Inspection on 21/01/09 for Milford Manor

This inspection was carried out on 21st January 2009.

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

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

Other inspections for this house

Milford Manor 26/01/07

Milford Manor 02/03/06

Milford Manor 08/09/05

Milford Manor 03/02/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Milford Manor Milford Manor Gardens Salisbury Wiltshire SP1 2RN     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: Sally Walker     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Milford Manor Milford Manor Gardens Salisbury Wiltshire SP1 2RN 01722338652 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): wessexcarepp@hotmail.co.uk Wessex Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 29 Number of places (if applicable): Under 65 Over 65 29 29 0 dementia old age, not falling within any other category physical disability Additional conditions: 29 0 1 The home may admit people to the home over the age of 60 years of age providing their assessed needs are similar to those of an Older Person. Date of last inspection Brief description of the care home Milford Manor is an established home that provides care and accommodation for up to 29 older people, most of whom may also have dementia. The home is owned by Wessex Care Limited and is located in a quiet residential area of Salisbury with public transport available into the city centre, with its shops and other amenities. it is an attractive home, with comfortable furnishings. All the bedrooms are single accommodation. There is a conservatory overlooking large, mature gardens. Car parking is available at the front of the house. There are good quality furnishings and fittings and a great deal of work has gone into making the home an attractive and Care Homes for Older People Page 4 of 32 Brief description of the care home pleasant place for people to stay. Efforts have been made to make the environment more accessible to people with a dementia. Care Homes for Older People Page 5 of 32 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: This unannounced Key inspection took place on 21 January 2009 between 9.25am and 7.10pm. Mrs Tracey Morris, registered manager, was present during the inspection. Mr and Mrs Airey, Directors of Wessex Care Limited, were present during the feedback. We spoke with people who use the service, visiting relatives, one of the district nurses and staff. We looked at care plans, risk assessments, rotas, staffing recruitment and training files, the arrangements for people to hold small amounts of cash in the safe, menus and medication. We made a tour of the building. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. Care Homes for Older People Page 6 of 32 We asked the home to send us their AQAA (Annual Quality Assurance Assessment). It was completed in full detail and returned on time. We have included some of this information in this report. The last key inspection was on 26th January 2007. Fees for the home were between 570.00 pounds a week and 610.00 pounds a week. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: Detailed pre-admission assessments are carried out with people who are considering using the service and their relatives. This information informs the initial care plan, in place when the person is admitted. Individual care plans are very detailed about how all aspects of the persons care and support is provided, during the day and at night. The care plans focus on what people are able to do. Communication care plans are very detailed. Risk assessments accompany the care plans. Peoples risk of developing pressure damage is regularly assessed. All other aspects of risk are detailed in their care plans and regularly reviewed. The use of any equipment, for example, bed rails, is discussed with the person and their relatives. People choose who provides their intimate personal care. Staff make sure that people are well groomed throughout the day, paying special attention to ensuring their clothing is changed after meals, if needed. Peoples nutrition is regularly monitored. Care plans identify how people are encouraged to maintain a good diet. People have good access to relevant healthcare professionals. Advice given is acted upon. Safe systems are in place for the control and administration of medication. A full time activities co-ordinator is employed. People have access to a range of group and one to one activities, both at the home and in the locality. Activities take place during the evenings. People enjoy a range of healthy meals served in their preferred location. Home made soup and snacks are available throughout a twenty four hour period. The chef has undertaken training in dementia care. Finger foods are available. Crockery has been introduced following guidance on nutrition for people with dementia. The home acts on any comments received from people, their relatives or visitors. Outcomes of complaint investigations inform the quality assurance audits. Staff are familiar with the local safeguarding vulnerable adults procedure. The providers continue to upgrade and improve the environment. Advice about improving the environment for people with dementia has been put in place. Large pictorial and written signage is in place so people can find their way around the home. Peoples bedrooms have pictures of items that interest them so they can find their rooms more easily. Toilets and bathroom doors are identified by colour. The grounds continue to be upgraded. People are not restricted from taking the various ornaments around the home to their rooms if they take a liking to them. All the radiators are guarded to reduce the risk of scalding should people fall against them. Window openings to the first floor have restricted openings to reduce the risk of Care Homes for Older People Page 8 of 32 people falling out. A robust recruitment process is in place. No one commences work until their suitability to work with vulnerable people has been confirmed. Staff are well inducted and receive a range of relevant training. A dementia care consultant has been engaged to advise staff on working with people with dementia. Staff engage with people in a positive manner. Good relationships have been established. Staff took time to speak with people. Mrs Morris is undertaking a Diploma in Dementia Care. