Inspection on 15/07/09 for The Check House

This inspection was carried out on 15th July 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

The Check House 25/07/08

The Check House 30/08/07

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 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Check House Beer Road Seaton Devon EX12 2PR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Oliver     Date: 1 5 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: The Check House Beer Road Seaton Devon EX12 2PR 0129721858 01297625496 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Check House Limited Name of registered manager (if applicable) Mrs Elizabeth Wilson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May admit a maximum of 4 people who require nursing care between the ages of 45 64 years The maximum number of persons accommodated at the home at any one time shall not exceed 49 Date of last inspection Brief description of the care home The Check House is owned by The Check House Ltd. The Check House is a nursing home providing hotel style accommodation, care and nursing for up to 49 older people and for people who do not require nursing. The home does not offer intermediate care, and there are smoking restrictions. The house is a detached Grade II listed property in Seaton, East Devon with outstanding views of the sea across a sweeping garden with terraces. Care Homes for Older People Page 4 of 35 care home 49 Over 65 49 0 Brief description of the care home Residents accommodation consists of 43 single rooms and 3 double rooms over three floors. The home has its own minibus. The homes statement of purpose and service user guide, which includes details about the philosophy of the home and details about living at the home, is available to all residents and visitors, on request. A copy of the most recent inspection report is available for all to read in the entrance hall of the home. Information received from the home indicates that the current weekly fees are currently #866.00 single room and #1071.00 double room. Fees for respite accommodation are currently # 131.50 single room and #205.00 double room per night. All fees quoted above are for accommodation only Nursing fees will be additional to these quoted. Services not included in this fee include Hairdresser, Chiropody, Toiletries, Optician and Dentist. There is no charge for the use of the minibus. Care Homes for Older People Page 5 of 35 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 is 2 stars. This means that people who use this service experience good quality outcomes. This inspection was undertaken over 8 hours in one day by one inspector. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent surveys to 15 people living at the home, 10 staff and 10 health care professionals. Twelve questionnaires were completed and returned to us from people living at the home expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to Care Homes for Older People Page 6 of 35 make a judgement about the service provided. To help us understand the experiences of people living at this home we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. We also spoke with 8 staff, including the manager, deputy and ancillary staff, individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. The current weekly fees are £866.00 single room and £1071.00 double room. Fees for respite accommodation are currently £ 131.50 single room and £205.00 double room per night. All fees quoted above are for accommodation only Nursing fees will be additional to these quoted. Services not included in this fee include Hairdresser, Chiropody, Toiletries, Optician and Dentist. There is no charge for the use of the minibus. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Copies of the inspection report are available from the office. What the care home does well: People who are considering moving to a care home are given good information about The Check House before any decision to move in is made. Trial visits are encouraged and a senior member of staff from the home will also carry out a careful assessment before anyone is admitted to the home to ensure their needs can be met. Not all people spoken to during this inspection were able to recall their admission to the home but all expressed complete satisfaction with the outcome. The home has drawn up detailed care plans covering aspects of care needs. Risk assessments have also been drawn up on all aspects of health and personal care and clearly show how the home identifies potential health risks and puts preventative measures in place. The home has good links with all relevant health professionals and treatment has been provided where needed. The care staff have completed daily reports showing that the care plan has been followed and outcomes are being met. These give a clear picture of daily events for each person living at the home. Medications are stored safely and only experienced, trained staff carries out the administration. Records of medicines administered have been well maintained. Evidence was obtained in various ways through this inspection to show that those living at the home are treated in a dignified manner and their privacy is upheld at all times. Those who were able expressed complete satisfaction in the way they are treated by the staff. The staff were calm and unhurried and assisted people in a friendly, caring and respectful manner. Care plans and daily reports showed that people could exercise choice and control of all aspects of their lives and some people talked about how they are able to lead their lives just as they want without unnecessary rules or restrictions. The home provides a good range of activities to suit all interests. Excellent arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. All people we spoke to praised the standard of meals provided. The menus are balanced, varied and nutritious meals and suit all individual dietary needs. The