Inspection on 14/10/09 for Milton House

This inspection was carried out on 14th October 2009.

CQC found this care home to be providing an Good service.

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

Other inspections for this house

Milton House 15/10/07

Milton House 20/12/06

Milton House 28/06/06

Milton House 04/10/05

Milton House 10/05/05

Milton House 25/01/05

Milton House 08/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

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 17/02/2010.

Key inspection report Care homes for older people Name: Address: Milton House West Street Bridgwater Somerset TA6 3RH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: kathy McCluskey     Date: 1 4 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 30 Information about the care home Name of care home: Address: Milton House West Street Bridgwater Somerset TA6 3RH 01278422235 01278431511 julie.gohot@somersetcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Somerset Care Limited care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Elderly persons of either sex, not less than 60 years, who require general nursing care Registered for a total of 51 places in Categories OP and PD Staffing levels are monitored on a monthly basis to suit the dependency levels of individual service users. Staffing should not fall below 1 - 10 at night and 1 - 5 during the day. Up to three persons of either sex, between the ages of 50-60 years, who require general nursing care. When the home reaches provision of care for 40 service users requiring nursing care 2 Registered Nurses must be provided at night to comply with the staffing notice in line with Somerset Health Authority. Date of last inspection Brief description of the care home Milton House is a purpose built care home situated in the town of Bridgwater and is within walking distance of the town centre. It is owned by Somerset Care Ltd. Care Homes for Older People Page 4 of 30 Over 65 51 0 0 51 Brief description of the care home Accommodation is provided over two floors with a shaft lift giving access to the first floor. Bedrooms are for single occupancy and some are fitted with en-suite facilities. Some bedrooms have limited space. A nurse call system is installed throughout the home and ramps and grab rails are appropriately sited to assist people with mobility difficulties. The home has a very pleasant and well designed garden which is accessible to wheelchair users. Parking at the home is limited although restricted parking is available outside of the home. The home is registered with the Care Quality Commission (CQC) to provide general nursing care to a maximum of 51 older people. It is not registered to accept people whose primary care needs are for their dementia or other mental health needs. Registered general nurses are on duty 24hrs a day. The registered provider is Somerset Care Ltd. The registered manager is Julie Bohot. The comapny area manager is Mrs Sylvia Stowe. We were informed that current fee levels are between £539 and £750 per week for nursing care. Fees are determined on the assessed needs of the individual and of the bedroom to be occupied. The home has a contract with the local authority and will accept people who require assistance with funding. Extra charges include personal items, toiletries, newspapers, hairdressing, chiropody and staff escorts to attend appointments. Information about fees should be obtained directly from the home. Care Homes for Older People Page 5 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over one full day by regulation inspector Kathy McCluskey. The term we used throughout this report refers to we the Commission. The home completed its Annual Quality Assurance Assessment (AQAA) and returned this to the Commission within agreed timescales. The AQAA is a self assessment which focuses on how well outcomes are being met for people using the service. It also provides us with some numerical information. Extracts from the AQAA have been included in this report as appropriate. As part of this key inspection we sent comment cards for a number of people using the service, staff and health care professionals to seek their views on the quality of the service provided. We received completed comment cards from 8 people using the Care Homes for Older People Page 6 of 30 service, 7 members of staff and 3 health care professionals. Comments have been included in this report where appropriate. We were informed that 44 people were currently receiving nursing care at the home. The registered manager was available throughout this inspection and we were given unrestricted access to all parts of the home. Records required for this inspection were made available to us. During the inspection we were able to meet with a number of people using the service and staff. We were able to observe interactions with people throughout the day. We would like to thank all those involved for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 30 What the care home does well: Management procedures ensure that people benefit from a well run home. The registered manager is supported by a deputy manager and a company area manager. An open and inclusive management style is promoted. Effective quality assurance systems are in place to ensure that the quality of the service is regularly monitored and reviewed. We were able to see evidence that changes had been made based on the views of people using the service and other stakeholders. The home ensures that staffing levels are based on the assessed needs/dependency levels of people using the service. People using the service told us that their needs were met. People also told us that the staff were kind and that they were treated with respect. Staff told us that they were able to meet peoples needs and that they also had time for quality time with people. The use of agency care staff have reduced and the home acknowledge the need to reduce the use of agency nurses. We were able to see that the home are actively taking steps to address this. The home ensure that staff have the skills and training to meet peoples needs. We found mandatory training to be up to date. NVQ training is promoted and staff were very positive about the training opportunities available to them. Staff told us that they were well supported and we were able to see evidence that staff received appropriate and regular