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 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. Detailed information is gathered from all those involved in the care of people who are considering using the service. Evidence: In the AQAA the providers told us that the statement of purpose is also available in large print. The home assesses the needs of those people who are considering using the service. These assessments are carried out by either Mrs Airey, one of the providers, or Mrs Bellinger, service manager, prior to the person being admitted. The assessments were very detailed and showed that all aspects of the persons needs were assessed. Consultation takes place with the person, their relatives and others involved with their care. This information informs the initial care plan that is in place when people are admitted to the home. Care Homes for Older People Page 11 of 32 Evidence: In the AQAA the providers told us that obtaining life histories is part of the preadmission assessment. We spoke briefly with the family of someone who was being admitted that day as an emergency. They told us they had been recommended the home by the funding agency. They were shown the bedroom and had a chance to discuss details with the manager. Although a stressful situation, the person and their family appeared to have been given time and support during the admission process. Care Homes for Older People Page 12 of 32 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. Care plans are very detailed in how each persons care is to be delivered and monitored. The care plans direct the care. People have good access to relevant healthcare professionals. Safe systems are in place for managing peoples medication. Staff ensure people are treated with respect and their privacy is upheld. Evidence: A care plan was in place for all those people using the service. Newly admitted people had a preliminary care plan detailing all their care needs, gathered from their preadmission assessment. There was good information in care plans about how people preferred their personal care to be carried out. This focused on what people were able to do for themselves as well as support and prompting from staff. The care plans identified peoples medical, as well as social history. There were records of outcomes of consultations with healthcare professionals. There was very good consideration of information about peoples sleep patterns, how their bed is made up, what they wear and how their room is set up at night. The care plans were very detailed for those people who may not be able to use speech to express themselves. There was guidance Care Homes for Older People Page 13 of 32 Evidence: to staff on how people communicated and made their wishes known. The daily records identified staff interventions in relation to peoples care plans. Risk assessments were in place for different aspects of peoples care and support. Assessments were in place for determining peoples mental capacity regarding decision making. People have their risk of developing pressure damage assessed on admission and monthly thereafter. We saw pressure relieving equipment in place where indicated in peoples care plans. The home has policies and procedures on the safe use of bed rails. The policy states that these rails are only used when people are at serious risk of falling out of bed. Agreements are drawn up with people and their families about the safe use of any bed rails for individuals. Risk assessments were in place for those people with bed rails in place. Bumpers were in place so that any risk of injury was reduced. People had their risk of falls and moving and handling regularly monitored. Action has been taken to address the requirement we made that where frequent care charts are indicated, that they are kept up to date and accurate. We looked at these charts in peoples bedrooms and found them to be regularly recorded. We saw that people were positioned according to the description and time in the chart. Action has been taken to address the good practice recommendation we made that drinking vessels should be measured so that a more reliable total can be made of fluids taken. We saw that records included the amount of fluids taken. However daily totals were not always being recorded. We advised that the frequent care charts should indicate exactly what is to be achieved each day, in terms of fluids or regular turning of the person for easy monitoring. People have their nutritional needs assessed and the outcome recorded in their care plan. The care plans about how the person is supported in eating and maintaining a healthy diet were very detailed. The plans identified where and what the person liked to eat and any food supplements. The daily reports recorded whether people with a poor appetite had eaten meals during the day. A dietician had been consulted about one persons limited diet and how to introduce different foods. People are weighed on admission and monthly thereafter. We noted in some of the records that imperial and metric weights were being used. We advised that a common method was used. Mrs Morris told us that as a result of identifying toilet and bathroom doors by colour and signage, peoples continence had improved. We saw evidence in care plans of catheter care during the day and at night. We could not establish whether action has been taken to address the good practice recommendation we made that any mouth care guidance is recorded in peoples care plans where indicated. There was no one receiving specialised mouth care, so this is Care Homes for Older People Page 14 of 32 Evidence: no longer a recommendation. Action has been taken to address the good practice recommendation we made that intimate personal care giving is reviewed. We said that this should include examples of issues often presented when caring for people who may not be able to verbally express their preferences. Details were recorded in peoples care plans. We saw that staff were making efforts to ensure that people were well groomed and had clean glasses, nails and teeth. We saw that staff were making sure that people changed their clothing if food