Inspection on 20/11/08 for High Trees Residential Care Home

This inspection was carried out on 20th November 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

High Trees Residential Care Home 16/01/07

High Trees Residential Care Home 27/10/05

High Trees Residential Care Home 31/05/05

High Trees Residential Care Home 09/09/04

High Trees Residential Care Home 07/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: High Trees Residential Care Home 24 Clay Hill Enfield Middlesex EN2 9AA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tony Brennan     Date: 2 0 1 1 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 30 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 30 Information about the care home Name of care home: Address: High Trees Residential Care Home 24 Clay Hill Enfield Middlesex EN2 9AA 02083632238 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Deborah Olive Hurril Type of registration: Number of places registered: Khemchand Prakash Hurril care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home High Trees is a registered care home, which provides care for 12 older people of mixed gender. Mr Khemchand Hurril owns the home. The home is situated in a residential area in Enfield and is easily accessible by public transport. The premises are constructed of two floors with the lounge and dining areas on the ground floor. There are five bedrooms on the ground floor and five bedrooms upstairs. Two bedrooms are shared. There is a very attractive large conservatory at the rear of the property, which leads onto a well-maintained garden and patio. The fees are #380 a week. This report is available through the internet. Copies may also be obtained from the provider of this service. 0 Over 65 12 Care Homes for Older People Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. This unannounced key inspection was undertaken as part of the annual inspection programme. We sought to confirm that the home continues to provide good outcomes for residents. Prior to the inspection the home had completed its Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment provided us with information about the home and how it was seeking to provide the best outcomes for people. We also looked at any other information we had received about the home since the last inspection. This included any information regarding incidents that the home had told us about. Care Homes for Older People Page 5 of 30 The inspection took place over one day. We were assisted by Deborah Hurril, the registered manager, with the inspection. Comment cards were received from residents. We spoke with three people who live at the home, two members of staff and three relatives. We observed care practice and interaction between staff and people living at the home. We toured the building and examined a number of records relating to the care, health and safety and management of the home. At the end of the inspection feedback was given to the registered manager. As part the inspection planning it was agreed that an expert by experience would accompany us on the inspection visit. The expert by experience, Firdause Sheikh, assisted with the inspection by speaking to people who live at the home. He also observed the care of people living at the home. The expert by experience observations are reflected in this report. We would like to thank the staff that assisted us by answering questions about the running of the home. We would also like to thank the people who live at the home who discussed their views of the service they receive. What the care home does well: High Tree has continued to provide good outcomes for residents. The statement of purpose identified the skills and staffing resources available to meet the needs of people. A resident told the expert by experience that she was satisfied with the care she received and, Everyone is so nice here. The manager and staff look after us and they do a good job. The home provides a statement of purpose that is specific to the home and the resident group that they care for. A person who lives at the home said, The home is very nice. I am happy here. The people case tracked had both assessments from placing authorities and ones carried out by the home. These identified the residents needs for support and care. Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. The annual quality assurance assessment, and discussions with the registered manager showed us that there had been continued improvement in how residents needs are being supported. The expert by experience commented that, Residents are well cared for. People we spoke to told us that they felt staff understood their needs. People are involved in the planning of their care that affects their lifestyle and quality of life. We spoke with people who live at the home who told us that they are provided with regular activities. People are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. People with whom we spoke confirmed that they knew how to make a complaint. A person told us, I have not had to make a complaint about anything. I know I can talk to the manager about anything if there is a problem. The home has an open culture that allows people to express their views and concerns in a safe and understanding environment. People living at the home felt confident that any concerns they raised would be handled sensitively and appropriately. A person told us, I can tell staff if I am worried about things. People feel safe and well supported by the home which has their protection and safety as a priority. One of the bathrooms has been converted into a walk-in shower. The registered manager told us that she was just completing the redevelopment of the homes kitchen. We saw that a number of improvements have been made to the kitchen. The home makes sure that the environment is developed to provide improved outcomes for residents. A resident told us that, staff always come and help. I could not manage without them. The staffing level is reviewed regularly to make sure there is sufficient staff to meet the needs of residents. Staff training records showed that staff had done training in the essential areas. The home ensures that all staff receives relevant training that is focused on delivering improved outcomes for people. Care Homes for Older People Page 7 of 30 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.