dining room and waiting staff provide a restaurant like atmosphere. The home has an excellent range of policies and procedures that have been regularly updated and staff have been given training and instruction on the policies to ensure they are followed correctly. People living at the home and their relatives and visitors can feel confident that complaints and concerns will be addressed promptly and a satisfactory outcome reached. All areas of the home are clean,safe and hygienic. The home employs sufficient staff to meet the needs of those living there. Good recruitment practices ensure people are safeguarded from abuse. Staff are competent and deliver high quality care in a safe manner. Care Homes for Older People Page 8 of 35 The home is well managed. There is an open and positive atmosphere throughout the home. Quality assurance procedures and systems to safeguard the health and safety of residents and staff at the Home are in place . In response to questionnaires sent before this inspection staff told us The manager is always making sure that enough staff are always on duty to ensure good quality care is being rendered to the residents In response to the question what does the home do well we were told The Check House provides a calming and relaxing atmosphere for the service users to live in. Residents are encouraged to ask for individual things that make them feel at home. e.g Menu choices and ways of entertaining friends and relatives another tries to make everyone happy and comfortable in the Home and good food, individual care plans, good activities and the Home is always clean and tidy. What has improved since the last inspection? What they could do better: No requirements were made as a result of this inspection. Five recommendations for good practice were made. The service should continue to further development of care plans to ensure they include details of how people wish their care to be provided. When creams are prescribed a record should be kept of their application. Only agreed over the counter medication should be kept at the home to be administered to people without a doctors prescription. Medication when no longer required should be returned to a pharmacist or destroyed, Care Homes for Older People Page 9 of 35 they should not be used for anyone other than the person they were prescribed for] The results of surveys should be published and made available to current and prospective users of the service, their representatives and other interested parties, including the Commission. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 35 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 35 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 provides clear, detailed information to people considering moving in. People can be confidant that they will receive the care and support they need if they do move into the home. Evidence: During this inspection we looked at the admission records of three people, one of whom had moved into the home within the last three months. We talked to them about how they chose the home, about the information that was shared, and about the discussions and agreements that were reached on the care they need. Not all were able to remember their admission clearly and generally their admission had organised by relatives or Social Services. We found that the manager had visited them to carry out an assessment of their health and social care needs and to give them information about The Check House. Care Homes for Older People Page 12 of 35 Evidence: Information is also gathered from the individual, staff on ward if appropriate, and relatives or representatives. The assessment records has been improved since the last inspection and showed that comprehensive information had been gathered form and incorporates the Mental Capacity Act requirements. This means that before people are admitted to the Home they can be assured that the home is able, in relation to staffing, staff knowledge and environment, to meet their health and social care needs. Staff told us that the needs of potential users of the service are discussed before a person is admitted to the Home. This means that all care staff are aware of peoples health and social care needs. All prospective residents and, or, their family or representatives are encouraged to visit the home, meet other residents and have a meal if they choose before the decision is made to make it their home. The manager told us that brochures, which provide comprehensive information about the Home, are sent out on request. Displayed in the entrance hall are the Homes Statement of Purpose and the most recent inspection report for visitors and people living at the home to refer to if they wish. All people living at the home who we spoke to, who were able to communicate, confirmed that the home had provided ample information about The Check House before they decided to make it their home and the home had lived up to their expectations. One person told us that his wife had gone looking for suitable places for me to move to when I left hospital. She chose Check house and I dont think she could have found a better place for me. Another person commented daughter viewed the home and was given information. We sent questionnaires to 15 people living at the home and received responses from 10. All responses confirmed that people received enough information about Check House before they moved in so they could decide if it was the right place for them. One comment included in a questionnaire stated My mother did spend various days in Check House so she did know the home and also know the staff before going to stay permanently in the home. An information pack was available. The home does not offer intermediate care. Care Homes for Older People Page 13 of 35 Care Homes for Older People Page 14 of 35 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 provides staff with the information they require to meet