was spilled on their clothes following a meal. Staff told us that if people wanted to go out and were insistent despite the weather being cold, staff would accompany them for a short walk around the vicinity. Chairs had been removed from the front entrance to dissuade people from sitting near the door. Mr Airey told us that some visitors had been very concerned that some people would be unsafe through leaving the building unattended. One of the people we spoke with told us Im looked after very well. Another person told us that the assistant manager would get their GP to visit when needed. They also told us that their medication was administered when they needed it. We noted that people who had diabetes did not have details in their care plans of how their condition was managed and monitored, or by whom. Mrs Morris told us she would immediately address this, which she did. One of the people we spoke with told us that the district nurse regularly dressed a wound on their leg. We saw information about this in their care plan. One of the visiting district nurses told us about improvements to the health of one person who they had been visiting before their admission to Milford Manor. They told us that staff were approachable and there was always staff available to discuss their patients conditions and treatment. They told us that none of the people using the service had any pressure sores. There was guidance to staff in some care plans about managing any behaviours. It was clear that the community psychiatric nurse had been consulted and given advice on managing and monitoring behaviours. Behaviour charts were in place where indicated. One of the visiting relatives told us about the positive move to this home from another care home, for their family member. They told us the home kept them informed about their relatives condition. They told us their relative was happier at Milford Manor and had increased their weight. They said they were very pleased with the care and Care Homes for Older People Page 15 of 32 Evidence: support their relative was given. We looked at the arrangements for managing peoples medication. Mrs Morris told us that another medicine trolley had been purchased for the newer part of the building. People can administer their medication following a risk assessment. Only staff who are trained by the manager can administer medication. The medication administration records were being satisfactorily maintained. Details of what prompts an administration of a medication prescribed to be taken when needed were detailed in peoples care plans. We advised that when the prescriber has detailed as directed on the prescription, more detailed directions should be requested. We saw from care plans that peoples medication is reviewed with their GP soon after admission. We saw evidence in one care plan that the persons quality of life had improved following a review and reduction in the amount of medication the person had been taking. There was evidence that relatives are also involved in reviews of peoples medication. The home had a copy of the British Pharmaceutical Societys Formulary, so staff could gain information about peoples medication. In a survey form one of the relatives told us Am confident in the professionalism and care shown to my elderly father since he was admitted to Milford Manor. Another relative told us Very helpful. Very satisfied with my fathers care. Care Homes for Older People Page 16 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about peoples interests is gained before they come to the home. Peoples social history informs their activity care plan. A full time activities person ensures that a range of activities is available both during the day and in the evenings, at the home and in the locality. People are encouraged to choose how they spend their day. Consideration is given to supporting people with dementia to eat and enjoy their meals at any time of the day or night. Evidence: An activities co-ordinator is employed from 9:00am to 5:00pm each day. One of the kitchen assistants also likes to help with activities. Another staff was engaged with activities projects as part of their NVQ. The activities person told us about what they had planned for the coming three months. These included a trip to the seaside, to a musical at Salisbury City Hall and to Salisbury Playhouse. They told us that people had enjoyed outings to the New Forest and to Wilton House gardens. Sometimes a coach trip might include people from other homes in the Wessex group in Salisbury. Relatives are also invited on the trips. Notices of the set weekly activities are displayed around the home. There is a regular coffee morning, hairdressing and exercise group. There is no formal activities programme. We were told that activities take place Care Homes for Older People Page 17 of 32 Evidence: according to what people might like to take part in each day. The activities could be one to one time or group work. The activities co-ordinator told us that they would take people around the garden in the better weather or in a wheelchair to walk along the river. They said they also took people in a taxi to the local market held every week. Some people liked to go shopping or out for a coffee. Other events included a cheese and wine evening or a film. The local library visits regularly. We saw people doing artwork and another group was playing dominoes. Board games were available. There was a large board that fitted over the snooker table to accommodate board games and other group activities. The activities co-ordinator planned to plant up the pots on the decking outside the sitting room. In the AQAA the providers told us that they intend to improve the decking area with bird boxes, seating and sensory plants that are safe if eaten. They also told us they plan to access a local swimming pool. The chef had purchased items to cook for Burns Night that coming Friday. A wildlife rescue centre was due to bring some of their birds for people to see. The activities coordinator told us that the other homes in Wessex Care are often invited to join in with the homes activities. People also make reciprocal visits to the other homes. We were told that evening activities were being trialled and benefits were