supervision. Systems are in place to ensure that people who are thinking about using the service are appropriately assessed before a placement is offered. We were able to see documented evidence of pre-admission assessments in the care plans examined. The home also obtains assessments from appropriate health care professionals where available. Comments from health care professionals were positive regarding the homes pre-admission procedures. Each person has a plan of care which is developed from a range of assessments. We found care plans to contain up to date information about each persons assessed needs and instructions for staff on how needs should be met help to ensure a consistent approach to care. We were able to see that procedures were in place to ensure that peoples health care needs were met. Health care professionals told us that the home liaised well with them and would seek advice and input where required. Safe procedures are followed for the management and administration of peoples prescribed medication. We were able to see evidence that people are provided with opportunities for social stimulation. A range of activities are offered each day and the home plan to further improve this area by employing designated activity staff. People benefit from a wholesome and varied menu. People were very positive about the meals available. All meals are freshly prepared at the home by designated catering staff. Special diets are catered for and we were able to see evidence that people are consulted on their preferences and choices. Care Homes for Older People Page 8 of 30 The home provides up to date information about the home and services offered. The Statement of Purpose and Service User Guide are made available to people using the service and to those thinking about moving to the home. These documents are made available in a range of accessible formats. On admission people are provided with a contract so that they are aware of the terms and conditions of occupancy and fees to be charged. The home follows appropriate procedures to ensure people are protected from the risk of harm or abuse. Robust systems are followed for the recruitment of staff and for the management of peoples money. All staff have received training in the protection of vulnerable adults and annual updates are mandatory for staff. Up to date procedures are in place to ensure the health and safety of persons at the home. 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 on page 4. Care Homes for Older People Page 9 of 30 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 10 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 11 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. The home ensure that people are provided with sufficient information to enable them to make an informed decision about moving to the home. The homes pre-admission assessment procedures ensure that placements are only offered once all parties are satisfied that an individuals assessed needs can be met. Evidence: The home have a Statement of Purpose and Service User Guide which provides people with information about the home and services offered. These documents were not reexamined at this inspection as we were informed by the registered manager that there had been no changes since the last inspection. The Statement of Purpose was seen to be displayed in the reception area of the home. We were informed that the Service User Guide is also available in large print, braille and audio. Care Homes for Older People Page 12 of 30 Evidence: Eight people using the service completed comment cards for the Commission and all confirmed that they had received enough information about the home to enable them to make an informed decision to move there. We spoke with two people who had recently moved to the home and they told us that their relatives had been provided with opportunities to visit the home on their behalf. They also told us that they had been provided with information about the home which they found helpful. We were able to see evidence that the home follow appropriate pre-admission procedures which ensure that placements are only offered to people where the home is confident that it can meet their needs. The registered manager visits people who are thinking about using the service and completes an assessment of needs. Documented evidence of this was seen in the care plans examined. We were also able to see evidence that the home obtains assessments from health care professionals as appropriate. The registered manager told us that placements will only be offered where the home are satisfied that it can meet an individuals assessed needs and that the needs/dependency levels of people currently using the service are also taken into consideration. We were also informed that the size of the bedroom available is also taken into consideration as some bedrooms have limited space for wheelchairs/hoists. We received three completed comment cards from health care professionals and all confirmed that the home completed. Th appropriate assessments on people thinking about using the service. They also told us that the home communicated effectively with health care professionals; Staff have worked closely with adult social care to deliver care appropriate for each individual, The manager requests assessments and will visit the individual to check that the home are able to meet their needs prior to admission. Staff told us that they were provided with up to date about people using the service and of people who are moving to the home. They told us that care plans contained up to date information and that they were always provided with a hand over prior to commencing a shift. Staff told us that they did not experience any difficulties meeting the needs of people currently using the service. We were able to see that people are issued with a contract which identifies the terms and conditionals of occupancy. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning procedures ensure that peoples assessed needs and preferences are identified and kept under review. The home ensures that peoples health care needs are met. People are treated with respect and their right to privacy upheld. The home follows safe procedures for the management and administration of peoples medication. Evidence: The home uses the companys computerised care planning system to store and update information about peoples assessed needs. Information is password protected and can only be accessed by authorised staff. The home also maintains hard copies of peoples care plans. We examined four care plans at this inspection. Care plans were found to contain up to date assessments and peoples needs had been clearly identified. We were also able to see evidence that peoples preferences were also Care Homes for Older People Page 14 of 30 Evidence: considered. We found that one care plan had not been personalised to that individual. The home uses a generic format which is then amended to identify the individuals needs. In one care plan this had not been fully completed with regard to dental care and for their preferences with regard to retiring to bed and getting up in the morning. Some references to his/her had not been amended. This was brought to the attention of the registered manager at the time and it was acknowledged that this was an oversight. A recommendation has been raised. We were informed that two people were currently being treated for a pressure sore. We found up to date wound management plans in place which identified the size and status of the wound and treatment prescribed. Regular entries by the registered nurses confirmed that treatment was being delivered in a consistent manner. We have recommended that the wound management plans include a date for review so that the effectiveness of the treatment can be appropriately reviewed within acceptable timescales. The registered manager informed us that the home have established very good links and support from local health care professionals. Comment cards received from health care professionals confirmed that the home liaises appropriately with them to ensure that peoples health care needs are met. Eight people using the service completed comment cards for the Commission and five stated that the home always ensured that their medical needs were met. Three responded usually. Seven members of staff completed comment cards and they confirmed that people received care and support in line with their assessed needs. They told us that Milton House provides a high standard of care and that people receive very good care and support. Care plans contained information about each persons contact with health care professionals. We were also able to see that the home monitors peoples weights on a monthly basis so that any concerns can be addressed. We were able to speak with a number of people during this inspection and all were very positive about the care they received. They told us, the staff are very kind to me and they treat me with respect, I think all the staff are very helpful, I am very happy here and am able to make choices about what I do. During the inspection we noted staff interactions with people to be very kind and professional. We observed staff knocking on bedroom doors before entering and offering assistance with personal care in a discreet manner. The homes completed AQAA informed us that the home have appointed a dignity champion to promote service users dignity within the home. Care Homes for Older People Page 15 of 30 Evidence: We were able to see that people in their bedrooms and in communal areas had access to a call bell. There was a mixed response when we asked people if staff responded promptly to call bells. Some people felt that staff responded promptly and some told us that they sometimes find it hard when we have to wait to use the toilet. We shared this information with the registered manager during feedback. We were informed that call bell response times are monitored by the home. We examined the homes procedures for the management and administration of peoples medication. The home uses the monitored dosage system (MDS) with preprinted medication administration records (MAR). Peoples prescribed medication is managed and administered by the registered nurses on duty. Medicines are stored on each of the two floors. We found all medicines to be appropriately and securely stored with no excess stocks. MAR charts were found to be fully completed. MAR charts contained photographs of each individual to aid identification. Clear information was seen to be in place which identified any known allergies. Clear information was available on the use of prescribed as required medication. We found appropriate procedures were being followed for controlled drugs in use. 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. The home ensure that people have opportunities for social stimulation and the home are looking to further improve this area through the recruitment of designated activity staff. People are supported to make choices about their lives. People benefit from a wholesome and varied menu where choices and special diets are catered for. Evidence: We were informed that the home are in the process of recruiting designated activity staff. Activities are currently being delivered by care staff in addition to care hours so that people receive designated activity time. We were informed that activities take place everyday between 1400hrs and 1700hrs. During the afternoon we observed approximately ten people joining in with a game of table skittles followed by a reminiscence session. People appeared to enjoy both sessions. We spoke with a number of people during the inspection and they told us that there was always something going on if you wanted to join in. People were aware of what Care Homes for Older People Page 17 of 30 Evidence: was going on and were keen to show us the activity board displayed in the dining area. This identified a number of planned activities which included handicrafts, skittles, games and bingo. Three people told us how much they had enjoyed recent trips out to Bridgwater fair and local concerts. The registered manager stated the recruitment of activities staff will ensure that people who are unable to leave their bedrooms, will be offered appropriate time for one to one social stimulation. The completed AQAA stated that in the last twelve months the home have improved the activity provision by, increasing the range of activities provided. It told us that the home have purchased various pieces of equipment and a parachute which helps to improve flexibility and some simple exercise. It also told us that the home have purchased a range of reminiscence aids. People have access to a beautiful and well thought out