the needs of individuals in a safe and respectful manner, while promoting their dignity and independence. Continued improvement in gathering information about how people wish their care to be carried out will further promote person centred care. Medication is generally well managed. Attention to ensuring that only agreed over the counter medication is kept at the home, and ensuring medication is returned to a pharmacist when no longer required, will further promote safety at the Home. Evidence: The home is continually working towards improvement and care plans continue to improve resulting in staff being well informed about individual needs and wishes of Care Homes for Older People Page 15 of 35 Evidence: people living at Check House. Person centred care plans implemented for all residents over last three months are currently being audited to ensure compliance. During this inspection three peoples files were looked at in detail and all included detailed information to ensure that staff are aware of how to meet individual daily health and social care needs. The plans are developed with people individually and relatives are involved with the persons consent. Plans are based on an up to date assessment covering all aspects of their health welfare and social care needs. Plans of care were informative, very detailed, well written, clear and easy to understand. There are also daily notes written by care staff that show how peoples personal and social care needs are being met. The home monitors peoples dental and optician checks and chiropodists are used according to peoples needs. Information relating to the involvement, and advice from health care professionals such as skin care specialists and nutritionists were included in peoples plans of care. This means that they benefit from the involvement of health care professionals to ensure that health care needs are met. Assessment of potential risks to people living at the home is undertaken as part of the care planning process and kept under review. This includes the risks of falling and nutrition. Care plans are reviewed regularly and appropriate changes are made to reflect changing needs and individual choice. Individuals and relatives are encouraged and supported to be involved in this review. Clear details are recorded of any changes. However, we did see one care plan where instructions from a health care professional had been recorded in a persons daily report but had not been detailed in the care plan. This means that because up to date information relating to changes in the needs of this person were not clearly detailed this could result in care needs not being met. Commented included in a survey returned by a health care professional confirmed that the service has good personalised care plans. Medication is well managed at the home, records were accurate, up to date and indicated that it is appropriately administered. Photos of individuals are kept with the administration records to reduce the risk to people, who are not always able to confirm their identity, of receiving incorrect medication. Care Homes for Older People Page 16 of 35 Evidence: Staff who handle medicines have received training in the safe handling of medication. This means that people are kept safe by the homes management, storage and administration of medicines at the home. The ethos of the Home is that people should be encouraged to maintain their independence for as long as they wish or are able. As part of the pre admission assessment the wishes and abilities of individuals to manage their own medication is undertaken. At the time of this inspection we were told that no people are undertaking this. The manager undertakes a monthly in house audit of the homes medication policy and procedure and has recently audited medication administration records. Some deficiencies were found as a result of this, which are currently being dealt with at the Home, thereby further protecting people receiving medication by ensuring that they all receive the correct medication at the appropriate times. We noted that several people have been prescibed creams or ointments to be applied regularly. Staff are not recording when these have been applied. This potentially puts people at risk of not having prescibed creams/ ointments applied as directed. this was discussed with the manager who will ensure that a system is developed to ensure a record is maintained. The Home has a Homely Remedies policy, which clearly states medicines that can be bought over the counter that have been agreed by doctors may be given to their patients at the Home. The list includes medicines such as pain relievers, indigestion remedy and cough linctuses, the reason for administering it and how long it may be given before a doctor is consulted. During this inspection we looked at the stock of homely remedies and saw pain relievers that can not be bought over the counter and several other remedies that doctors had not agreed may be administered. There was no indication that these had been given to any of the people living at the Home. However, the pain relievers had been prescribed by a doctor for a person but it was not clear who for as the label had been obscured. The medication had either not been returned to a pharmacist when they were no longer needed by that person or were prescribed for a person at the Home and were not being used. This potentially puts people living at the Home at risk of receiving medication that has not been prescribed for them by a doctor. People felt that their privacy was respected and staff were seen to knock on doors and wait to be invited in before doing so and were also seen offering personal care in a Care Homes for Older People Page 17 of 35 Evidence: discreet manner. All of the 10 people currently living at the Home who responded to questionnaires felt they always or usually received the care and support they needed. All staff who responded to questionnaires