being assessed. The activities organiser works from 11.00am to 7.00pm for two days a week to accommodate this programme. Church ministers provide regular services. Music is now provided during these services following suggestions from people who use the service and their relatives. In the AQAA the providers told us that large print bibles are available in the communal areas together with a copy of the local church newsletter. In the AQAA the providers told us that activities and entertainments provided are age appropriate and we do not tolerate attitudes referencing age by visiting entertainers or others. Each person has an activity care plan detailing what they like to do, with a record of what they had been involved with. Photographs are also included in the care plans forming some of the persons life history. One person showed us the bird table just outside their bedroom. They talked about the enjoyment they got from feeding and watching the different birds. They told us they liked to watch their television. They said they would join in with some of the musical activities. They told us about three different music and singing sessions they had attended recently. They said staff try to stop you from becoming bored, they ask you Care Homes for Older People Page 18 of 32 Evidence: what you like to do. Mrs Morris told us that one of the people who use the service was a market gardener. There were plans to install raised growing beds in the garden so that the person could continue with their gardening interests. One of the visiting relatives told us they could visit whenever they wanted and were always made welcome. When we arrived at the home people were having their breakfast, either in the sitting room, dining room or in their bedrooms. We were told that if people did not want to come to the dining room for meals, they would be given them where they were. We saw that one person who had got up from the lunch table and returned to their bedroom, had their pudding taken to them. The lunch and evening meals for the day were written on a board in the dining room. The writing was legible, but due to the build up of chalk the letters were not in contrast with the background. We asked one person who was sitting by the board if they could read what was for lunch. They said they had difficulty reading the board. The lunchtime meal was either curry and rice or chilli con carne. The meal was served according to peoples appetite and well presented. As well as the main dish there were three vegetables. The chef told us that there was always a minimum of two vegetables served at lunchtime. We saw that people could eat their meal where they wanted. Some people ate in the dining room or where they were sat in the sitting room. Other people ate in their bedrooms. We saw that meals taken to peoples rooms was served one course at a time and that the meal was covered. The evening meal was mushroom soup, fish fingers and tin tomatoes, with creme caramel for pudding. The chef had a list of peoples likes, dislikes and any food allergies. A dietary requirements form is filled out with people who are new to the service. This is amended as needs change. The menus contain an element of finger foods so that those people who cannot manage cutlery can still eat their meals independently. There was a supply of freshly made soup available throughout the day and night. The chef told us that cake and biscuits were also available if people wanted. The chef had undertaken training in dementia care. Special diets are catered for. The chef told us they were a trained chef and were currently undertaking NVQ Level 3 in catering. They had also sought the advice of the dietician when planning the menus. The menus are changed to take into account the different seasons and availability of fresh ingredients. A record of any changes to the menus are kept on file. There were alternatives of omelette, salads and a vegetarian option. Care Homes for Older People Page 19 of 32 Evidence: In the AQAA the providers told us they had introduced yellow crockery, following recent research that food intake is increased on a yellow plate. Mrs Morris told us that she had monitored peoples food intake and weights since the introduction of the crockery and found that people were gaining weight. We were told that music was used at mealtimes to create a peaceful mood. We spoke with one person who said they liked the home and the food was good. They told us there were lots of things to do. Another person told us that the food was not bad at all. Another person told us the food was good. They said they were given what they wanted. They also said I cant stand salt and they have cut down on the salt they put in my meals. In a survey form one of the relatives told us The whole family are delighted with Dads care. We couldnt have chosen a more caring home for Dad. Lots of activities arranged but Dad not able to join in as too poorly, but opportunity is there for those who can join in. We all hope dad can stay here as long as is possible. Care Homes for Older People Page 20 of 32 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. Systems are in place for people who use the service, their relatives or others to make complaints about the service. Complaints are taken seriously and fully investigated. Staff are trained in safeguarding vulnerable people and know how to report any allegations of abuse. Evidence: We looked at the complaints log. We saw that any complaints are fully investigated, with a detailed letter going to the complainant, telling them the outcome of the investigation and if any action is to be taken by the home. There had been no complaints since September 2008. Mrs Morris told us that outcomes of complaints investigations are considered as part of the quality audit so that the service can be improved. One of the relatives we spoke to told us they had received a form asking them if there was anything they were not satisfied with, or whether they wanted to make a complaint. They told us they would let staff know if they or their relative was unhappy. One of the people who use the service told us they were quite happy and had no complaints. Another person told us they listen to you, I feel you can talk to them. They said they did