Inspection on 13/04/10 for Nyton House

This inspection was carried out on 13th April 2010.

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

Nyton House 30/09/09

Nyton House 03/07/09

Nyton House 23/06/09

Nyton House 06/04/09

Nyton House 15/04/08

Nyton House 15/12/06

Nyton House 31/01/06

Nyton House 24/08/05

Nyton House 01/02/05

Nyton House 29/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: Nyton House Nyton Road Westergate Chichester West Sussex PO20 3UL     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: Val Sevier     Date: 1 3 0 4 2 0 1 0 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Nyton House Nyton Road Westergate Chichester West Sussex PO20 3UL 01243543228 01243543039 daviscarehomes.nyton@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Mary Davis,Mr Philip Norman Davis Name of registered manager (if applicable) Ms Felicity Jayne Hillary-Warnett Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 23. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) - maximum number 1. Date of last inspection Brief description of the care home Nyton House is a care establishment registered to provide accommodation for up to twenty-three service users in the category OP (old age not falling in any other category) and one named person in the category DE (E) over sixty five years of age. Care Homes for Older People Page 4 of 29 Over 65 0 23 1 0 3 0 0 9 2 0 0 9 Brief description of the care home The establishment is situated in the village of Westergate. Local bus routes are near by. Accommodation is provided on ground, first and second floor level. A vertical lift services each floor. All rooms are generally for single occupancy however there are five rooms that can be used as doubles providing the occupancy levels do not exceed twenty-three. The service is privately owned. The proprietors are Mr and Mrs Davis. The current fees range from #450 to #850. (#850 is for a double room) Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service 2 star. This means the people that use this service experience good quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 13th April 2010 between the hours of 09:15 and 3:15pm Prior to the visit to the home we reviewed, previous inspection reports and information received from the home. This included the Annual Quality Assurance Assessment (AQAA) which was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is meeting the needs of people who live at the home. We met with the registered manager, responsible individual, Care Homes for Older People Page 6 of 29 three staff, and there were four people who use the service involved in the inspection visit. Two visitors on the day indicated that they were happy with the service at Nyton. We looked at three pre admission assessments, four care plans, medication records, staff files and training records and fire prevention testing and training records. We sent out ten surveys to people who use the service, and at the time of writing the report we have had ten surveys returned from people who use the service. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Whilst we have been told that the home plans to imbed the improvements they have made to the service offered at the home, this improvement must be sustained to ensure that the home continues to be compliant. Care Homes for Older People Page 8 of 29 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. 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. Evidence: The AQAA for the home said:Information about the home is displayed in the brochure and in the statement of purpose in all rooms, identifying the services and facilities in the home as well as showing each rooms facilities. Contract for residency is given out to the residents or their advocate or family as soon as possible. We have experienced a time delay in receiving the signed contracts back, but we are working on improving this by having the documents signed before admission. The needs assessment is started when at the initial enquiry, when we identify what our room availability is and should the rooms have mobility limitations, this is made clear so that prospective clients do not further their enquiry if we cannot meet their needs. Meeting the needs of the client is essential and we identify their care need category at the enquiry level Care Homes for Older People Page 11 of 29 Evidence: or if we needed to carry out a trial if there is an uncertainty as to the suitability of the home. We do not take people who have nursing needs and would be better placed in a nursing home. We are unable to take those who are likely to wander as we do not have a locked door policy here, the clients like to roam the home and its grounds freely but obviously they must be safe to do so at all times risk assessments are in place to support this. The costs are also disclosed at this time so that no unexpected costs are made nearer the time of admission as there are cheaper homes offering residential care in the locality which we would refer clients to if money is limited. Although we do not bar social services clients and should clients run out of personal money whilst in the home, we do not ask them to leave, although we would ask if they are in one of the more deluxe and expensive rooms a cheaper alternate room will be proposed, however the care will remain the same no matter what the room cost is. There have been several new admissions to the home since our last visit, the manager or senior staff member carries out the pre admission assessment. We were able to see where this had been carried out and see what is completed at the time of the assessment. We saw that there was information on individual needs based on their present and past medical history for example, history of falls. The assessment offered choices and space for individual issues. For example needs assistance to get out of the chair with one person, needs encouragement as confidence lost due to falls. There were risk assessments, information on mood, sleep patterns, pain and physical health, current care providers and equipment that may be needed. All surveys returned from people that use the service or their representative indicated that they had received enough information to help them decide that Nyton House was the right home for them. They acknowledged that someone from the home had come to see their relative and they had been able to visit the home. One comment we received in a survey said the staff at the home have played a vital role in enabling a successful transition for an individual from their home to living at Nyton House. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans detail the needs of the individual and support staff are to give. The medication records and administration within the home are carried out in a safe manner and protect the people who use the service. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that:The individual care plans are complied after the pre admission assessment and built on as we develop a greater understanding of their individual needs on admission. The care plan is then reviewed at least monthly. As far as is possible we get the client and their relative or advocate to sign the care plans to agree with the planned care. The care plan includes all the activities of daily living as well as risk assessments, mental capacity and nutritional assessments, and the advance care plan, which allow all care staff to have a clear and defined guide to how to deliver the care and what to monitor for should their condition change. The Key Workers support the manager in updating the care plans as needed. Health care and the provision for all clients in the home to have any ongoing conditions as well as Care Homes for Older People Page 13 of 29 Evidence: monitoring for any additional conditions and ailments quickly acted on and with the support from our local GP surgeries, we can support the clients in their treatment unless their needs are best served in either the local hospital or in our nursing home located 3 miles away, taking into account the clients wishes and needs. Staff are skilled in basic assessments of common ailments as well as having 5 senior staff on the rota to support the carers in monitoring for signs and symptoms of problems. The care plans and basic observations and weight which can detect areas needing additional review are reviewed at least monthly. We now audit the stock received, the process of administration and the practices used by staff which has been supported by training from an outside provider as well as workbooks to show understanding of the medication system and the method of staff administration and stock control as well as how to clearly detail when and why medication have not been given. We now also perform supervisions on medication rounds to ensure the staff continue to keep to the new standards of medications Privacy and Dignity of our clients is foremost in our thoughts when giving any care. Staff are trained to knock on doors before entering, toilet doors are locked, those who share rooms are offered screens to provide privacy as well as being treated at all times with courtesy and respect. This is also clearly detailed in the care plans at appropriate places. this is completed a copy is printed off and discussed with the person who is using the service and they sign it to say they understand and agree with it. Care staff can access the printed care plans which are kept in individuals rooms. We looked at four care plans and saw plans to address individuals needs such as washing and dressing, bathing, and catheter care. We saw that information was available for staff on how they would support individuals with their needs, individual strengths and abilities and what staff needed to do to support them. One care plan for example had information that told staff about how to encourage mobilisation including when they were in bed as the individual had restricted mobility which may lead to complications with their circulation. We saw that tools were used to help monitor the individuals well being. We saw risk assessments had been put in place with information on how staff could lessen those risks for example manual handling and falls and nutritional assessments. For example weight loss, one care plan said offer high calorie option when available, take monthly weights and monitor whether clothes hang loose and dietary intake for signs of further weight loss. Offer snacks in between meals and milky drinks. We saw that the district nursing team was supporting the home with care of wounds Care Homes for Older People Page 14 of 29 Evidence: following a fall for example. A district nurse visited the home whilst we were there to advise and treat someones leg. Another individuals care plan we saw was evaluated and reviewed as needs changed due to their mental well being and ability. We saw that measures had been put in place to enable them to walk about the home as they wished safely. We looked at the medication storage and administration records. The home has two trolleys to store medicines and additional lockable cupboards to keep medicines safe including one in each individual bedroom. A small cupboard next to a downstairs bathroom contains the controlled medication and a cupboard underneath has the controlled drug book which the manager was advised by their local pharmacy adviser to keep out of public view. We have been advised that there is another cupboard in the bathroom which holds stock medication, and where the home stores the months supply before use. We have been told that there are occasionally problems with the lock on this door and that this is not always secure. This is being looked at outside of this report. We have been informed since the visit, that the management were aware of the problem and has ensured that the door is now secure. We saw that there are individual care plans for the use of medication. A few residents were managing their own medicines. People able to manage their own medicines are supported to do so against a risk assessment completed by the manager and with discussion with the GP. The home has advised us that they have repeated training in medication for staff and that staff will receive supervision at medication administration times to support them. We observed that safe practice is followed when giving medicines. The person who is administering medication wears a red tabard asking not to be disturbed because they are working with medicines. The manager says this works well most of the time and helps staff to be less distracted by others. We saw that controlled drugs are managed in accordance with the regulations and guidance. People we spoke with on the day said they were very happy with the care at the home staff were helpful and kind. Surveys for people who use the service have been completed by themselves, their relative or advocate. One respondent said that that their friend is usually dressed well with make up and jewellery and that they seem happy. Care Homes for Older People Page 15 of 29 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. People