confirmed that they are always given up to date information about the needs of people. Comments made in questionnaires from staff included,Yes, they always tell us if there are changes in the care plan, and also changes are written in the communication book so everyone can read . Care Homes for Older People Page 18 of 35 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. Everyone living at the home is offered good choices in all aspects of daily living. Social activities are well managed. They provide daily variation and interest for individuals and create opportunities for increasing their independence. Meals are nutritious and balanced and provide individuals with choice and variety. Evidence: We spoke to the manager and deputy who confirmed that the aim of the home is to make sure that people who live there are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The Home offers regular and appropriate activities to which all people living at Check House and their families are invited. People are also encouraged and supported to maintain contact with the local community and some continue to visit hairdressers and opticians they visited before moving to check House. Care Homes for Older People Page 19 of 35 Evidence: Plans of care include details of individual preferences in relation to daily routines such as getting up, going to bed, social activities, interests, hobbies and contact with the community. Plans are regularly reviewed and details were made to meet peoples changing needs, choices and wishes. A record is kept of all activities people take part in. All those we spoke to said that there is always something going on at the home that they can take part in if they wish. A weekly programme of events is clearly posted in the hall on a prominent notice board and those people who normally stay in their rooms are told of events. The programme of activities includes exercises, painting, quizzes, bingo and crafts. The home also has a shopping trolley that sells toiletries, papers, magazines and confectionery for people to buy if they wish. Check House employs 3 members of staff to undertake activities 7 days a week. People living at the Check house are provided with a 7 day activities programme to enable them to choose what they take part in and a weekly programme of events is clearly posted in the hall on a prominent notice board. People who normally choose to stay in their rooms are told of events and staff spend time with those people who choose not to take part in activities. During this inspection one person called for a member of staff to write a postcard for them. We were told nothing is ever too much trouble for them and they always have time for you. Activities undertaken at the Home include gentle exercise sessions, netball, bingo, discussion groups, crosswords, board games and quizzes. Outings in the Homes mini bus are also undertaken. We were told that last week several people went to Dartmoor and had lunch, which everyone enjoyed. Several photographs of outings and events are displayed on a notice board in the hall. All of the 10 people living at the home who responded to surveys agreed that there are always or usually activities that they could take part in at the home. One person commented, There is a list of activities for the week on notice board and in residents rooms, and staff do assist the residents where necessary. Check House does have a mini bus for trips, and another They do their best, there is always a lot going on if required. As well as providing entertainment Check House also provides occupational therapy, physiotherapy, chiropody, beauty therapy and hairdressing. The manager told us that social care plans need improvement and must reflect the life stories of people living at the Home and this is currently being undertaken. Plans Care Homes for Older People Page 20 of 35 Evidence: are also underway to form a Computer Club at the request of some of the residents. Several people spoke about how their relatives and visitors are made to feel welcome at the home. Visitors are offered drinks and are made to feel part of the family. We looked at the visitors book and it was clear that many people received visitors and they came at different times of the day. People moving into Check House are encouraged to bring personal possessions and small items of furniture with them to make their rooms feel homely and this is agreed before admission. Most of the rooms seen during this inspection were personalised and people spoke about the pleasure having their own things around them gave them. All of the people spoken to during this inspection said that the food served was very good. Some said that it was not an easy job cooking for a number of people and you cant please all of them all the time. All people who responded to questionnaires agreed that they always enjoy meals served at the home. People are given the choice of being served their meals either in their rooms, the lounge, and conservatory or in the comfortable dining room where they are served by waiting staff. Daily menus are displayed on one of the notice boards as well as on each table in the dining room for people to refer to. A choice of meals is always available at lunch and the evening meal, providing for personal requests and a vegetarian option is always available. Lunch served during this inspection was well presented and nutritious. We were told by the cook that the menu reflects local seasonal ingredients. People can have almost anything they ask for and several people have enjoyed fresh fish and even lobster. The cook enjoys their job and told us they get great satisfaction from the knowledge that people enjoy their meals and the whole dining experience. Care Homes for Older People Page 21 of 35 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. There is a clear and simple complaints procedure that ensures complaints are responded to promptly with satisfactory outcomes. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that residents are protected at the home. Evidence: The home has a detailed, clear and simple complaints procedure, which is prominently displayed for all those living at the Home and visitors to see. The home has developed a system to maintain records of all complaints received and how they are managed. Three complaints had been made to the home since the last inspection and none to the Care Quality Commission and all were responded to following the Homes Complaints Procedure. People living at the home that we spoke to during this inspection said that if they were unhappy about anything they would not hesitate to raise any matter at any time and were sure that it would be dealt with to their satisfaction. Staff said that if anyone made a complaint they would report it to either the manager or deputy manager. If it was something that they were able to sort out themselves then they would. They were confident that no issue that was raised would ever be ignored. Care Homes for Older People Page 22 of 35 Evidence: All of the 10 people living at the home who responded to questionnaires agreed that the always or usually know who to speak to if unhappy or wanted to make a complaint. One person commented, Always able to speak to management, matron or care workers. All staff that responded to questionnaires confirmed that they always knew what to do if concerns or complaints are made to them. There was nothing to suggest that people living at Check House are anything other than well cared for at the home. People spoken to said that staff were very helpful, respectful and that nothing was ever too much trouble for them. Records were seen showing that staff have received training in Adult Protection issues and the manager is a Dorset County Council Adult Protection trainer. A procedure for responding to abuse is available and staff were aware of this. They were able to describe differing types of abuse and gave good details of what they would do if they suspected abuse was occurring. They were aware of the homes Whistle blowing policy and that it would support them in reporting bad practice. They felt confident that they would be listened to if they raised concerns about bad practice. People spoken to during this inspection praised staff for their kindness and described staff as kind, caring, polite and friendly. They also confirmed that they felt well cared for and safe living at the home. Care Homes for Older People Page 23 of 35 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. The standard of the environment has improved providing a comfortable, clean and safe environment for those living in, working at and visiting the home. Evidence: The Check House is well maintained and provides comfortable accommodation including 43 single and 3 double rooms, the majority being en-suite and with views, 3 lounge areas, a conservatory and a dining room. There are three resident lifts which gives access to all the floors. People are encouraged to furnish their rooms with personal effects including furniture where possible and all rooms have temperature controls. Several individual bedrooms were visited, with peoples permission, during this inspection. Bedrooms were comfortable and personalised with sentimental items, photographs and small pieces of furniture. This means that people are encouraged to make their rooms personal to them and to be able to maintain a comfortable environment. The majority of the rooms have excellent sea views with the lower floors having access out onto the garden via patio doors. The home has a programme for redecoration and improvement to ensure that people Care Homes for Older People Page 24 of 35 Evidence: enjoy a good standard of accommodation. Rooms are refurbished regularly and all rooms seen during this inspection were well decorated and maintained. The home is furnished in a way to actively avoid any institutional feel whilst providing appropriate furniture and aids for all levels of disability. The home has the necessary equipment to assist people and meet their needs including aids, hoists, and assisted toilets and baths which are capable of meeting peoples individual needs. All bathrooms have special adapted baths to allow access for the majority of residents, a shower room and wet room is also available. All corridors are wide and well lit. Staff told us they had the equipment they needed to ensure that care was provided safely. The Home has been assessed by an Occupational Therapist and the Certificate is displayed in the foyer. The home is furnished with high quality furnishing and fittings and is maintained to a high standard. The home employs two maintenance people, one who also takes care of the garden and the other who also undertakes driving duties. Environmental risk is being well managed and information provided prior to this inspection indicates that steps have been taken to reduce risks from radiators, monthly checks are made of the radiators and the majority of residents beds are not near to the radiators. The home was clean and free from offensive odours throughout at the time of this inspection. We had a full tour of the building during this inspection and all the areas were extremely clean and fresh. Hand washing facilities are provided in all rooms and bathrooms to ensure good hygiene practice at the home. Staff have the necessary protective equipment, such as gloves and aprons. Liquid soap and disposable towels are available in toilets and bathrooms to promote good standards of hygiene within the Home. The Check House has a dedicated team of housekeepers to maintain the high level of cleanliness that is recognised by those living there and visitors. People responding with surveys said the home was always clean and fresh. The gardens around the home are accessible, and a variety of garden furniture including chairs and tables with sun shades are available and used by many people, weather permitting. A gardener is employed to keep the gardens and lawn looking nice. Shady areas are provided in the grounds for people to sit and enjoy the views. All people living at the home enjoy views of the garden and the sea, which are available from several areas. Care Homes for Older People Page 25 of 35 Evidence: The laundry is well equipped and managed by an experienced member of staff. The necessary equipment is available, including two washing machines and two dryers. A red bag system is used for any soiled laundry ensuring staff are protected. The laundress takes great care with peoples personal items of clothing. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. Care Homes for Older People Page 26 of 35 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. People benefit from having trained, skilled staff in sufficient numbers to support them, and the smooth running of the home. Evidence: The manager has promoted the role of key workers for each person living at Check House with the aim that they get to know the resident well and support them with personal tasks. Registered nurses are also key workers for a number of people. This works towards meeting the homes ethos of maintaining person centred care for all residents living at The Check House. People living at the home say that staff are always or usually available when needed, that they listen and act on what is said and that they are well cared for by staff. People who responded to surveys confirmed that staff responded to their needs promptly. This was confirmed during this visit when staff responded promptly to peoples needs in a kindly manner. Throughout the day we saw staff asking people if they wanted a drink, were comfortable, reassuring people, visiting those who wished to stay in their rooms and engaging people in conversation. We spoke with one relative who was concerned that staff didnt always respond to their relatives needs in a timely way. We discussed the persons issues with the Care Homes for Older People Page 27 of 35 Evidence: manager who told us that they are working with the relative at the moment to help address any issues of concerns they may have. All newly employed staff undergo a period of training when they start working at the home to enable them to get to know the people living there, the homes philosophy of care. safety procedure. care procedures and the general layout of the home. The time taken to complete this training will depend on past experience and individual ability. All new staff are inducted into their role fully using the services own developed induction package based on the National Skills for Induction. Care staff have commenced the NVQ 2 or 3 in Social Care & Health recently with 3 new recruits waiting to commence after their probation period has been completed. All staff who responded to survey confirmed the Induction training provided at the Home covered everything they needed to know to do their job well. One member of staff commented in a survey they were waiting to finish their induction training. Training is a priority at Check House. The Manager and the Deputy has responsibility for all training provision and an enthusiastic approach to training has been undertaken by both. The Deputy Manager has recently completed the Registered Managers Award,has a Professional Trainers Certificate and is due to complete her NVQ Health & Social Care level 4 shortly. The Manager has a City and Guilds training certificate, has recently completed a Dementia Level 2 Course and is a Manual Handling Trainer.[ as are two other members of staff also] Training is ongoing using a variety of resources including in house, external provided by the NHS, Social Services or local Hospice or other providers. Recent subjects include: Adult Protection, Continence Care and Catherisation Palliative Care, Wound Care, Health & Safety and Infection Control Staff who attend external training are expected to cascade the information to their colleagues by way of formal training sessions. We were told that all the care staff have either completed or have commenced an NVQ or have an equivalent qualification. The cooks and kitchen assistant have either completed (or are due to commence soon) an NVQ in Hospitality and Cooking. A training matrix is updated on computer when training is completed and a hard copy is also available. We looked at well maintained individual staff training records all of which included confirmation of all training undertaken and all planned. This means that all staff are kept up to date with current good practice. The manager told us that the increase and diversity of training has actively motivated staff. Staff we spoke to during this inspection told us that training opportunities had increased and one said they felt far more valued and professional as a result. Care Homes for Older People Page 28 of 35 Evidence: Information provided by the manager prior to this inspection stated the service employs a high ratio of senior experienced carers and offers NVQ training for all and that the service does not use agency staff. The Home has a team of bank staff who continue to deliver continuity of care within the home. The manager also told us that good staff are our most important resource and we are as sympathetic to their needs as we are to our service users. Registered Nurses lead the care team at Check House at all times, with the Manager taking the Clinical Lead. Staffing levels are assessed according to residents needs. The manager discussed the recruitment procedure at the home and how it has been developed so that it considers the needs of people living at the home. She stressed the importance, and time taken, to make sure that only good quality carers are recruited so that a high standard of service is offered at the Home. We looked at three recently employed staff files. All included evidence that the home had conducted a robust recruitment procedure. Files