not know how to make a complaint as they had not needed to. They went on to say that they were asked at the residents meetings if they had any complaints or worries. Care Homes for Older People Page 21 of 32 Evidence: We asked staff to tell us about what they would do if they observed or were concerned about safeguarding issues. They were familiar with the local safeguarding reporting procedure. All staff had been provided with a copy of the booklet entitled No Secrets in Swindon and Wiltshire. Staff had received training in safeguarding vulnerable people from the local police unit. Senior staff had also recently received this training from another training provider. In the AQAA the providers told us that they had joined the organisation Action on Elder Abuse. No money is held on peoples behalf. Relatives or solicitors are expected to manage peoples finances if the person is unwilling or unable. The home pays for any hairdressing, chiropody or other small expenditures, then invoices the person responsible for finances for the individual. Records and receipts were kept of all expenditures. There is a petty cash imprest for other expenditures. Care Homes for Older People Page 22 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant effort has been made to ensure that the environment is accessible and safe for people with dementia. People benefit from a well maintained, clean and homely environment. The providers continue to find ways to improve the environment for peoples benefit. Evidence: All of the bedrooms are single accommodation. People can bring small items of furniture and possessions to personalise their rooms. The activities co-ordinator told us that they were linking with families to encourage more personalisation of bedrooms. There is large signage with pictures associated with different rooms. Peoples bedrooms have large signs with their name written and pictures or photographs associated with them and their interests. For example, people in uniforms or birds and flowers. One bedroom had the persons name on the door in their first language. One bedroom is allocated for respite care. People have a key to their bedrooms following a risk assessment, which may include consultation with their relatives. The providers continue to upgrade the environment for the safety and comfort of people who use the service. New vanity units have been fitted to some of the bedrooms. The bathroom and toilet doors have been painted red to identify them to Care Homes for Older People Page 23 of 32 Evidence: people who use the service. These rooms are also identified by large signs in words and pictures. A new deck area has been built which can be accessed from the sitting room and conservatory. Mrs Morris told us that there were further plans to develop the gardens, currently under discussion with the providers. One area, was providing raised beds for planting and a tool shed. There is a full time gardener. There is also a full time maintenance person who addresses day to day maintenance issues. There is a full time painter who keeps the premises in good decorative order. We asked staff how they would respond to people who were adamant that they wanted to go outside. Staff told us of examples where they had accompanied people out of the building for a short walk and returned when the person was ready, usually because of the recent cold weather. The grounds are fenced to the rear of the property to enable people to have safe access to the gardens. Action has been taken to address the requirement we made that the undersides of toilet safety frames and bath hoists are cleaned to infection control standards. We looked at these areas during the morning and again during the afternoon and found them to be cleaned to a good standard. We saw that cleaning staff cleaned the toilets at least twice a day. The rota showed that a cleaner is employed during the afternoons until 6.00pm. We did not detect any unpleasant odours at any time during the inspection. There were many pictures and ornaments around the home. Mr Airey told us that people could remove ornaments to their bedrooms if they wanted to. We noted that radiators had been fitted with guards, to ensure people were not at risk should they fall against them. We noted that windows to the first floor had restricted opening so that people were not a risk of falling out. We asked some of those people we spoke with in their bedrooms, how they would summon staff if they needed help. Some told us about their call bells. Others were not able to tell us how to use the call bells. One of these people told us that staff were usually about. Another person told us that staff come as soon as you call. Mrs Morris told us that continence accidents had reduced since all the doors to toilets and bathrooms had been painted red and identified by signage. All of the toilets had been fitted with red seats. People we spoke with told us that they were satisfied with the laundry service. Staff Care Homes for Older People Page 24 of 32 Evidence: had access to hand washing facilities, hand cleaning gel and protective gloves and clothing. Care Homes for Older People Page 25 of 32 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. Staffing levels enable people to be well supported. Staff are well trained. A robust recruitment process protects people from anyone unsuitable to work with vulnerable people. Evidence: The care staffing rota showed that there is a minimum of a shift leader and 3 care staff on duty during the day for four days a week. On Monday, Wednesday and Friday there is a senior carer with four care staff. At night there are two waking night staff. Mrs Morris may work some of the shifts. There was a notice board showing key members of staff, who was on duty and who was leading the shift. On the day of the inspection there were a shift leader and three care staff. There was also a care support staff, two housekeepers, a kitchen assistant and the chef. We looked at the staff recruitment arrangements. A robust recruitment process is in place. Action has been taken to address the good practice recommendation we made that to whom it may concern references are not accepted. We said that referees should be contacted independently as part of the recruitment