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 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The statement of purpose is an accurate description of the service provided. Residents needs are assessed prior to admission to the home to make sure they receive the care and support they need. National Minimum Standard number six is not applicable to this service, as the home does not provide intermediate care. Evidence: We found that the needs of the people case tracked were within a range of those specified in the statement of purpose. The statement of purpose identified the skills and staffing resources available to meet the needs of people. A resident told the expert by experience that she was satisfied with the care she received and, Everyone is so nice here. The manager and staff look after us and they do a good job. Surveys from residents confirmed that they all had been given sufficient information about the home Care Homes for Older People Page 10 of 30 Evidence: so that they could decide if it was the right place for them to live. A relative confirmed that, They told us everything about the home, and how they would help mum. The home provides a statement of purpose that is specific to the home and the resident group that they care for. The statement of purpose confirmed that the cultural and religious needs of people would be respected. Records showed that people were supported by the home to maintain contact with their church or other community groups. The annual quality assurance assessment identified that peoples cultural and religious needs would be identified in initial assessment and their care plans. We spoke with the registered manager who told us that cultural and religious needs would be addressed and identified through initial assessments and care planning. Initial assessments and care plans for the people case tracked reflected their cultural and religious needs. One person told the expert by experience, I go to church across the road. People are supported to maintain their cultural and religious identity. People living at the home have varying degrees of disability. The environment has been adapted so that it is accessible. For example, since the last key inspection a walk-in shower has been provided for residents. We observed that people were able to move about the home safely. The homes environment is adapted to meet peoples diverse needs. A person who lives at the home said, The home is very nice. I am happy here. The annual quality assurance assessment stated that there were comprehensive pre admission assessments in place. The people case tracked had both assessments from placing authorities, and ones carried out by the home. These identified the individuals needs for support and care. All surveys from residents confirmed that they received the care and support they needed. As part of the assessment process information on the needs of people had been obtained from health professionals. This had been used to inform the homes own assessment. A district nurse spoken to confirmed that staff follow up on treatment and Take an interest, by asking what needs to be done to help residents. Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. Initial assessments recorded the involvement of people and their representatives in identified areas where they needed support. Both relatives and residents living at the home told us that they had been actively involved in the initial assessment process. We found that initial assessments reflected the individuals preferences and how they wish they needs to be met. Detailed initial assessments are carried out with the involvement of people and their representatives to make sure their needs are identified. Care Homes for Older People Page 11 of 30 Evidence: A person told us, Staff are very caring. Care staff spoken to were able to explain the individual needs and preferences of the four people case tracked. Training records showed that staff had all the necessary training to meet the needs of residents. We observed the interaction between staff and residents. We found that it supported residents continued well being. Admissions to the home only take place when staff have the necessary skills to meet the assessed needs of perspective residents. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples personal, social and medical care needs are fully planned for. People who use the service are fully protected by safe procedures for handling medication. Peoples right to privacy is supported. Evidence: The annual quality assurance assessment and discussions with the registered manager showed us that there had been continued improvement in how residents needs are being supported. The care practice that we and the expert by experience observed confirmed that staff met residents needs. The expert by experience commented that. Residents are well cared for. We found that the care plans of all the people case tracked were detailed and clearly identified how the needs of people would be met. Care plans were based on initial assessments of the people case tracked. For example one of the people case tracked was identified in their initial assessment is having a Care Homes for Older People Page 13 of 30 Evidence: history of falls. The registered manager has carried out a falls risk assessment. A care plan has been put