included details of past employment, application form, training certificates, health declarations, evidence of identity, police checks and references. Staff files are stored in locked cabinets and are only accessible to management staff. This procedure means that people living at the home are protected by the homes recruitment procedure. Since the last inspection staff are now receiving annual appraisals and supervisions as required. The Deputy Manager has taken responsibility for the supervisions and will update the training files when completed. Contracts for supervision are in the process of being completed for all staff and the supervision form now has an action required section which will be signed off when completed. This means that people living at the Home are cared for by a well supported team of staff. Care Homes for Older People Page 29 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well managed home that is working hard towards trying to make sure the home is run in their best interests. Health and safety is well managed. Evidence: The Registered Manager of The Check House was appointed in February 2009. The Manager is an experienced Registered Nurse and with the previous Manager now supporting her as the Deputy, The Check House has a well structured management team that works well together. Both the manager and the deputy manager have successfully completed Registered Managers Awards. During this inspection the Manager had an open friendly approach towards all living and working in the home. One member of staff told us she is firm but fair. She listens and things get done. Care Homes for Older People Page 30 of 35 Evidence: The manager and staff have worked hard to meet the requirements made at the last inspection and prior to this inspection the manager sent us information about the management of the home and how the home has carried out improvements based on the feedback from the last inspection. Records are securely stored in lockable filing cabinets, and those seen were up to date. We were told that records would be made available to people living at the home, or their representative with their consent. All Policies have been reviewed and updated in May 2009 and we noted they are now more clearly filed for easier management. Since their appointment the Manager has taken responsibility for Annual Quality Assurance audits at the Home and has produced a Quality assurance system to self monitor all aspects of care and the management of the home. We were shown the outcome of the most recent audit relating to the quality of food served at the Home, the results have yet to be audited. The results of this survey will be included in the homes statement of purpose and be made available to other interested parties. Peoples feedback about such things as the quality of their life at the home, staffing, meals, cleanliness and activities is sought on a daily basis. This ensures that people living at the home are given a say in the homes running. The Manager has implemented a monthly audit schedule including, medicines, care plans and in particular accident management. Resident meetings are held regularly at the home, since the last inspection, and people are encouraged to discuss any topics they wish. Minutes are kept of all meetings held at the Home including staff meetings. Most people living at the home choose to have personal finances looked after by their family or legal representatives. The home will keep small amounts of money for people who receive services such as hairdressing, chiropody and other personal items that may be needed. Clear records and receipts are kept of all outgoings Staff told us that since the last inspection they receive regular supervision. They said they found it positive as it provided an opportunity for them to talk about their work and training needs. They confirmed that they had all had up to date training in relation to Safeguarding Adults and Moving and Handling. Care Homes for Older People Page 31 of 35 Evidence: All staff that responded to questionnaires and those spoken to during the inspection confirmed that the manager met with them regularly to give support and discuss how you they were working. Comments included, the manager supports me and other staff well. I get regular feedback and all training I need. This makes me feel valued another the manager has an open door policy and is very supportive of staff and Management listen to me. The home is visited one a month by a manager from another service within the Company group of Homes, who carries out an unannounced inspection of the home. The completed report is sent to the managing director and to the manager. This forms part of the homes quality assurance system, which gather peoples views relating to the running of, and the quality of life experienced at the home. All records of Maintenance including gas, fire safety and staff training are up to date and available in the office. Information received before this inspection indicated that all equipment is well maintained regularly all of which contributes towards ensuring that The Check House is a safe place for people to live. Care Homes for Older People Page 32 of 35 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 33 of 35 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 9 Continue to develop care plans to include details of how people wish their care to be provided. Only agreed over the counter medication should be kept at the home to be administered to people without a doctors prescription. Medication when no longer required should be returned to a pharmacist or destroyed. [ They should not be used for anyone other than the person they were prescibed for] A record should be kept of the use of creams/ ointments. 3 33 Outcomes of Quality Assurance surveys should be made available to people living at the Home and other interested parties including the CQC. 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