process. We saw that references are followed up by the Human Resources Manager. If references are not suitable for any reason, other referees are requested. The HR manager may also make Care Homes for Older People Page 26 of 32 Evidence: telephone contact with previous employers. A record was kept of these telephone calls. All the documents and information required by regulation were on file. No one commences duties without checks on the Protection of Vulnerable Adults list, to ensure their suitability to work with vulnerable people. All new staff have a period of induction. They shadow a more experienced member of staff. The home keeps a record of individual training that staff have undertaken. Mrs Morris and Mrs Bellinger, service manager, were in the process of implementing new training records and a training plan for 2009. In house training takes the form of videos and discussion. Recent training has included risk assessment, medication, first aid and food hygiene. Staff had also received training from a local advocacy service. Staff are expected to give feedback on any training they have received. Mrs Morris is the homes trained trainer in moving and handling and keeps staff up to date with current practice. The dietician has trained staff in using MUST (Malnutrition Universal Screening Tool). The providers have engaged the services of a dementia care consultant. They are advising on providing care to people with dementia, providing more advanced training to all staff, not just care staff and advising about changes to the environment. The consultant will also attend relatives meetings to offer advice and support. We saw a member of staff deal sensitively with one person who came into the kitchen at a very busy time. The person was resistant to being asked to leave. The staff managed to move the person away from the risks to their safety in a professional and kind manner. We also saw staff respond well to another person who was anxiously demanding something to eat. They made the person some sandwiches, all the while talking to them about the content and chatting about their day. From other observations it was clear that good relationships had been established. We saw that staff had time to talk with people during their shift. Mr Airey told us staff would be funded to NVQ Level 4 depending on their role. The home had nearly achieved 100 of staff having NVQ Level 2 or 3. Staff are expected to undertake NVQs. In the AQAA the providers told us that they have sourced NVQ training for those staff whose first language is not English. One of the people who use the service described the staff as not too bad. Another person told us that staff were very kind, they look after all your comforts. If theres anything you want, they get it for you. They are very good when you need them, I dont feel isolated. Ive not had to call them at night. Care Homes for Older People Page 27 of 32 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. Mrs Morris has extensive experience of working with people with dementia. She continues to seek further training. The home is run in the best interests of people who use the service. All staff have regular supervision. Systems are in place for maintenance and servicing of equipment for the protection of peoples health and safety. Evidence: Mrs Morris changed her day off to be present during the inspection. Mrs Morris has managed the home for nearly four years. She is a registered nurse, but not employed in that capacity. Occasionally she works some shifts in the other nursing homes run by Mr and Mrs Airey. This is to comply with retaining her nurse registration. Mrs Morris has NVQ Level 4 in management and care and the Registered Managers Award. She told us she has started a Diploma in Dementia Care. She said she was doing short observations of staffs interactions with people using the service. Her Care Homes for Older People Page 28 of 32 Evidence: findings were then discussed with staff. The providers regularly review all the policies and procedures yearly or when needed. The last major review was carried out in September 2008. One of the visiting relatives told us that the home regularly sent them forms asking for their views about different aspects of the service. The home carried out its quality audit in January 2009. The home surveys others involved with the home, not just the people who use the service and their relatives. Relatives meetings take place on a regular quarterly basis and their views contribute to the quality audit. Mrs Morris showed us the analysis of the responses to the recent questionnaires. An action plan would be drawn up to address any issues arising. In the AQAA the providers told us that the outcomes are then posted on the notice boards. All staff have regular supervision. Regular staff meetings also take place. Mrs Morris has monthly management meetings with the providers. Individual fire risk assessments have been carried out with people who use the service. A fire specialist is contracted to carry out the homes fire risk assessment. Contracts are in place for regular servicing and maintenance of fire equipment. The maintenance manager carries out regular health and safety checks on the environment, equipment and tasks. Mrs Morris has carried out an audit of all falls and accidents and as a result of findings, has increased the number of chairs in the sitting room and improved the lighting around the home. All staff are regularly trained in health and safety, moving and handling, food hygiene, fire protection and infection control. In the AQAA the providers told us that they have access to a translator system so that any documents can be translated into several different languages. Care Homes for Older People Page 29 of 32 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 30 of 32 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 8 8 A common standard should be used when recording peoples weights, for easy monitoring. Fluid intake charts should indicate the individual amounts which people should achieve each day. The charts should be totalled for monitoring purposes. More detailed prescribing instruction should be requested when a prescription states as directed. 3 9 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!