who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. Evidence: The AQAA for the home said that:Meals and mealtimes are a major part of the homes daily life. Our clients eat with their eyes, enjoying a meal which is colourful, presented well and part of a social interaction with their friends. We offer a seasonal menu over a 4 week period offering choice of menus which have been developed after meetings and questionnaires from the clients and the catering department. We have a large dining room conservatory that offers a restaurant feel to the home, with both small and large tables laid out and clients can choose where to sit on a daily basis, supported by the staff to ensure that personalities do not detract from the enjoyment of the meal. We offer two options for each meal and currently one is hot and one is a salad during the summer months. Dietary requirements are provided for as needed. We ask on a daily basis what the clients food choices are to avoid confusion from asking the day before. Meal sizes are also befitting the clients appetite as a large meal offered to a small person will put them off their meal as they feel overwhelmed by it. Care Homes for Older People Page 16 of 29 Evidence: Social Contact and Activities within the home is whatever the clients wish it to be individually. Some are reluctant to join in with group activities, preferring to enjoy their visits from friends and family. Others enjoy sitting in the lounge and chatting to other like minded clients. We have one client who keeps in contact with this family on the Internet in his room. This is not a home where the clients have bingo and quizzes, it is a tranquil setting where they enjoy the home, the gardens, trips out in both small and large groups to places of interest locally as well as enjoying music and talks. Clients and their family members regularly meet with the staff to discuss their care plan which is located in their room. Any other information is available to the client on their request. Throughout their stay at Nyton House, we always ask whether or not the clients wish to join in with any activities offered, we ask them about their care and seek clarification on issues arising on a daily basis. Our clients have responded to the choices available in all areas well and we are confident that due to our high occupancy level that we offer them the quality of life they and their families wish for. We saw examples of newsletters for the home on the notice board in the hallway and they included minutes from the residents meetings. We saw that mention had been made of the new menu and cook. There was a list of monthly events trips out in the homes new vehicle for example. The home has a gnome called Arthur which people are encouraged to find and move around the garden for others to find. We saw examples of activities available for people to participate in; piano mornings, sherry or soft drink in the lounge, church services, ladies meetings, hand massage and reminiscence. We saw a photo of one of the more senior people living at the home in a sports car, they had told their dentist how much they admired it and the person gave them a lift home. It seemed that the individual enjoyed this trip very much. We spoke with the cook who said that the home has just started the new spring menu. There is a new a new cook working at the home and the one on the day expressed how they work as a team complementing each others ways of cooking. There has been appreciation expressed by the people who live at the home and the member of staff explained how they are adjusting the new menu, for example some people have found the new sweets offered quite rich in cream. People we spoke with said they enjoyed the food, although sometime there is too much for them and they have to remind staff what they like and how much. We looked at the menu for the day of our visit and saw choices available for each meal. The cook explained that they go round after each meal and ask what the individual would like for their next meal. Meals are offered in either the dining area or the individuals own room. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process and the staffs knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said:Complaints procedures are clearly identified in each clients room as well as displayed in the main hall and in the staff room. We have proved that the complaints are acted quickly and within the time scale of 28 days and the outcome has been favourable since the new manager has taken over. The rights of the clients are always respected and supported. Clients are well informed and on several meetings we have discussed that although they are in a care home setting, they must be given full details of all that is happening in the home, with every one given the same opportunities with or without support as needed. They have been offered information about being vulnerable and that they must still retain their own individuality, that although they are often frail they must be helped to retain their interests and independence with risk assessments and support needed to continue with as many control measures in place to protect them as possible but also to allow them to live life with quality and enjoyment, not wrapped in cotton wool and too scared to do things they still enjoy. Protection within this care setting has been an area where we needed to improve. Staff are employed using a robust recruitment procedure with only suitable applicants being taken forward to further review of their skills by attending training so that their skills and understanding and ability to retain Care Homes for Older People Page 18 of 29 Evidence: information relevant to their role can be judged in addition to the interview. Supervisions now play a routine role in the homes management and this is reviewed with the staff member. Supervisions also take into account recent training to test the full understanding by the staff member. The home has a complaints procedure, people we spoke with said they knew how to complain and people who returned surveys said they were aware of the complaints procedure. The manager also showed us documents about a complaint they had made with a family regarding the care and support from health services, of one of the people who lived at the home. The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Adult Protection flow chart on how to report suspected abuse. We saw that the manager had purchased information relating to the Mental capacity Act and guidance on Deprivation of