in place to prevent further falls. There were clearly defined actions highlighted in the care plans to meet the needs of people. We found that residents choices and preferences are recorded in their care plans. The registered manager explained that she had started reflecting residents capacity to make decisions in their care plans. Staff spoken to were aware of these issues. They had recently started training on mental capacity. Residents changing capacity to make decisions were reflected in their care plans. The care plans for the people case tracked were found to reflect their choices and preferences. People commented that they had been asked about how they wish to be supported by staff. Staff were observed to interact respectfully and sensitively with people living at the home. The expert by experience observed that one resident. Smart appearance gave out a clear message that she had been well looked after. Obviously some one had administered good personal care. People said that staff respected their privacy and treated them with respect. People we spoke to told us that they felt staff understood their needs. We saw examples where staff members did relate well with people living at the home. For example speaking to people in a way that was appropriate given their age. One of the residents told us. Staff take time to ask how I want things done. A key worker system is in place. Care plans were personalised, and referred to the cultural needs of people. This included whether or not they wish to take part in religious services. A resident said. I have Communion from the church every week. I have a friend who keeps me in touch with whats happening at my church. People are involved in the planning of their care that affects their lifestyle and quality of life. Detailed nutritional, tissue viability, falls and manual handling assessments are in place. People were being weighed regularly and action taken if their weight changed. The people case tracked all had nutritional assessments. One of the residents case tracked was identified in their care plan and risk assessment has been at risk of choking. Their risk assessment and care plan outlined how they should be assisted to eat and drink to prevent them from choking. This care plan had been prepared with the involvement of the resident and their GP. The care plan provided clear guidance on how the resident wished to be supported. We observed how this resident was helped to eat and drink. The guidance in the care plan was being followed. The member of staff supported the resident to eat at their own pace. Each care plan includes a manual handling risk assessment. Equipment had been provided to assist people to mobilise safely and independently. We spoke with one of the district nurses who regularly visit the home. She told us. I have seen the way Care Homes for Older People Page 14 of 30 Evidence: staff move residents, the practice is good. We observed staff assisting a resident to walk. The member of staff did this in a way that maintained the residents safety. Management of risk ensures that safety issues are addressed whilst at the same time improving the quality of life for people living at the home. Diary notes showed that appropriate medical attention and advice is sought. All surveys from residents confirmed that they had access to the medical support they needed. A resident told the expert by experience. Here they are looking after the illness as well as the old age. Diary notes also confirmed that the people case tracked had access to their General Practitioner when necessary. A person told us. The doctor always visits regularly. Where the General Practitioner had recommended specific medical interventions these were followed up. A district nurse told us. Staff asked the guidance and follow up on treatment that residents need. Residents health is promoted to ensure their continued well being. The registered manager explained that she has been working with staff to improve the support provided to residents with end of life care needs. This has included training based on the Liverpool pathways and gold standard in palliative care. We saw that care plans had been drawn up, with the participation of residents and their families, on end of life care needs. The district nurse told us that the homes staff had used her guidance and training to make sure that peoples end of life needs are addressed. The home works closely with external professionals and specialist for advice and support to help the residents to meet these needs. Residents wishes about dying and terminal care are openly and sensitively discuss and are part of their person centred care plan. The records of medicines received, administered and returned to the pharmacist were all complete. We were able to confirm that people were getting their medication as prescribed by their general practitioners. We found where the General Practitioner had made changes to residents medication this was signed to confirm the change had been made. We found that the medication for each of the people case tracked was accurately recorded. Medication records are fully completed, contain the required entries, and are signed by appropriate staff to ensure peoples safety. The people we case tracked had their consent to staff administering their medication recorded in their care plans. Two people self-administered their inhalers. This was recorded in their care plans. A detailed risk assessment had been completed with the participation of the General Practitioner and the resident. We saw that both residents had a lockable space in their bedrooms to keep their inhalers. Residents are encouraged and supported to manage their own medication. Medicines were stored safely. All medicines are stored at the appropriate temperature. Separate records were maintained for controlled drugs. The management team Care Homes for Older People Page 15 of 30 Evidence: monitor staff to make sure that the correct procedures are followed when administering medication. Regular management checks are carried out to make sure that medication is administered safely to people. Training has been provided on the safe administration of medicines. Training records confirmed that this training had taken place. We were able to observe staff administering medication, and confirmed that this was done safely. Staff understands how to administer medication safely to people living at the home. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with varied activities to meet their needs. People living at the home are supported to maintain contact with relatives and other representatives of their choice. The menu offers a balanced diet to people living at the home. Evidence: We spoke with people who live at the home who told us that they are provided with regular activities. Surveys from residents also confirmed that they usually have activities. We observed that activities were taking place at various times throughout the day. We saw that people were enjoying playing a broad game, talking with staff and listening to music. The expert by experience noted that residents, Expressed satisfaction with the indoor activities. People spoken to told us that these activities are provided regularly. Peoples interests were recorded as part of their care plans. We found that the residents who we case tracked had their emotional and personal interests recorded in the very person centred way. A relative told us that she had seen activities taking place. She felt that residents Care Homes for Older People Page 17 of 30 Evidence: always enjoyed the sing a longs. Diary notes showed that people had regular contacts with family, friends and the wider community. One resident told the expert by experience that he uses his own scooter to go out. This persons daily notes confirm that he regularly visit shops in the local area. People are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. We observed that staff spend time talking with people who live at the home and listening to what they had to say. Staff spoken to understood the importance of oneto-one contact for people. A relative said, The attention residents receive from the staff is very good. We could see from daily notes that residents had regular contact with relatives and friends. A resident told the expert by experience that, My great grand children come to visit me. They use the lounge as their playground. And nobody minds. The expert by experience noted that, there was a general approval of the manner in which the residents visitors were welcomed. Relatives commented that there were no restrictions on visiting the home. A relative commented on this, they are always welcoming here. People told us that they could see visitors in private if they wished. The home supports residents to maintain and develop their family and personal relationships. The menu showed that options are offered at each meal. The registered manager explained that she would be consulting residents about the variety of meals being offered. This will support more individualise meal plans for residents. We spoke with people who were generally pleased with the quality of the food provided. A person who lives at the home said, Food is very good. Another person commented about the choice of food offered and that staff, do ask what you would like to eat. They come round and asked what you would like for tea. The expert by experience noted that, The food looked very fresh and appetising. Every body seemed to be enjoying what ever they were having to eat. People are offered a variety of meals that reflect their personal preferences and meet their dietary needs. Meals were balanced and nutritious. Peoples dietary needs are recorded as part of their care plans (for example if they were diabetic or needed a puree meal). We observed that meals were well presented in a warm and friendly way. We saw that people were supported to eat. We observed that this was done at the pace of the people being assisted. People are able to enjoy the food they prefer and like. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that their complaints will be listened to, taken seriously and acted upon. The homes procedures protect people from abuse. Evidence: The annual quality assurance assessment confirmed that a clearly defined complaints policy with agreed timescales for managing complaints was in place for people to use. We found that the detailed policy was in place. People living at the home told us they had received a copy of the complaints policy. No complaints had been referred by the Commission to the home since the last key inspection. A complaints book is available to record all concerns, allegations and complaints. We found that the complaints book recorded the actions that had been taken to address issues. There had been one complaint since the last key inspection. The complaints record showed actions taken to resolve complaints. We found that there were large number of compliments from relatives about the care people were receiving. People with whom we spoke confirmed that they knew how to make a complaint. A person told us, I have not had to make a complaint about anything. I know I can talk to the manager about anything if there is a problem. The home has an open culture that allows people to express their views, and concerns in a safe and understanding Care Homes for Older People Page 19 of 30 Evidence: environment. There were policies on handling abuse and protection. People living at the home felt confident that any concerns they raised would be handled sensitively and appropriately. A person told us, I can tell staff if I am worried about things. There had been no adult protection issue since the last key inspection. We found that staff had received training on adult protection. The registered manager has completed the host local authoritys training the trainer course. She provides the training for staff to make sure they understand how to respond to allegations of abuse. Staff spoken to could recognise the signs of potential abuse, and explained how they would respond to it. A relative said, The staff attitude towards the residents is good. People feel safe and well supported by the home, which has their protection and safety as a priority. