 of 36 Evidence: A member of staff said: I havent worked in the area of care before, but I have found the support of the care staff, the manager and the training I have received really helpful in moving into this area of work. Care Homes for Older People Page 30 of 36 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. The home is being run by a competent manager, and the people who use the service are supported by a committed staff team who ensure it is run in their best interests and is a safe place to live. Evidence: The AQAA told us that the home continues to ensure clients live in a home which is run and managed by a person who is fit to be in charge and clients benefit from the ethos, leadership and management approach of the home. The AQAA went onto tell us that the clients are safeguarded by the homes financial accounting, policies and procedures and protection to the clients and staffs health and safety. This was tested by spending time with the manager, observing her practice and running of the home, observing her interactions between staff, clients and relatives. We also viewed health and safety documents including fire safety records, quality monitoring records such as regulation 26 reports and speaking with clients, staff and Care Homes for Older People Page 31 of 36 Evidence: visitors. Through the course of the visit Mrs Emery demonstrated that the clients and staff benefit from her leadership. Interactions between clients, staff and visitors was respectful and she provided direction and information when required. Staff commented that Mrs Emery is supportive and easy to approach. Clients and visitors were complimentary of Mrs Emerys presence in the home and her understanding of their needs. A visitor said: Mrs Emery has been very supportive and is a very knowledgeable lady. The manager told us she has an open door policy and can be easily accessed by staff, clients and visitors. This was observed on the day of the visit. The home has a number of quality monitoring tools in place to assess if the home is meeting the needs of the clients and staff. These include monthly unannounced visits by the owner who will meet and seek the views of clients, staff, visitors. it also includes viewing various records to ensure the home is complying with the Care Homes Regulation and National Minimum Standards. A record of the visit is kept in the home. The record informs the reader of good practice and areas that require action. These are known as regulation 26 visits. The manager informed us that she holds regular meetings with her trained staff to discuss good working practices, clinical changes and professional development. Care staff do not currently attend staff meetings and feel they would benefit from having a forum to discuss care staff issues. The manager stated that staff receive regular individual mentoring meetings, (Support and Supervisions) where they are able to discuss their keyworking role, any concerns or training needs they may have. Mentoring forms seen at the time of the visit evidenced this. The manager informed us that the home does not hold client meetings, although their views are sought through regular contact, an open door policy and completing an annual questionnaire. The home has a comment and suggestion box where clients and visitors are encouraged to share their views about the home. The home does not look after clients personal financial affairs but provides a safe place for clients to hold their money. The home will invoice clients and/or their representatives for hairdressing, chiropody and personal requisites such as toiletries Care Homes for Older People Page 32 of 36 Evidence: and papers. A record of these purchases and payment balances is kept and appeared to be in order. Fire records provided evidence that the home regularly tests and inspects all fire safety appliances and equipment. The manager stated the maintenance man is the homes allocated fire marshal. She went on to tell us that the fire marshal has undertaken specific training to enable him to provide regular fire safety training to all staff, including night staff and carry out checks on fire safety equipment. In addition to the regular checks carried out by the homes fire marshal the home contracts out to an external fire safety provider to undertake annual checks. The manager provided evidence that all staff receive health and safety training, which includes safe food handling, moving and handling, first aid and infection control. Controlled substances hazardous to health (COSHH) are securely locked away, there are notices discreetly displayed around the home reminding people of good hygiene practices and all appliances such as gas, electric and hoists are regularly checked to ensure they are in goods working order. There was evidence that the maintenance man has recently carried out an annual check on all small electrical appliances. Care Homes for Older People Page 33 of 36 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 34 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 12 It is good practice when writing clients person - centred plans to refer to the client by their name. Where there are identified risks associated with an activity requested by a client/s the home must be able to demonstrate why the activity cannot take place. The manager is advised to change the contact details of the Commission for Social Care Inspection, so people who use the service know who to contact if they feel a complaint has not been dealt with appropriately. The manager may wish to consider holding meetings with care staff to ensure their collective views and needs are shared and listened to. 3 16 4 33 Care Homes for Older People Page 35 of 36 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. 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. 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