garden. The garden is made up of different areas for people to enjoy. One individual was keen to show us the range of vegetables that they had enjoyed growing. All areas of the garden are accessible to wheelchairs/people with mobility difficulties. We asked people if they were able to make choices about their lives. They told us that they were. We were informed that people can choose where and how to spend their day. Care plans contained information about peoples preferences. Throughout the day we observed staff offering people choices. People were very positive about the meals available at the home; The food is wonderful, there is always plenty to eat, the menu is very good. All meals are freshly prepared on the premises by the homes catering staff who follow a well balanced four week menu. People are offered choices for every meal. This was observed during the inspection. We were also able to see that special diets are catered for. We were able to see lunch being served during this inspection. The majority of people had their lunch in the spacious dining room. Tables had been attractively laid and a choice of drinks were offered. The meal offered was as per the days menu and this looked wholesome and plentiful. We did note that some people were assisted to the dining room for 1230hrs but were not served their meal until 1315hrs. Two people told us that you sometimes had to wait for quite a long time for lunch. We discussed this with the registered manager who stated that this was not usually Care Homes for Older People Page 18 of 30 Evidence: the case. It was agreed that the length of time people may be waiting for lunch is kept under review. Care Homes for Older People Page 19 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. The home has procedures in place which enable people to raise concerns. Procedures are in place to reduce the risk of harm or abuse to people using the service. Evidence: The home display an appropriate complaints procedure titled seeking your views. We were able to speak with a number of people during this inspection and all were able to confirm that they knew how to make a complaint. They told us that they would not hesitate in raising concerns if they had any. Of the eight people who completed comment cards for the Commission, six confirmed that they knew how to make a complaint. The registered manager told us that the home have not received any complaints in the last twelve months. The homes completed AQAA stated that improvements have been made in the last twelve months as, senior staff have an improved approach to communication with service users, staff, visitors and the multidisciplinary team, Previously complaints received were related to poor communication. The home have up to date procedures in place to reduce the risk of harm or abuse to people using the service. Staff told us that they were aware of the whistle blowing Care Homes for Older People Page 20 of 30 Evidence: policy and what to do if they suspected any form of abuse. Staff told us that they had received up to date training in the protection of vulnerable adults (POVA). This was also confirmed by staff training records. The completed AQAA told us that, staff have recently attended POVA training and it is now mandatory that this is attended annually. Care Homes for Older People Page 21 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 live in a home which is comfortably furnished and well maintained. People have their own bedroom which they can personalise. A range of aids and adaptations are in place to assist people with their mobility needs. The standard of cleanliness is good and appropriate procedures are in place to reduce the risk of the spread of infection. Evidence: During this inspection we viewed communal areas and a selection of bedrooms. We found areas to be comfortably furnished and well maintained. We were able to see that a programme of maintenance/redecoration was in place. We were informed that the corridors were due to be redecorated. A maintenance person is employed by the home and works every morning. All bedrooms are for single occupancy. Bedrooms have the provision of an adjustable bed. The AQAA told us that all but four beds have been replaced with new electric profiling beds and that more beds were on order. We were able to see a good supply of pressure relieving equipment in use and staff confirmed that they had access to sufficient hoists and other equipment to assist people with mobility difficulties. Some Care Homes for Older People Page 22 of 30 Evidence: bedrooms are quite small and have limited space for additional equipment. The registered manager stated that the needs of individuals are always considered and that they ensure the bedroom is able to accommodate peoples needs. We were able to see that people are able to personalise their bedrooms. Grab rails and ramps are appropriately sited to assist people to mobilise. A shaft lift gives access to the first floor. A call bell system is installed and people are provided with pendants as appropriate. The home have sufficient assisted bathing facilities. People have access to a very pleasant garden which is accessible to wheelchair users or people with mobility difficulties. The garden has been very well designed and provides a number of pleasant areas for people to enjoy. The homes completed AQAA told us that all staff attend annual updates in infection control and that the home, follow the latest guidance from the Health Protection Agency. The home employ domestic and laundry staff who cover a 7 day period. A full time housekeeper is also employed. During a tour of the premises we found cleanliness to be of a good standard and there were no malodours. Staff hand washing facilities and sanitising gel were seen to be appropriately sited throughout the home. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensure that staffing levels are appropriate to the assessed needs and numbers of people using the service. The home have procedures in place to ensure that staff have up to date skills and training to enable them to meet peoples assessed needs. The home follows robust procedures for staff recruitment which reduce the risk of harm or abuse to people using the service. Evidence: The registered manager told us that staffing levels at the home were determined by the assessed needs of the people using the service. Staff told us that staffing levels were good and that they were able to meet peoples needs as well as being able to spend quality time with people. People using the service did not express any concerns about staffing levels. Eight people completed comment cards for the Commission and in response to the question, Are staff available when you need them?, 3 responded Always, 4 usually and 1 sometimes. Seven members of staff completed comment cards and 5 stated there were usually enough staff to meet peoples needs, 1 responded always and 1 sometimes. Staff commented things could be improved if there was less use of agency nurses. The Care Homes for Older People Page 24 of 30 Evidence: registered manager confirmed that this was an issue that they are in the process of addressing through a recruitment drive. We were informed that 44 people were currently residing at the home and were receiving nursing care. We were informed that minimum staffing levels were currently 2 registered general nurses throughout the day and night with 10 care staff in the morning, 9-10 carers in the afternoon/evening and 3 carers at night. The home also employs care support staff, catering, laundry, domestic and maintenance staff and a full time housekeeper and administrator. The registered manager works in addition to the care hours and is supported by a deputy manager who also has 2 supernumerary management days each week. We looked at the homes procedures for staff recruitment. We examined recruitment files for the three most recently employed staff. Recruitment files contained all required information and we were able to see that staff had not commenced employment until the home had received appropriate references and checks against the criminal records bureau (CRB) and protection of vulnerable adults register (POVA). An appropriate risk assessment was in place for staff who commenced employment on a POVAFirst pending the full CRB. We were able to see that newly apppointed staff follow an appropriate induction which follows the Skills for Care common induction standards. Training records confirmed that staff had received up to date mandatory training and certificated evidence was seen in the recruitment files examined. Staff spoken with were very positive about the training opportunities available to them. The homes completed AQAA told us that of the 44 permanent care staff employed, 22 have acheived a minimum of an NVQ level 2 in care. This equates to 50 which meets the recommendations of the National Minimum Standards. Care Homes for Older People Page 25 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. Effective management procedures are in place which ensure that people benefit from a home which is appropriately managed. People benefit from an open and inclusive style of management. The home follows safe procedures for the management of peoples money. Up to date procedures are in place which ensure the health and safety of persons at the home. Evidence: The registered manager Julie Bohot is a registered general nurse who has also achieved the registered manager award. The homes completed AQAA confirmed that she ensures that she keeps up to date with professional and legislative requirements. The registered manager is supported by a recently appointed deputy manager and a company area manager. We were informed that the registered manager has full time Care Homes for Older People Page 26 of 30 Evidence: management hours and that the deputy manager has two management days a week. People spoken with told us that they found the management team approachable. This was also confirmed by staff. The completed AQAA stated that the registered manager follows an open door approach as per company policy. It also told us that people are encouraged to approach the registered manager with any concerns they may have so that they can be addressed at the earliest opportunity. We were able to see evidence that the home has effective systems in place to monitor the quality of the service provided. The home seeks regularly seeks the views of people using the service and other stakeholders. We were able to see an analysis of a survey completed in May and June of this year. Comments were noted to be positive. Actions taken to address any comments had been recorded and this information was seen to be displayed in the reception area of the home. We were able to see documented evidence that regular meetings are held for staff and people using the service. As part of the homes quality assurance procedures and in line with the requirements of the Care Homes Regulations, monthly visits are conducted by a company area manager and reports are maintained at the home. Comment cards received from staff confirmed that they were provided with opportunities to meet with their manager to discuss the way they were working. Staff spoken with confirmed that they received regular supervision sessions. We were able to see documented evidence of formal supervision sessions in the recruitment files examined. Topics covered followed the recommendations of the National Minimum Standards. The home assists people to manage small amounts of pocket money. Money is securely stored and appropriate records are maintained. Individual records are in place and two staff signature and receipts are obtained for all transactions. We were informed that people are provided with lockable storage in their bedrooms and that they are encouraged to use this or hand over valuables for safe keeping. Two possible thefts have been investigated by the home in the last year with police involvement. We examined the homes procedures for ensuring the health and safety of persons at the home. No concerns were identified during a tour of the premises and all records and staff training were found to be up to date. 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 1 2 7 8 The home should ensure that the generic care planning documentation is fully personalised to each individual. Wound management plans should identify a date for review so that the effectiveness of prescribed treatment can be appropriately monitored within an acceptable timescale. The home should keep under review, the length of time people wait for lunch to be served. 3 15 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 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. 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