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that provides a safe and homely environment. The home is clean and hygienic. Evidence: The expert by experience noted that, The Service is located in a calm and relatively pollution free area. The environment is suitable for a care home. We walked round the home and found that it was accessible for people. We observed that people were able to access all areas in the home safely. The home has the necessary adaptations to support people to move around safely. Bathrooms and toilets were fitted with appropriate as the adaptations to meet the needs of residents. These are accessible to people who have mobility difficulties. We saw that the home was appropriately decorated and furnished. Records showed that these had been maintained. There is a dining and sitting area for the use of people. As the expert by experience observed, I could see a door on the other side of the activity room I went through this to find myself in a very spacious lounge, elegantly decorated with antique furnishings. At the far end of the lounge a door opened into a beautiful garden. The homes environment is appropriate to the specific needs of residents and promotes their independence. The annual quality assurance assessment, and discussions with the registered Care Homes for Older People Page 21 of 30 Evidence: manager highlighted that a number of improvements had been made to the homes environment. One of the bathrooms has been converted into a walk in shower. The registered manager explained that this was done to respond to changing needs of residents. We saw that the walk in shower had the appropriate at adaptations for the needs of people whose mobility is restricted. Residents with whom we spoke felt that this was a good addition to the homes facilities. The registered manager told us that she was just completing the redevelopment of the homes kitchen. We saw that a number of improvements have been made to the kitchen. The registered manager explained that this would make it easier to provide a range of meals to residents. There is some rubbish left outside in the garden from the redevelopment of the kitchen. The registered manager explained that the builders will remove this in the coming days as they complete their work. The home makes sure that the environment is developed to provide improved outcomes for residents. We saw that bedrooms were personalised with items of furniture and pictures belonging to people. One person said. My bedroom is very nice. Another resident told us.I have got my own furniture in my bedroom. The manager told me that I could bring my furniture with me when I came to live at the home. The registered manager explained that she encourages and supports people who live at the home to personalise the bedrooms. People had a lockable space in their rooms to keep their personal and valuable items. People are encouraged and supported to personalise their bedrooms. We saw that the home was clean. A relative confirmed that. The home is clean the bedrooms always smell lovely. We found that a range of appropriate measures are in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. Staff have received training on infection control measures. Staff spoken to understood how to work to minimise the possibility of cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. The experts by experience noted. I found the rooms were clean and smelling of freshness. Effective infection control measures are in place to make sure that residents are safe. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient staff are always available to meet the needs of people who live at the home. Staff have all the skills to meet the assessed needs of people who live at the home. People who live at the home are protected by the homes recruitment practices. Evidence: Surveys from residents confirmed that there were always enough staff available to meet their needs. The rota showed that a consistent staffing level was being maintained in the home. We observed that staff were available to provide individual care for residents. A resident told us that, staff always come and help. I could not manage without them. Staff said that the current staffing level allowed them to meet the needs of residents. The registered manager explained that she will be carrying out a review of the staffing level due to the increasing needs of residents. This will allow her to determine whether any changes to the staffing level need to be made to meet the needs of people living at the home. The staffing level is reviewed regularly to make sure there are sufficient staff to meet the needs of residents. Care Homes for Older People Page 23 of 30 Evidence: The annual quality assurance assessment highlighted that staff had been on a range of courses. Residents spoken to felt that staff had the necessary skills to meet their needs. A resident said, Staff know how things should be done. Training records showed that staff had been on a range of courses relating to the needs of people who live at the home. There were training certificates available to confirm this. We observed that staff understood how to respond and communicate with residents. Staff spoken to were able to explain how they supported people in a person centred way. A resident said, Staff are