Liberty. Care Homes for Older People Page 19 of 29 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. People who use the service have a pleasant and homely environment to live in which also has had some adaptations to meet individual needs. Evidence: The AQAA for the home said:The premises here at Nyton, the Queen Anne building set in the extensive landscaped grounds, offers a high standard of living for our clients within in the grade 2 listed building status that does put constraints on the homes adaptations, but this is part of the charm and facilities offered at Nyton House. The communal areas include a large formal lounge complete with its highly respected fireplace and a grand piano, the conservatory dining room and the quiet lounge library offer a variety of rooms for their use as well as the extensive grounds offering many areas where they can both join in with others or enjoy their own company outside of their own rooms. Lavatories and Washing Facilities are available on all floors with additional toilets on the ground floor where the communal areas are located. Most rooms offer en suite facilities, with the exception of three rooms on the ground floor, one on the first and three rooms on the second floor, but all the clients bedrooms offer washing facilities. Adaptations and equipment is used according to the clients needs taking into account the homes constraints. We have a lift to all floors which although small, accommodates 2 persons. We do have 2 hoists should clients need support with mobility but there are constraints in getting them into some rooms. Bathing hoists or baths for people with restricted mobility are on all floors. Individual accommodation is Care Homes for Older People Page 20 of 29 Evidence: sufficient for clients to live in, with all rooms passing their required room size. Where possible we do encourage clients to avoid overcrowding in the room and one client requested that her furniture be displayed in the library as it was too large to keep in their room having moved from a large double on the first floor to a ground floor single room when their mobility was deteriorating. Individual accommodation in the clients rooms are in many cases, filled with their own furniture. Any electrical items are all tested before being used and then checked on a yearly basis, meeting fire regulations. Soft furnishings are limited in communal areas, but many clients enjoy displaying lifelong collections which make their room their home. The heating and lighting in the home is in places suitable for the character of the home and could be altered to more efficient methods, however, with the constraint of the homes listing and limitations due to its age and its original features, this is at times difficult to maintain to the standard of the elderly inhabitants. Many of our clients feel the cold even when hot, so we do supply them with additional heaters and warm bed linen to ensure they are comfortable in their rooms. Hygiene and control of infection within the home is regularly audited and the manager has attended the Champions of Infection course run by the local PCT. There has also been the introduction of training over the past three months, linked to the NHS Cleaner Homes and the NMC Essential Steps to Infection Control as well as following guidelines relating to Swine Flu from the NHS. We looked around some of the home and we were able to see communal areas such as the dining room, lounge, conservatory, bedrooms and bathrooms. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures. The home has fish and a budgie. The home was seen to be very clean throughout, with no malodour. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home.. Individuals commented to us that they were happy with their accommodation those that had them liked having ensuite facilities. They described small pieces of furniture that they had been able to bring. They liked the lounges where they could sit with others and chat, watch television, read or listen to music or just be quiet. Care Homes for Older People Page 21 of 29 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. Current recruitment practices at the home help to protect the people who use the service. Staff have received all the mandatory training that is expected each year, and training to help them meet specific individual needs. Evidence: The AQAA for the home said:Staff complement is matched to the level of client occupancy and support needed for those clients along with the appropriate skill mix of those staff members to ensure that they are suitably skilled and competent to perform those tasks. Staff are supervised in their work and this is performed approximately 8 weekly and a review of the findings discussed and actions taken to address shortfalls in skills and experience as needed. 50 of care staff having undertaken NVQ 2 or above, with all staff being given the opportunity to undertake an NVQ level 2 or above with the support of the manager who is an NVQ assessor. 5 staff are trained nurses who are working at the home as senior carers. 7 staff are currently undertaking either an asset course in Safe Handling of Medications or Palliative Care with Northbrook College, which can be used towards part of an NVQ course. 2 staff have now been trained in giving complementary massage. We have 60 of care staff with Emergency First Aid at Work certificate. Recruitment is carried out using a robust procedure which firstly asks for the candidate to complete an application form. This will help identify those with poor writing skills, and then the suitable applicants are selected to attend and interview whereby part of the interview includes an introduction to a client and Care Homes for Older People Page 22 of 29 Evidence: then watch the interaction and communication between the applicant and the client. After the interview 2 written references are sought and those with positive references are invited back to complete a CRB and when all are returned positively, then an offer will be made for the job in writing. During the wait for the completed forms, applicants may be invited to attend training to prepare them for their start date, with fire, safeguarding of vulnerable adults, health and safety, infection control, COSHH, food hygiene, first aid and dementia being completed before the end of their probation period, usually 8 to 12 weeks when a contract is given. Staff training includes fire training 3 monthly for night staff and 6 monthly for day staff, as well as the yearly training of safeguarding of vulnerable adults, health and safety, infection control, COSHH, food hygiene, medication and safe handling of medications, first aid and dementia and also we are planning palliative care training for all care staff to attend. The training is then reviewed with the use of supervisions to ensure full understanding and implementation of the skills learnt at training are used in the daily routine and actual care for the clients at Nyton house. The staffing structure at the home consists of the responsible individual, registered manager, care staff, kitchen staff, and housekeeping. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. We looked at three staff files for people that have been employed since September 2009. We saw that there were two references, there was evidence that a CRB had been carried out and they were dated before the employee commenced work at the home. The new staff undertake induction training which includes an introduction to the home for example fire procedures. The individual works through a pack on areas such as the home, safeguarding and their own personal development. We saw that the individual meets with the manager as needed before being signed off as completing the induction. We saw that the majority of staff had undertaken mandatory training in areas such as fire, manual handling, first aid, food hygiene and health and safety. The manager was aware of people where there was difficulty with them attending training and training has been offered flexibly. Where there have continued to be difficulties other action has been taken by the homes management. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures monitor and maintain the quality of the service provided and which, promote the safety and welfare of those living and working in the home. Evidence: The AQAA for the home said:The manager has progressed their managerial skills by enrolling on a part time year course with Skills for Care working with a senior NHS manager to improve their knowledge and understanding in managerial areas and to support the staff in a more effective manner. Day to day operations of the home are now open and documented about staffs expectations for shifts, duties to be carried out on a daily basis and care given on ad daily basis to clients. Shift guidelines and reviews of job descriptions are clearly displayed and handed to staff on commencement of work to ensure there is no misunderstanding; this is supported by senior staff working with new staff during their induction. Clients are spoken to on a daily basis or more by the management to ensure their needs are acted on and prompt action taken when their conditions change. This is supported by their care plans individually written. Financial Procedures are detailed in the Terms and Care Homes for Older People Page 24 of 29 Evidence: conditions of residency for clients and the terms and conditions of employment for staff, which have been recently updated to take into account recent changes affecting the care industry and employment rights. Service Users money is handled either by the client themselves or by their relatives. Staff supervision is carried out at 6 times a year, taking into account training given and also identifying training needed as well as reviewing the skills and performance the staff member displays on a daily basis. By working with staff on the floor the manager can perform a more factual assessment of their skills and abilities as opposed to the hearsay from another staff member or a relevant to ensure the standards and practices are in keeping with standards and training, a one to one by the manager is ideally suited in this workplace. The review will then be made on how to act on shortfalls and where improvements to performance are needed by the staff member concerned. Information and training in safe working practices is given to staff from day one to ensure they follow safe working practices and that the clients and the staff themselves are working with as many control measures in place to ensure their safety and wellbeing. This is reviewed at supervisions and on a daily basis. The policies and practices are in folders for all staff to follow and are clearly indexed, annually or more frequently if needed updated. The manager has been at the home for nearly a year. Ms Hillary Warnett has attended training to update herself in areas such as assessor in manual handling and is currently undertaking a diploma in palliative care. She showed us how she is preparing the home to meet the outcomes in the Health and Social Care Act which will regulate the service later this year. Part of that is looking at the outcomes and how the home is compliant and how they may become complaint. The manager said this is helping her to identify what training needs to be done with staff or what she needs to implement or change. We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. We saw that the manager has undertaken staff and resident meetings and resident and relatives meetings. The residents commented on food, staff, activities and the homes environment. The manager also undertakes surveying of the service at regular intervals. Examples of information gathered from these meetings and surveys are: With regards to health care issues requiring your input, how well does the staff at Nyton House consult you in relation to service users assessments and care planning 0 I am rarely asked for advice. 0 I am occasionally asked to advice. 0 I am generally asked to advice. 39 I am consulted regularly. 61 I am always asked for advice and to contribute when needed. Please give any comments you want to make Care Homes for Older People Page 25 of 29 Evidence: here. Pharmacist I am always consulted for advice when needed GP I am asked for advice when appropriate (did not tick boxes) DN Keep me informed of changes that are significant. The manager told us that the home does not manage or look after any personal money. The manager informed the commission in the AQAA that the servicing of all utilities and equipment used in the home has taken place. We looked at the records for fire safety training and monitoring of equipment we saw records that indicated that fire safety equipment and emergency lighting has been tested regularly Fire training records indicated that staff have had fire training. Care Homes for Older People Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 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. 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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