doing a good job. Staff are supported through training to meet the individual needs of people who live in the home. The registered manager was able to show 50 per cent of staff have achieved the National Vocational Qualification in care. The registered manager explained that a number of staff are also either working towards or have completed their national vocational qualification in care at level three. Training records we examined confirmed this. A relative observed that, Staff pay attention to the needs of residents. Staff training records showed that staff had done training in the essential areas, such as food hygiene, health and safety, administration of medication and infection control and first aid. Staff had also completed training on dementia, the Mental Capacity Act, and have commenced a course on end of life care. Training records we saw confirmed this. We observed that staff demonstrated that they knew how to support and care for people. The registered manager explained that the home recently won an employers excellence award from Cornel College. This was awarded to the home as it had demonstrated in its training and development, That it fully understood the need to provide training for staff. The home ensures that all staff receives relevant training that is focused on delivering improved outcomes for people. We looked at two staff files. These contained all the necessary documentation to ensure that these members of staff were safe to work with people who live at the home. Their employment record had been checked. Two references and a CRB check had been obtained prior to them starting work at the home. This showed that the home followed a clear recruitment procedure that ensures the safety of people. The staff group reflect the cultural backgrounds of people living at the home. People living in the home said they felt that staff could be trusted. Robust recruitment procedures are followed to ensure the safety and well being of people. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Appropriate management structures are in place to ensure that people receive the care they need. People who live at the home are consulted about the quality of the service, and encouraged to make suggestions for improvement. People who live at the home have their financial interests protected by the homes procedures. People who live at the home and staff are protected by the homes health and safety procedures. Evidence: Both residents and relatives commented positively on the management and leadership of the registered manager. The registered manager has extensive experience of managing a service for older people. The registered manager has maintained and updated her skills regularly. She has a clear understanding of the key principles and focus of the service to make sure that people receive the care they need. She has also provided training on a range of areas to staff. We observed that the registered Care Homes for Older People Page 25 of 30 Evidence: manager spent time talking to people who live at the home. The registered manager has a clear understanding of how to deliver good outcomes for people living at the home. Staff spoke very highly of the registered manager. They said they felt well supported and received clear directions and leadership. A member of staff said, the manager is very professional. You can talk about things. She is always available. The registered manager and staff work to make sure that the home is running in the best interests of people who live there. We observe this throughout the inspection. The expert by experience noted that, the manager joined the residents at lunchtime. She spent time finding out how residents were doing. Relatives and other professionals provided positive feedback about how the home was managed to makes sure that the needs of people are met. The home has a system for obtaining the views of the quality of the service it provides. The home makes sure that any areas for improvement are addressed. A survey of the views of people who live at the home, relatives and professionals had recently been carried out. The findings of this survey had been action to improve the home. Staff meetings take place to make sure that staff are aware of how they should support and care for people. Peoples views are sought and provide the bases for improving the quality of the service. The home does not hold money for residents. The home invoices their families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any expenditure. The registered manager explained that one of the residents manages his own money. We saw that he had a locked space for its money in his bedroom. When we spoke to this resident he explained that he keeps his money there. A risk assessment has been carried out and the arrangements to support him to manage his finances are highlighted in his care plan. People who use the service can have confidence in the homes procedures for handling their money safely. The home has a consistent record of meeting the relevant health and safety requirements and closely monitors its own practice. Fire drills were taking place and the fire alarm was tested regularly. We found that the fire risk assessment includes an assessment of all the potential fire risks in the home. We questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. We discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents to ensure the safety of people Care Homes for Older People Page 26 of 30 Evidence: who live and work at the home. The temperatures of the fridges and freezers were recorded and within safe limits. Health and safety checks, procedures and training make sure that people living in the home are safe. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 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. 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